Ga. Comp. R. & Regs. R. 111-4-1-.06 - Changes in Coverage and Option
(1)
Open Enrollment Period and Retiree
Option Change Period. The Open Enrollment period and Retiree Option
change period shall be a minimum period of fifteen (15) days and shall begin no
earlier than October 1 and shall end no later than November 15 of each year.
The Commissioner shall announce the dates of the periods each year. Eligible
Employees, enrolled Retirees and Extended Beneficiaries shall be given an
opportunity to make the changes in Coverage election as reflected in the
following paragraphs.
(a)
Active
Employees. Eligible Active Employees, eligible Employees on Approved
Leave of Absence Without Pay and Extended Beneficiaries shall be given an
opportunity to enroll or change Coverage during the Open Enrollment
period.
(b)
Retirees.
During the Retiree Option Change Period, enrolled Retirees shall be
given an opportunity to change Coverage Option to any Option for which the
Retiree is eligible.
(2)
Returning Employee from an Approved Leave of Absence. An eligible
Employee who did not continue Coverage during an Approved Leave of Absence
Without Pay which included the Open Enrollment period shall be offered the
opportunity to enroll, discontinue, or change Coverage within fifteen (15)
calendar days of the date the Employee returns to work.
(3)
Qualifying Event During a Period of
Ineligibility. When an Employee loses eligibility for Coverage and
subsequently resumes eligibility for Coverage within the same Plan Year, and a
Qualifying Event under these regulations occurs during the period of
ineligibility, the Employee shall have the opportunity to request a change in
Coverage election for the remainder of the Plan Year that is consistent with
that Qualifying Event. The request to change Coverage election must be received
by the Administrator within thirty-one (31) calendar days following the date
the Employee resumes eligibility through an Employing Entity. The effective
date of the requested action shall be consistent with the new employment
provisions of these regulations. The Administrator shall request supporting
documentation to demonstrate the Qualifying Event has occurred. Failure to
fully document the occurrence of the Qualifying Event within the allotted time
shall result in reversal of the new Coverage election and restoration of the
Employee's former Coverage election.
(4)
Retired Employee's Discontinuation
of Coverage. An Enrolled Retired Employee may discontinue Coverage for
him or herself at any time. A discontinuation may be made by advance notice to
the Administrator or by failing to timely pay required Premiums. Once a Retired
Employee discontinues Coverage for him or herself, the discontinuation is
permanent except as described below.
(a)
TRICARE Supplemental Coverage. If a Retired Employee discontinues
SHBP Coverage and elects TRICARE Supplemental Coverage, which is offered by the
Administrator, the Retired Employee may re-enroll in SHBP Coverage during the
next Retiree Option Change Period as long as he or she has maintained
continuous coverage under either SHBP Coverage or TRICARE Supplemental
Coverage.
(b)
Termination of
Medicare Advantage Coverage by CMS. If a Retired Employee's Medicare
Advantage coverage is terminated by CMS due to enrollment in another plan or
failure to pay Medicare Part B premiums, the Retired Employee will be
automatically enrolled in another SHBP Option in accordance with the procedures
of the Administrator, and will be charged the required Premiums.
(c)
Employment as an Active Employee.
If a Retired Employee who has discontinued Coverage becomes employed as
an Active Employee, he or she may re-enroll in the SHBP as an Active Employee.
An Enrolled Retired Employee may discontinue Coverage for a Dependent at any time. A discontinuation of Coverage for a Dependent will be permanent except as described below.
(d)
PeachCare for Kids Coverage.
If a Retired Employee discontinues SHBP Coverage for a Dependent child
and enrolls that Dependent child in PeachCare for Kids, the Retired Employee
may re-enroll the Dependent child in SHBP Coverage during the next Retiree
Option Change Period as long as the Dependent child has maintained continuous
coverage under either SHBP Coverage or PeachCare for Kids.
(e)
Qualifying Event. If an
Enrolled Retired Employee discontinues Coverage for a Dependent and experiences
a qualifying event described in Internal Revenue Service Regulation 1.125.4,
subsection (6) below will apply and the Retired Employee may be able to
re-enroll the Dependent.
(5)
Reinstatement of Employee Across
Plan Years. If an Employee was reinstated to employment for a period of
time inclusive of the applicable Open Enrollment period, the Employee shall be
offered the opportunity to enroll or change Coverage within fifteen (15)
calendar days of the return to work.
(6)
Qualifying Event Coverage
Changes.
(a) A Member shall be eligible
to make a change in coverage or tier on account of the qualifying events set
forth, and in the manner described, in Internal Revenue Service Regulation
1.125-4, so long as the Member and the Employing Entity (if applicable) satisfy
requirements established by the Administrator. This subsection does not apply
to a Retired Employee who has discontinued SHBP coverage for him or herself. In
general, requests to enroll, change, or discontinue coverage must be received
by the Administrator no later than thirty-one (31) calendar days following the
qualifying event. Requests to enroll newly eligible Dependent children must be
received by the Administrator no later than ninety (90) calendar days following
the qualifying event. Requests to make election changes as a result of death
must be received by the Administrator no later than ninety (90) calendar days
following the qualifying event. Where necessary to comply with federal law,
election changes may be accepted within the deadline established by the law.
The effective date of the Coverage election shall be the first of the month
following receipt of the request, unless otherwise noted in Internal Revenue
Service Regulation 1.125-4. The Administrator shall request supporting
documentation to demonstrate the Qualifying Event has occurred. Failure to
fully document the occurrence of the Qualifying Event within the allotted time
shall result in reversal of the Coverage election and restoration of the
Member's prior Coverage election.
(b)
Additional Changes Permitted for
Retirees. An enrolled Retiree may change to any Option to which the
Retiree is eligible upon occurrence of one or more of the following events,
provided the request is received by the Administrator within thirty-one (31)
calendar days following the Qualifying Event: at the time of retirement; at the
time that the annuity amount to be received from a state supported
participating retirement system becomes insufficient to satisfy the Option
premium; at the time that the Retired Member becomes eligible for Medicare
coverage; or, subject to approval by the Centers for Medicare and Medicaid
Services, at the time the enrolled Retiree requests in writing to move from his
or her current Option to a Medicare Advantage plan offered by the same Third
Party Administrator.
(c) Married
enrolled Retirees may change Tier in order to become individual Enrolled
Members at any time when no individuals other than the Spouse are enrolled in
the Coverage. The change in Coverage will be effective within two (2) calendar
months following the requested change.
(7)
Documentation. The
Administrator may require documentation that a Qualifying Event permitting
enrollment, change or discontinuation of Coverage has in fact occurred outside
the annual enrollment period. When required, documentation appropriate to the
event will be specifically described and must be received by the Administrator
within the allotted time. Failure to document appropriately or within the
allotted time shall result in the reversal of the requested Coverage action and
restoration of the Member's prior Coverage.
Notes
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