60PER10-2: Spouse Program
SPECIFIC REASONS FOR FINDING AN IMMEDIATE DANGER TO THE PUBLIC HEALTH, SAFETY OR WELFARE: This year’s General Appropriations Act, which sets the benefits for State of Florida employees, made some important changes to state employee health and life insurance benefits which will become effective July 1, 2010. The Department of Management Services (Department), specifically the Division of State Group Insurance (DSGI) within the Department, must immediately amend Rule 60P-6.0075, F.A.C., to account for these changes in benefits. With this emergency rule amendment to immediate reflect this sessions legislative changes, the regular rule promulgation procedure, rather than the emergency-rule process, will be undertaken to memorialize this delegation.
Without this rule emergency rule, until the Department is able to adopt their new rules following the regular rule promulgation procedure, the actions of DSGI would be open to litigation and rule challenges from the public. Rules which reflect such a drastic change in legislation are critical to ensure the proper functioning of DSGI in handling health insurance claims for all employees Florida State government and their dependents. Absent this emergency rule, which would only “bridge the gap” until the new rules can be adopted through the regular rule promulgation procedure, a lapse in the DSGI’s ability to administer these critical functions would result. If DSGI is unable serve these functions, the safety and welfare of the public that has state group health insurance is put at risk. This emergency rule allows the Department’s seamless transition from the old rule to the new.
With the filing of this emergency rule, a mirror, non-emergency rule is simultaneously being noticed for promulgation. The non-emergency version of this rule will offer all of the protections required by Chapter 120, F.S. This emergency rule version will only be effective for 90 days or until the permanent rule is promulgated, whichever occurs first.
REASON FOR CONCLUDING THAT THE PROCEDURE IS FAIR UNDER THE CIRCUMSTANCES: The Department of Management Services (Department) has determined that the adoption procedures used for this emergency rule is fair given the circumstances. The Department is required to adopt this emergency rule without delay in response to new legislation establishing this critical change in the way state group health insurance is administered. With the filing of this emergency rule, a mirror, non-emergency rule is simultaneously being noticed for promulgation. This non-emergency version of this rule will offer all the notices required by Chapter 120, F.S. This emergency rule version will only be effective for 90 days or until the permanent rule is promulgated, whichever occurs first.
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 PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS: Michelle Robleto, Director, Division of State Group Insurance, Department of Management Services, 4050 Esplanade Way, Tallahassee, FL 32399-0905, telephone (850)921-4658, fax (850)488-0252
THE FULL TEXT OF THE EMERGENCY RULE IS:
(Substantial rewrite of Rule 60P-2.0036 follows. See Florida Administrative Code for present text.)
60PER10-2 (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.
THIS EMERGENCY RULE TAKES EFFECT ON July 1, 2010.
Rulemaking Specific Authority 110.123(5) FS. Law Implemented 110.123 FS. History–New 8-22-96, Repromulgated 1-31-02, Amended 7-1-10.