Ga. Comp. R. & Regs. R. 478-2-.04 - Eligibility
(1) Active State
Employees. Employees who are actively at work, on approved leave with pay other
than personal sickness or disability, or on suspension with pay may participate
in the Flexible Benefit Plan if the employee is a regular full-time employee
who works a minimum of thirty (30) hours per week and whose duties are expected
to require at least nine (9) months of service. Contingent workers of the Labor
Department, employees who are working on a temporary, seasonal, or intermittent
basis, and employees working in a sheltered workshop operated by a county
family and children services, mental health subdivisions or other employing
entities are not eligible to participate in the Program. Eligible employees are
as follows: (03-27-97/04-09-97)
(a) a member
of the General Assembly or a full-time employee of the General Assembly;
(07-30-86/08-08-86)
(b) a person
who works full time and receives his compensation in a direct payment from a
state department , agency, community service board , authority, or institution of
State government, exclusive of the Board of Regents of the University System of
Georgia; (03-27-97/04-09-97)
(c) a
person who works full time and receives his compensation from a county
department of family and children services or a county department of health
which receives funds through the grant program of the Department of Human
Resources; (07-30-86/08-08-86)
(2) Active Educational System Employees.
Employees, who are not considered temporary or emergency employees, and who are
actively at work or on approved leave with pay, other than sick or disability,
may participate in the Flexible Benefit Plan if the employee receives pay from
one of the educational institutions that has elected to participate in the Plan
and who meets the work requirements, as follows: (12-18-90/01-01-91)
(a) Persons serving in a certificated
position and who work at least 17.5 hours per week; (03-27-97/04-09-97)
(10-6-05/10-26-05)
(b) Employees
who work at least 17.5 hours per week for a county or regional library;
(03-27-97/04-09-97) (10-6-05/10-26-05)
(c) Persons serving a non-certificated
position and who work at least 20 hours per week or 60% of the time normally
required for these positions, if that's more than 20 hours per week; and
(03-27-97/04-09-97) (10-6-05/10-26-05)
(d) Persons eligible for the Public School
Employees Retirement System and who work at least fifteen (15) hours per week
or 60% of the time normally required for these positions. if that is more than
fifteen (15) hours per week, (O.C.G.A.
45-18-50;
45-18-52)
(10-6-05/10-26-05)
(3)
Employees on Leave Without Pay. Active employees who are eligible to
participate in the Flexible Benefits Program may continue all insurance options
in which enrolled by paying the required after-tax premium during a period of
"approved leave of absence without pay" for a period up to twelve (12) months,
subject to the conditions in these regulations. An employee will be considered
to have one (1) continuous period of leave without pay if the employee returns
to work for a period of time, and fails to have three (3) or more consecutive
payroll deductions or reductions during the return to work.
(03-27-97/04-09-97)
(4) Employees
on Suspension Without Pay. Employees who are eligible to participate in the
Flexible Benefits Program may continue all insurance options in which enrolled
by paying the required aftertax premiums during a period of "suspension without
pay" for a period of up to twelve (12) months, subject to the conditions in
these regulations. (Authority O.C.G.A.
45-18-50)
(06-28-90/07-01-90)
(5) Employees
on Military Leave. Military leave is the period of time during which an
employee is ordered to military duty or the period, as provided by law, during
which an employee is attending military training. Employees who are eligible to
participate in the Flexible Benefits Program may continue the coverages and
options, consistent with policy and contractual limitations of each benefit
option, not to exceeed twelve (12) consecutive calendar months.
(03-27-97/04-09-97)
(6) Employees
on Military Reservist Activation Leave. Military Reservist Activation Leave is
the period of time during which an employee is activated on an emergency basis.
Employees who are eligible to participate in the Flexible Benefits Program may
continue the coverages and options, consistent with policy and contractual
limitations of each benefit option, not to exceed twelve (12) consecutive
calendar months. (03-27-97/04-09-97)
(7) Employees on Reduced Working Hours Due to
a Disabilty. Employees who are eligible to participate in the Flexible Benefits
Program, but due to disability are placed on reduced working hours by the
employing entity, may continue the options for which enrolled by paying the
required after-tax premiums during the period of reduced working hours. The
premium payments for coverage shall not exceed twelve (12) calendar months, and
will be subject to the following condition: (03-27-97/04-09-97)
(a) Notification to the Administrator . The
Administrator shall require documentation as necessary to provide certification
that the employee is physically or mentally incapable of working the required
hours to be considered full-time. (03-27-97/04-09-97)
(b) Documentation and Approval. Appropriate
documentation may include but is not limited to certification from a qualified
medical practioner that outlines the disability and the timeframe for which the
employee is required to remain on reduced working hours. The Administrator may
require periodic recertification of the disabling condition and circumstances
in order to substantiate the period of coverage continuation.
(8) Retired Employees Enrolled in
the Dental Option . Employees who were eligible to participate and were enrolled
in the dental option of the Flexible Benefits Program at the time of retirement
on or after April 1, 1997, shall be eligible to continue the dental coverage
and option in which enrolled if: (03-27-97/04-09-97)
(a) The employee is eligible to immediately
receive an annuity from the Employees Retirement System, Legislative Retirement
System, Teachers Retirement System, Public School Employees Retirement System,
Superior Court Judges or District Attorney's Retirement System.
(b) A retired employee shall be entitled to
continue dental coverage for the spouse upon retirement or may enroll the
spouse in accordance with Section
478-2-.06.
(03-27-97/04-09-97)
(9)
Surviving Spouse of an Employee Enrolled in the Dental Option. The surviving
spouse of a deceased employee may continue dental coverage provided the spouse
is immediately eligible to receive a monthly benefit from the Employees
Retirement System, Legislative Retirement System, Teachers Retirement System,
Public School Employees Retirement System, Superior Court Judges or District
Attorney's Retirement System. The spouse may elect coverage as a surviving
spouse, or if an active employee, through payroll reduction, but cannot elect
double or dual coverage under this provision. (03-27-97/04-09-97)
(10) Surviving Spouse of a Retired Employee
Enrolled in the Dental Option. The surviving spouse of a retired employee may
continue dental coverage provided the retired employee was enrolled in the
family dental option through March 31, 1997, and the spouse is immediately
eligible to receive a monthly benefit from the Employees Retirement System,
Legislative Retirement System, Teachers Retirement System, Public School
Employees Retirement System, Superior Court Judges or District Attorney's
Retirement System. (03-27-97/04-09-97)
(a)
Restrictions on Surviving Spouse . The spouse may elect coverage as a surviving
spouse , or if an active employee, through payroll reduction, but cannot elect
double or dual coverage under this provision.
(b) Surviving Eligible Dependent Children.
The surviving spouse may elect to continue coverage for surviving eligible
dependent children.
(11)
Continuation of Coverage for a Dependent Child of a Deceased Employee. Upon the
death of an active or retired employee, an eligible dependent child who was
covered under the family dental coverage and is the principal beneficiary under
one of the retirement systems may continue coverage consistent with these
regulations and the insurance contracts. The dependent child may not be covered
under this provision if he is a covered dependent child under another active or
retired employee, or is eligible as an active employee.
(03-27-97/04-09-97)
(12) Extended
Beneficiaries. Persons who meet the definition of Extended Beneficiaries are
eligible to participate in the dental options and health care spending account
by paying the required aftertax premiums or contributions as established by the
Council . (06-28-90/07-01-90)
(13)
Judicial Reinstatement of Employees. Employees who were eligible to participate
in the Flexible Benefits Program who are reinstated to employment by the State
Personnel Board or the judiciary shall have coverage reinstated for themselves
and any eligible dependents in accordance with the following:
(03-27-97/04-09-97)
(a) If the employment
reinstatement occurs within twelve (12) months of discharge and back-pay for
continuous employment is awarded, all retroactive premiums for the insurance
options must be collected and claims incurred during the period may be filed
for processing. Retroactive contributions for the health care spending account
may be waived by the Administrator ; retroactive contributions for dependent
care spending account are not to be made.
(b) If the employment reinstatement occurs
following a period longer than twelve (12) months after discharge and back-pay
for continuous employment is awarded, coverage for the employee and previously
covered dependents will be reinstated upon the employee 's return to work or in
accordance with judicial review. Medical underwriting and late entrant
penalties will not apply for any reinstated coverages.
(03-27-97/04-09-97)
(c) If
employment reinstatement occurs either within or in excess of twelve (12)
months of discharge and retroactive pay is not awarded, coverage may be
reinstated with the employee 's return to work. Medical underwriting and late
entrant penalties will not apply for any reinstated coverages.
(03-27-97/04-09-97)
Note: Dates following each paragraph represent (approval/effective) dates. (07-30-86/08-08-86)
Notes
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