The purpose of the amendment to Rule 60P-2.0036, F.A.C., is to create rule conformity with the changes outlined by the most recent General Appropriations Act. The effect will be that the rules reflect the most recent legislative intent. The Division ...

DEPARTMENT OF MANAGEMENT SERVICES
Division of State Employees’ Insurance

Rule No.: RULE TITLE
60P-2.0036: Spouse Program
PURPOSE AND EFFECT: The purpose of the amendment to Rule 60P-2.0036, F.A.C., is to create rule conformity with the changes outlined by the most recent General Appropriations Act. The effect will be that the rules reflect the most recent legislative intent. The Division of State Group of Insurance decided to substantially reword the entire rule for overall clarity, but the only substantive change is that the State no longer pays the entire premium for married couples who participate in the spouse program.
SUMMARY: These rules clearly lay out how the employees can become eligible and ineligible for this program. This rule also describes what will happen to coverage should an employee become ineligible. The most substantive change is that the State will no longer pay the entire premium for married couples who participate in the spouse program.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC 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 SCHEDULED AND ANNOUNCED IN FAW.
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 7 days before the workshop/meeting by contacting: Michelle Robleto, Director, Division of State Group Insurance, telephone [phone], fax [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: Michelle Robleto, Director, Division of State Group Insurance, Department of Management Services, 4050 Esplanade Way, Tallahassee, FL 32399-0905, telephone [phone], fax [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

(Substantial rewording of Rule 60P-2.0036 follows. See Florida Administrative Code for present text.)

60P-2.0036 Spouse Program.

(1) The spouse program is pretax family health insurance coverage where each employee contributes to the monthly premiums as determined by the annual funding by the Legislature through the General Appropriations Account.

(2) For the purposes of this section, “Designated Agent” means an entity the Department may contract with to provide benefits administration services, but does not include an employee’s agency personnel office or other employees of the employee’s agency, unless so designated in writing by the Division.

(3) Participation in the spouse program is voluntary and available to any married state employee whose spouse is also a state employee. To enroll in the spouse program, married state employees must submit an application completed by both spouses to the Designated Agent within the specified timeframe for one of the following events:

(a) Within thirty-one (31) days of marriage to another state employee in accordance with Rule 60P-2.002 or 60P-2.003, F.A.C.; or

(b) Within sixty (60) days of spouse’s new employment or re-employment with the State of Florida; or

(c) During the annual Open Enrollment period.

(4) In no case shall a retroactive effective date be assigned. Spouse program benefits begin the first of the month following receipt and approval by the Designated Agent of the application.

(5) Eligibility for and participation in the spouse program and state contributions shall cease, if one of the following disqualifying events occurs:

(a) One or both employees end employment with the state; or

(b) One or both employees go on leave without pay status; or

(c) The employees divorce; or

(d) The death of a spouse.

(6) All state employees participating in the spouse program shall report any above described disqualifying event to the Designated Agent to avoid any underpayment of premiums.

(7) Upon learning of ineligibility, the Designated Agent shall investigate and determine the effective end-date of participation in the spouse program and make the change, regardless of whether or not one or both spouses submitted an application to terminate participation. The effective end-date of participation in the spouse program shall be as of the date of the disqualifying event listed in subsection (5) above.

(8) Unless otherwise directed by the employee, each disqualifying event will result in the following health insurance coverage levels as follows:

(a) If one employee ends employment with the state, the remaining employee’s coverage level will be changed to family coverage level.

(b) If one employee goes on leave without pay status, the remaining employee’s coverage level will be changed to family coverage level.

(c) If the employees divorce, and there are eligible dependents, each remaining employee’s coverage will be determined as set forth under the terms and conditions of the divorce decree.

(d) If the employees divorce, and there are no eligible dependents, each remaining employee will be changed to individual coverage.

(e) If the employees divorce, at no time will family coverage level include a former spouse.

(f) If one spouse dies, and there are eligible dependents, the remaining employee’s coverage level will be family coverage.

(g) If one spouse dies, and there are no eligible dependents, the coverage level of the remaining employee will change to individual coverage.

(9) If participants in the spouse program do not timely notify the designated agent of their disqualifying event, the participants shall be financially liable for medical or prescription drug claims incurred by the participants and their dependents, and any premiums paid by the state during the time the participants and/or their dependents were not eligible.

(10) If an ineligible spouse returns to eligible state employment, the spouse program shall only become effective upon the re-enrollment in the program by both employees in accordance with subsection (3) above.

Rulemaking Specific Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 8-22-96, Repromulgated 1-31-02, Amended________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Michelle Robleto
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Secretary Linda H. South
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 17, 2010
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 23, 2010