To consolidate Rule 60P-2.001, F.A.C., into Rule 60P-2.002, F.A.C.1, F.A.C. To update the references in Rules 60P-2.004 and 60P-2.012, F.A.C., to reflect the changed numbering in Rule 60P-2.002, F.A.C..

 

DEPARTMENT OF MANAGEMENT SERVICES

Division of State Employees' Insurance

RULE NO.: RULE TITLE:

60P-2.001   Eligibility

60P-2.002    Enrollment

60P-2.004    Effective Date of Coverage

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

PURPOSE AND EFFECT: To consolidate Rule 60P-2.001, F.A.C., into Rule 60P-2.002, F.A.C.1, F.A.C. To update the references in Rules 60P-2.004 and 60P-2.012, F.A.C., to reflect the changed numbering in Rule 60P-2.002, F.A.C.

SUMMARY: Rules 60P-2.003, 60P-2.004 and 60P-2.012, F.A.C. are amended and Rule 60P-2.001, F.A.C., is proposed to be repealed.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The economic review conducted by the agency.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 110.123(5) FS.

LAW IMPLEMENTED: 110.123 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Tuesday, January 24, 2017, 2:00 p.m. until completed but no later than 5:00 p.m.

PLACE: 4050 Esplanade Way, Tallahassee, Florida, Room 101

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Michael A. Greif, Department of Management Services, 4050 Esplanade Way, Tallahassee, FL 32399, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Ms. Debbie Shoup, 4050 Esplanade Way, Suite 215, Tallahassee, FL 32399-0950, Phone [phone], Email: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

60P-2.001 Eligibility.

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 10-8-79, Amended 10-22-79, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.14, Amended 7-16-86, Formerly 22K-1.201, Amended 8-22-96, Repromulgated 1-31-02, Repealed         .

 

60P-2.002 Eligibilty and Enrollment.

(1) Eligibility to participate in the Health Program will be in accordance with Section 110.123, F.S.

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

(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.

(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.

(1) through (7) renumbered (5) through (11) No change.

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS. History–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             .

 

60P-2.004 Effective Date of Coverage.

(1) No change

(2) The coverage of an employee applying for enrollment during his or her initial enrollment period shall become effective as follows:

(a) If the employee’s agency personnel office enters the application information as required in subsection 60P-2.002(8)(4), F.A.C., into the state insurance computer system data base prior to the requested effective date, coverage shall be effective on the date requested.

(b) If the employee’s agency personnel office does not enter the application information as required in subsection 60P-2.002(7)(3), F.A.C., into the state insurance computer system data base, coverage shall be effective on the date requested provided the Department receives the completed application prior to the requested effective date. If the application is received by the Department after the requested effective date, coverage shall be effective on the first day of the month following the date the application is received. However, if the proper full month’s premium is received by the Department prior to the requested effective date, coverage shall become effective on the date requested, even though the application may not be received until after such date.

(3)-(9) No change

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, 8-7-83, Formerly 22K-1.17, Amended 7-16-86, 9-25-86, Formerly 22K-1.204, Amended 8-22-96, Repromulgated 1-31-02, Amended 3-16-05, Amended                 .

 

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

(1) No change.

(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)(2), 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)(2), 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)(2), 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) No change.

(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)(2), 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) through (7) No change.

(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)(2), 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) No change.

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        .

 

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Tami Fillyaw, Director, Division of State Group Insurance

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Chad Poppell, Secretary, Department of Management Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 28, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: December 30, 2016