60P-2.012. Employees Not on Payroll/Return to Payroll

(1) For all employees not on payroll, premiums shall be paid in monthly amounts by personal check or money order during the period the employee is not on the payroll. An employee who is not on the payroll during the calendar month, whether paid biweekly or monthly, shall pay the full premium for that month by either payroll deduction, or by personal check or money order. The insured employee has the responsibility for remitting the required premiums to continue coverage in effect. The agency from which the employee goes off the payroll shall be responsible for receiving these premiums and forwarding them to the Department pursuant to subsection 60P-2.006(5), F.A.C.

(2) Leave Without Pay.

(a) An insured employee granted leave without pay shall be eligible to continue coverage while on such leave provided the employee pays the full premium and notifies the Department in accordance with subsection 60P-2.002(6), F.A.C.

(b) An employee who does not continue coverage while on leave without pay may only apply for reenrollment in the Health Program after returning to work and by submitting an application in accordance with subsection 60P-2.002(6), F.A.C., to the agency personnel office within thirty-one (31) calendar days after returning to work or during the open enrollment period.

(3) Suspension. A suspended employee may continue coverage as an employee on leave without pay by paying the full cost of the premium. If an employee successfully appeals a suspension and receives full back pay, the employee is then entitled to the state contribution during the time of the suspension provided he or she was receiving the state contribution at the time of the suspension. An employee on suspension who does not continue insurance coverage may only apply for reenrollment in the Health Program after returning to work and by submitting an application in accordance with subsection 60P-2.002(6), F.A.C., to the agency personnel office during the thirty-one (31) calendar day period after returning to work or during the open enrollment period.

(4) An employee on leave without pay or suspension, as described in this section, who does not pay the premiums to continue coverage during such leave or suspension because of circumstances subsequently deemed as “extreme hardship” by the Department, may apply for reinstatement of coverage within thirty-one (31) calendar days after returning to work by making a request to the Department and agreeing to pay all back premiums. Such request must be in writing and submitted through the employing agency. The employee must demonstrate by clear and convincing evidence that the employee has suffered severe financial hardship resulting from a sudden or unexpected illness or accident to the employee or a dependent. If the Department approves the employee’s request, reinstatement will occur upon the Department’s receipt of a personal check or money order for the back premiums for the period not on payroll. Upon reinstatement, the employee may file claims for reimbursement of charges for covered services and supplies received during the period not on payroll.

(5) Layoff. An employee who is laid off in accordance with the rules promulgated by the Department shall be eligible to continue coverage while laid off for a period not to exceed two (2) years from the date of layoff, provided the employee pays the full premiums. An employee who does not continue coverage during such period, may only apply for reenrollment in the Health Program after returning to work and by submitting an application in accordance with subsection 60P-2.002(6), F.A.C., to the agency personnel office within thirty-one (31) calendar days after returning to work or during the open enrollment period.

(6) Workers’ Compensation Disability Leave.

(a) An employee who is on Workers’ Compensation disability leave is eligible to continue in the Health Program and shall be entitled to the state contribution during such leave. The agency shall collect personal checks or money orders on a month-to-month basis for the employee contributions during the period the employee will not be on the payroll and submit the contributions to the Department pursuant to subsection 60P-2.006(5), F.A.C.

(b) An employee who does not continue coverage under the Health Program while on Workers’ Compensation disability leave may only reenroll in the Health Program during the open enrollment period after such employee returns to work.

(7) Less than year round employment.

(a) An employee on an academic contract or who is regularly employed for less than twelve (12) months and who has worked at least eight (8) months during the prior consecutive twelve (12) month period is eligible to continue in the Health Program and receive the state contribution for a period not to exceed four (4) months while such employee is off the payroll.

(b) Employee contributions for such employees must be paid by advance payroll deductions, by collecting a single personal check or money order for the employee contribution for the entire period the employee will not be on the payroll or on a month-to-month basis.

(8) Military Leave. An insured employee granted military leave as defined under Personnel Chapter 60K-5, F.A.C., shall be eligible to continue enrollment in the Health Program while on such leave provided the employee pays the full premium. An employee who does not continue coverage while on military leave may apply for reenrollment in the Health Program as follows:

(a) If the employee returns to work within ninety (90) calendar days after separation from active military service, the employee may enroll in the Health Program for the type of coverage in effect immediately prior to going on military leave, by submitting an application in accordance with subsection 60P-2.002(6), F.A.C., to the agency personnel office within thirty-one (31) calendar days of returning to work. At the employee’s option, coverage under the Health Program may be effective the first day of the month in which the employee separates from active military service, provided the employee pays all back premiums. In addition, the Group Health Self Insurance Plan’s preexisting condition provision will not apply for persons insured under the employee’s coverage in effect immediately prior to the employee’s military leave.

(b) If the employee returns to work but does not enroll in the Health Program within thirty-one (31) calendar days of such return, the employee may only enroll during the open enrollment.

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 10-8-78, Amended 10-22-79, 7-1-80, 9-13-82, Formerly 22K-1.25, Amended 7-16-86, 9-25-86, Formerly 22K-1.212, Amended 8-22-96, Repromulgated 1-31-02, Amended 3-2-17.