60P-2.003. Changes in Coverage

(1) An employee enrolled in the Health Program may apply for a change to family coverage or individual coverage within thirty-one (31) calendar days of a QSC event if the change is consistent with the event or during the open enrollment period.

(2) A retiree, surviving spouse or participant with continuation coverage enrolled with family coverage may apply to change to individual coverage at any time, however, those enrolled with individual coverage may apply for a change to family coverage within thirty-one (31) calendar days of the date of acquisition of or loss of other group coverage for any eligible dependent or during the open enrollment period.

(3) A subscriber enrolled with individual coverage may apply for a change to family coverage prior to acquiring any eligible dependent. Since family coverage is effective the first day of any given month, a subscriber who will acquire the eligible dependent and is desirous of having immediate coverage of such dependent must:

(a) Submit an application and pay a full month’s premium prior to the first day of the month in which the dependent will be acquired. Otherwise, coverage cannot be effective on the actual date of acquisition.

(b) A subscriber applying for family coverage under paragraph (3)(a), above, may also add any other eligible dependents.

(4) If a subscriber enrolled with family coverage under an HMO plan is divorced, he or she may transfer such family coverage to the State Self Insurance Plan within thirty-one (31) calendar days after a covered dependent child is moved out of the HMO Region with the individual awarded custody of such child or during the open enrollment period.

(5) An HMO subscriber who no longer resides in the HMO Region; if an employee, no longer resides or works; must change HMO plans or transfer to the State Self Insured Plan.

(6) The employing agency shall request an effective date for the change in accordance with Rules 60P-2.004 and 60P-2.002, F.A.C., and indicate such date on the application.

(7) All applications for coverage changes must be approved by the Department, subject to the following:

(a) The Department shall approve a coverage change if the completed application is submitted to the employing agency within thirty-one (31) calendar days of and is consistent with the QSC event.

(b) Documentation substantiating a QSC event is as follows:

1. If changing to family coverage, proof of family status change or proof of loss of other group coverage is required.

2. If changing to individual coverage, proof of family status change or proof of change of employment status is required.

3. If adding an eligible dependent to family coverage, proof of family status change is required.

4. If terminating coverage, proof of family status change or proof of employment change is required.

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 10-8-78, Amended 10-22-79, 9-13-82, 8-7-83, Formerly 22K-1.16, Amended 7-16-86, 9-25-86, Formerly 22K-1.203, Amended 8-22-96, Repromulgated 1-31-02, Amended 6-2-22, Ratified by Laws of Florida Ch. 2022-160.