60P-2.002. Eligibility and Enrollment  

Effective on Thursday, March 2, 2017
  • 1(1) Eligibility to participate in the Health Program will be in accordance with Section 15110.123, F.S.

    17(2) Eligible dependents may only participate under a family coverage.

    27(3) The surviving spouse may participate in the Health Program with family coverage if there are eligible children to be covered; otherwise, the surviving spouse may only participate under an individual coverage.

    59(4) In order to participate in a HMO, the subscriber must reside in the HMO service area; if the subscriber is a state employee, he or she must either reside or work in the HMO service area.

    96(5) An employee or state officer may apply for enrollment in the Health Program through the employing agency personnel office:

    116(a) During the first sixty (60) calendar days of state employment or a new term of office;

    133(b) During open enrollment;

    137(c) Within thirty-one (31) days of a QSC of losing other group health coverage;

    151(d) Within thirty-one (31) days of a QSC of an increase in the number of work hours for an employee;

    171(e) Within thirty-one days prior to termination of employment and before the effective date of retirement.

    187(6) The employing agency shall request an effective date of coverage for enrollment in the Health Program in accordance with Rule 20860P-2.004, 209F.A.C., and indicate such date on the application along with the following required employee and agency information:

    226(a) Employee’s name, social security number, birth date, sex, home mailing address, employment status, pay plan, employment date, SAMAS organizational code, I.D. code, and other insurance carriers;

    253(b) Dependent’s name, social security number, birth date, sex, date dependent was acquired, relationship of dependent, documentation verifying dependent eligibility;

    273(c) Employee’s requested plan type, type of coverage and Spouse Program eligibility;

    285(d) Contains the signature and date of the employee and authorized signature and date of the employing agency certifying eligibility of the employee.

    308(7) The employee acknowledges that eligibility and enrollment are governed by Section 320110.123, F.S.; 322authorizes the State to reduce salary as often and in amount necessary to continue coverage; authorizes the State to deduct from salary any underpayment of employee contribution or overpayment of claims; acknowledges that premiums may change from time to time; authorizes any licensed physician or medical facility to release medical records of insureds to the health plan; certifies notification of COBRA rights and agrees to notify the Department at the time any dependent becomes ineligible for coverage; and agrees that all statements made on the application are complete and true.

    412(8) After completion by the employee and employing agency, the employing agency shall enter applicable information into the state insurance computer data base and retain the application.

    439(9) Upon learning of the death of an insured employee with family coverage, the agency personnel office, by certified mail, will notify the surviving spouse of his or her eligibility to continue coverage under the Health Program. A surviving spouse of a retiree shall be notified by the Department. Such notice shall advise the surviving spouse of the following:

    498(a) That family coverage may be continued if there are eligible children to be covered; otherwise the spouse may continue participation only under individual coverage;

    523(b) The amount of the applicable monthly total premium;

    532(c) That in order to continue coverage the surviving spouse must complete an application in accordance with subsection 55060P-2.002(2), 551F.A.C. The application must be submitted with one month’s total premium to the personnel office of the deceased employee’s agency and forwarded to the Department, or submitted to the Department for a retiree, either within thirty-one (31) calendar days after the end of the month in which the deceased employee died or within thirty-one (31) calendar days after receipt of the notice of eligibility to continue coverage, whichever is later.

    621(10) In no case shall any subscriber or subscriber’s eligible dependent be covered simultaneously under two coverages within the Group Health Program.

    643(11) An employee who applies for enrollment and is enrolled in the Health Program shall automatically be enrolled in the Pretax Premium Plan of the Flexible Benefits Program unless the employee submits a signed rejection which shall include the employee’s name, social security number, address, agency and a statement that this decision cannot be changed until the next open enrollment period.

    704Rulemaking Authority 706110.123(5) FS. 708Law Implemented 710110.123 FS. 712History–New 10-8-78, Amended 5-22-79, 10-22-79, 4-15-80, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.15, Amended 7-16-86, 9-25-86, Formerly 22K-1.202, Amended 8-22-96, Repromulgated 1-31-02, Amended 3-2-17.


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