To consolidate Rules 60P-2.007, 60P-2.008 and 60P-2.009, F.A.C., into Rule 60P-2.006, F.A.C., as rules on the same topic from the same chapter.

 

DEPARTMENT OF MANAGEMENT SERVICES

Division of State Employees' Insurance

RULE NO.: RULE TITLE:

60P-2.006   Employee Contributions

60P-2.007    Underpayment of Contributions

60P-2.008    Overpayment of Contributions

60P-2.009    State Contribution

PURPOSE AND EFFECT: To consolidate Rules 60P-2.007, 60P-2.008 and 60P-2.009, F.A.C., into Rule 60P-2.006, F.A.C., as rules on the same topic from the same chapter.

SUMMARY: Rule 60P-2.006, F.A.C., is amended and Rules 60P-2.007, 60P-2.008 and 60P-2.009, F.A.C., are proposed for repeal.

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: 17.04, 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-2.006 Employee Contributions, Underpayments of Contributions, and Overpayments of Contributions.

(1) Employee contributions.

(a) Employee contributions are due in advance of each month of coverage and shall be paid as follows:

(a) through (d) redesignated 1. through 4. No change.

(2) through (5) redesignated (b) through (e) No change.

(2) Underpayment of Contributions

(a) For employees, retirees and surviving spouses on the active or retiree payroll:

1. When it has been determined that a contribution has been underpaid, the Department shall notify the employee, retiree or surviving spouse of the underpayment by certified mail and shall notify the employee’s agency of the underpayment. This notice will advise the employee, retiree or surviving spouse of the nature of the underpayment and the methodology used to determine this amount and will request the employee, retiree or surviving spouse to contact his or her agency or the Department to resolve the problem so that future contributions will be correct. The notice shall advise of the following procedures for resolving the underpayment:

(i) If the full amount of the underpayment is not received by the Department within thirty (30) calendar days from the date of receipt of the notification of underpayment or if approval is not granted in accordance with subparagraph (2)(a)1.(ii), or if an administrative hearing is not requested in accordance with subparagraph (2)(a)1.(iii), the retiree’s or surviving spouse’s coverage shall be terminated. With respect to the employee, the Department will request the Department of Banking and Finance to initiate involuntary wage deductions where applicable.

(ii) If the underpayment involves more than one coverage period, the Department may approve an installment payment program provided a written request for such program is received from the employee, retiree or surviving spouse within thirty (30) calendar days from the date of the notification of underpayment; provided, however, that any such installment payment program is subject to approval of the Department of Banking and Finance in accordance with Section 17.04, F.S. Payroll deductions must be used whenever the employee is receiving a state payroll warrant issued by the Department of Banking and Finance.

(iii) The employee, retiree or surviving spouse may request an administrative hearing pursuant to Section 120.57, F.S., provided such request is received by the Department within twenty-one (21) calendar days from the date of receipt of the notification of underpayment. Such notice shall be mailed to the address on file.

2. When it has been determined that an agency has underpaid its contribution, the Department shall notify the agency of the underpayment in writing. Such notice will advise the agency that the full amount of the underpayment should be received by the Department within forty-five (45) calendar days from the date of the letter. The agency shall take appropriate action to insure that future state contributions are correct. Should any agency become more than sixty (60) days delinquent in payment of this obligation, the Department shall certify to the Comptroller the amount due and request the Comptroller to recover such underpayment in accordance with Section 17.04, F.S.

(b) For subscribers off the payroll:

1. As it applies to the employee, when it is determined that none of the required contribution is paid by the end of the coverage month, coverage will be canceled effective the first day of that month.

2. As it applies to all others, when it is determined that none of the required premium is paid by the coverage month, coverage will terminate effective the first day of the month.

3. If less than the required contribution is paid, the subscriber and the employee’s agency will be notified as described in subsection 60P-2.006(a), F.A.C.

(c) An employee whose coverage is suspended in accordance with subsection (2)(b)1. may only apply for reenrollment in the Health Program by settling all underpayment claims and resubmitting an application during the open enrollment period. A retiree, surviving spouse or an insured with continuation coverage whose coverage is terminated in accordance with paragraph (2)(b)2. may not reenroll in the Health Program.

(d) When it has been determined that an employee contribution has been underpaid, the Department shall notify the servicing agent to suspend the payment of claims until such underpayment has been resolved.

(e) Claims rejected by the Group Health Self Insurance Plan due to underpayment of premium shall be reprocessed upon receipt by the Department of the full amount of the underpayment or an approved signed agreement for installment repayment from the employee, retiree or surviving spouse, provided such claims were initially submitted to the Group Health Self Insurance Plan within sixteen (16) months from the date medical expenses were incurred.

(3) Overpayment of Contributions.

(a) Whenever the employee’s agency becomes aware of a total premium payment that is more than the amount required for the type of coverage selected, the agency shall take appropriate action to request a refund for the overpayment of premiums and to correct the contributions for any subsequent periods. The Department shall make such corrections for retired employees, surviving spouses and insureds with continuation coverage.

(b) Requests for refunds of any premium overpayments must be submitted by the employing agency.

(c) If an employee contribution has been overpaid and the Department is aware of a claim overpayment on behalf of any insured, a refund of the employee contribution overpayment shall not be processed until the claim overpayment has been resolved.

(4) State Contribution. Any state officer, full-time employee or part-time employee participating in the Health Program shall be entitled to the state contribution or prorated state contribution if any of the following conditions exist:

(a) The employee is at work or on approved leave with pay for a minimum of one day in the month previous to the month of coverage.

(b) The employee is either on academic contract or is regularly employed for less than twelve (12) months, provided the employee has worked at least eight (8) months during the prior consecutive twelve (12) month period. Such employee shall receive the state contribution for the entire twelve (12) months.

(c) The employee is on Workers’ Compensation disability leave.

(d) The employee successfully appeals a suspension and receives full back pay. In such cases, the employee shall receive the state contribution during the time of the suspension provided the employee continued coverage under the Health Program during the period of such suspension and was receiving the state contribution at the time of suspension.

(e) The employee successfully appeals a dismissal and receives full back pay. In such cases, the employee shall receive the state contribution during the time of dismissal provided the employee was receiving the state contribution at the time of dismissal and, upon reinstatement, pays all back employee contributions in order to have continuous coverage under the Health Program.

(f) When the spouse of an employee is also a state officer, full-time employee, or part-time employee, and both are covered under the Health Program, and the spouse is listed as an eligible dependent under the employee’s family coverage, the spouse shall also be eligible to receive the designated state contribution beginning with the coverage month following receipt of the applications by the Department.

(g) The state contribution for a part-time employee shall be on a pro rata basis so that the percentage of the cost contributed for the part-time employee shall bear that relation to the percentage of cost contributed for a similar full-time employee that the part-time employee’s normal workday bears to a full-time employee’s normal workday.

(h) The state contribution for full-time employees or part-time permanent employees shall continue in the respective proportions for a minimum of twelve (12) weeks for any such employee who has been granted an approved medical leave of absence.

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-1.22, Amended 7-16-86, Formerly 22K-1.209, Amended 8-22-96, Repromulgated 1-31-02, Amended                  .

 

60P-2.007 Underpayment of Contributions.

Rulemaking Authority 110.123(5) FS. Law Implemented 17.04, 110.123 FS. History–New 10-8-78, Amended 7-19-79, 10-22-79, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.20, Amended 7-16-86, 9-25-86, Formerly 22K-1.207, Amended 8-22-96, Repromulgated 1-31-02, Repealed                .

 

60P-2.008 Overpayment of Contributions.

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 10-8-78, Amended 10-22-79, 7-1-80, 9-12-82, 8-7-83, Formerly 22K-1.21, Amended 7-16-86, Formerly 22K-1.208, Amended 8-22-96, Repromulgated 1-31-02, Repealed           .

 

60P-2.009 State Contribution.

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-1.22, Amended 7-16-86, Formerly 22K-1.209, Amended 8-22-96, Repromulgated 1-31-02, Repealed                   .

 

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