Chapter 478-2 FLEXIBLE BENEFITS PROGRAM
Rule 478-2-.01 Definitions
| (1) | "Act" means the legislative act that authorized the establishment of a flexible employee benefit plan and is designated in the Official Code of Georgia Annotated as Article 3 of Chapter 18 of Title 45. (07-30-86/08-08-86) |
| (2) | "Active" means that the employee is receiving wages or salary through a department, school system, local employer, employer, agency, authority, board, commission, county department of family and children services, county department of health, or community service board and for whom the employee's cost of the coverage is stated as a payroll deduction or reduction. (03-27-97/04-09-97) |
| (3) | "Administrator" means the State Personnel Administrationor the Commissioner of Personnel Administration. |
| (4) | "After-Tax Premium" or "After-Tax Contribution" means the contract rate approved by the Council for a specific benefit or health care spending account contribution transmitted directly to the Flexible Benefits Program by the employee or extended beneficiary or the contract rate for after-tax options that have been approved by the Council to be offered through payroll deductions. (06-28-90/07-01-90) |
| (5) | "After-Tax Option" means any benefit option that is approved by the Council to be offered to employees through payroll deductions and for which the cost of the option is not a reduction of gross salary for the purposes of federal or state income taxes or FICA taxes. (06-28-90/07-01-90) |
| (6) | "Approved Leave of Absence Without Pay" means a period of time approved by the appropriate organizational official during which the employee is absent from work and is not paid wages or salary. (03-27-97/04-09-97) |
| (7) | "At Work" means that the employee is at the employee's customary place of employment, on paid leave for conditions other than illness or injury, or performing his normal duties at a place other than the place of employment or in a non-scheduled work period, must be able to perform normal duties on that day and cannot be hospitalized or otherwise institutionalized. (03-27-97/04-09-97) |
| (8) | "Annuitant" means a retired employee or surviving spouse or dependent child who receives a monthly retirement benefit from the Employees Retirement System, Legislative Retirement System, Superior Court Judges Retirement System, District Attorney's Retirement System, Teachers Retirement system, or Public School Employees Retirement System. (03-27-97/04-09-97) |
| (9) | "Beneficiary" means the person, individual, trust, or estate named by the employee to receive the value of the insurance proceeds at the employee's death. (07-30-86/08-08-86) |
| (10) | "Benefit" or "benefits" means any of the types of offerings under the Flexible Benefits Program. (07-30-86/08-08-86) |
| (11) | "Benefit Salary" means the amount of compensation used to calculate certain salary based coverages. This compensation is intended to be normal, regular, non-temporary, and shall include base salary and any special salary supplements that are intended to be regular and not of short duration. This salary amount shall not exceed the amount on which retirement contributions are calculated. (03-27-97/04-09-97) |
| (12) | "Cafeteria Plan" means a plan which meets the requirements of the Regulations of the Internal Revenue Service under Internal Revenue Code (IRC) 125. (03-27-97/04-09-97) |
| (13) | "Commissioner" means the Commissioner of Personnel Administration as created by the Official Code of Georgia Annotated 45-20-4. (07-30-86/08-08-86) |
| (14) | "Community Service Board" means a public community mental health, mental retardation, and substance abuse board established pursuant to the Official Code of Georgia Annotated 37-2-6. (03-27-97/04-09-97) |
| (15) | "Contractor" means a company or corporation approved to provide one or more benefit types under the Flexible Benefits Program. (07-30-86/08-08-86) |
| (16) | "Contribution" means the amount to be reduced by a salary agreement transferred to the Administrator for the employee's health and/or dependent care spending accounts. (03-27-97/04-09-97) |
| (17) | "Council" and "Employee Benefit Plan Council" are synonymous and mean the governing body as created in O.C.G.A. 45-18-51. (07-30-86/08-08-86) |
| (18) | "Department," "Employing Entity," and "agency" are synonymous and mean any of the separate and distinct employing entities defined as a State Employer, an Educational Institution, or a Community Service Board that employs an employee as defined in these regulations. (03-27-97/04-09-97) |
| (19) | "Dependent" means any eligible spouse, dependent child, fulltime student under age 26, or disabled child and as more specifically defined by the insurance option contracts and policies. (03-27-97/04-09-97) |
| (20) | "Educational Institution" means any separate and distinct local school system, regional educational services agency, and county or regional library whose heads are legally authorized to appoint employees to positions and whose heads have elected to participate in the Flexible Benefits Program administered by the State Personnel Administration (O.C.G.A. 45-18-52) (12-18-90/01-10-91) |
| (21) | "Employee" means a person eligible to participate in the Flexible Benefits Program. (07-30-86/08-08-86) |
| (22) | "Employer" means the State of Georgia and the department, agency, or entity from which the employee receives his compensation. (03-27-97/04-09-97) |
| (23) | "Extended beneficiary" means the individual who was covered as an active or retired employee or employee on approved leave of absence without pay; or a person who was covered as a spouse or eligible dependent of an active or retired employee or employee on approved leave of absence without pay on the day the dental option or health care spending account option was lost as a result of a qualifying event under the requirements of federal law and regulation known as the Consolidated Omnibus Budget Reconciliation Act (COBRA), as amended; and further defined and expanded under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to include a child who is born to the covered person, adopted or placed for adoption by a qualified beneficiary while on COBRA continuance. The applicable regulations for the health option are outlined in the Regulations of the State Personnel Board for the Health Benefit Plan. (03-27-97/04-09-97) |
| (24) | "Extended coverage" means coverage required to be made available by federal law or regulation to an extended beneficiary under the dental option or the health care spending account option of the Flexible Benefit Plan upon the occurrence of a qualifying event. The applicable regulations for the health option are outlined in the Regulations of the State Personnel Board for the Health Benefit Plan. (12-20-88/01-19-89) |
| (25) | "Flexible Benefits Program" or "Flexible Benefit Plan" or "Plan" or "Program" means the combination of approved benefits authorized for establishment by O.C.G.A. 45-18-52 and offered to all eligible employees. Benefit options may be those authorized in the Flexible Benefit Plan Document or authorized by the Council as an After-Tax Option and incorporated in these Regulations. (03-27-97/ 04-09-97) |
| (26) | "Flexible Benefit Plan Document" means the legal document required by the Regulations of the Internal Revenue Service for a cafeteria plan under IRC 125. Statutory benefit options as allowed by IRC 125 and authorized by the Council shall be incorporated in the Flexible Benefit Plan Document. (06-28-90/07-01-90) |
| (27) | "Fund" means any moneys received and accounted for on behalf of the Flexible Benefits Program. (12-20-88/01-19-89) |
| (28) | "Health benefit option" means any self-insured or health maintenance organization (HMO) option offered under the State Health Benefit Plan and which is included in the Flexible Benefits Program. (03-27-97/04-09-97) |
| (29) | "Insurance option" or "insurance" means the life, dependent life, accidental death and dismemberment, disability, dental, legal, and long-term care options and any other option for which a contract for underwriting the risk has been or is to be approved by the Council. (03-27-97/04-09-97) |
| (30) | "Option" means any specific benefit offering under the Flexible Benefits Program. (12-20-88/01-19-89) |
| (31) | "Plan Year" means the twelve-month period beginning on July 1, and ending on the following June 30. (06-28-90/07-01-90) |
| (32) | "Premium" means the cost to the employee for each insurance option offered under the Flexible Benefits Program. (03-27-97/ 04-09-97) |
| (33) | "Qualifying event" means an event as defined by federal law or regulation that authorizes eligibility for extended coverage under a health benefit plan. Qualifying events include a change in employment or family status such as: termination of employment (except for gross misconduct), employee layoff, reduction of employee's hours below the minimum number required for coverage eligibility as an active employee, end of twelve (12) month leave without pay period, covered employee's death, divorce or legal separation from the covered employee, or any reason for which a dependent child would otherwise become ineligible for coverage under the applicable option. (03-27-97/04-09-97) |
| (34) | "Retired Employee" means a former state employee, former teacher, or former public school employee who met the eligibility criteria when active, and who receives a monthly benefit from the Employees Retirement System, Legislative Retirement System, Teachers Retirement System, Public School Employees Retirement System, Superior Court Judges Retirement System, or District Attorney's Retirement System. (03-27-97/04-09-97) |
| (35) | "Retiring Employee" means a covered employee who is eligible to receive an immediate retirement benefit payment from the Employees Retirement System, Legislative Retirement System, Teachers Retirement System, Public School Employees Retirement System, Superior Court Judges Retirement System, or District Attorney's Retirement System. (03-27-97/04-09-97) |
| (36) | "Salary deduction" means an agreement between the employee and the employer, on behalf of the Council, to deduct amount from the employee's wages for the purpose of purchasing or contributing to the purchase of benefits as allowed under federal and state laws. (12-20-88/01-19-89) |
| (37) | "Salary reduction" means an agreement between the employee and the employer, on behalf of the Council, to reduce the employee's wages for the purpose of purchasing benefits as allowed under federal and state laws. (12-20-88/01-19-89) |
| (38) | "Spending account option" means the reimbursement accounts for eligible health or dependent care expenses as defined by the Plan. (12-20-88/01-19-89) |
| (39) | "Spouse" means an individual who is not legally separated, who is of the opposite sex to the member and who is legally married or who has submitted satisfactory evidence to the Administrator prior to January 1, 1997 of common law marriage to the employee or retired employee. (03-27-97/04-09-97) |
| (40) | "State Employer" means all separate and distinct divisions and subdivisions of state governments, including authorities, county departments of family and children services, or county departments of health, whose heads are legally authorized to appoint employees to positions. (O.C.G.A. 45-18-50) (03-27-97/04-09-97) |
| (41) | "State Personnel Board" or "Board" means the State Personnel Board established by Article IV, Section III, Paragraph I of the Constitution of the State of Georgia. (12-20-88/01-19-89) Authority O.C.G.A. 45-18-51(g). |
| (42) | "Surviving Spouse" means the living spouse of a deceased active or retired employee who was covered under the dental option offered under the Flexible Benefits Program. (03-27-97/04-09-97) |
Rule 478-2-.02 Organization
| (1) | Establishment
of the Council. The Governor shall appoint an Employee Benefit Plan Council
consisting of the following members: (07-30-86/08-08-86)
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| (2) | Filling of a Vacancy. Successors to the members of Council shall have the same qualifications and shall be appointed by the Governor for terms of office of four years and until their successors are appointed and qualified. A vacancy on the Council shall be filled by the Governor, who shall appoint a successor who possesses the same qualification as his predecessor and who will serve for the unexpired term. (07-30-86/08-08-86) |
| (3) | Organization of the Council. The chair of
the Council shall be appointed by the Governor and shall be synonymous with the
chair of the State Personnel Board. (07-30-86/08-08-86)
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| (4) | Meetings. Meetings of the Council shall be scheduled at the discretion of the Council chair. Where feasible, the meetings will be scheduled in conjunction with the meetings of the State Personnel Board as provided in Georgia Law, Chapter 20, Title 45. All meetings of the Council shall be open to the public. (07-30-86/08-08-86) |
| (5) | Quorum.Six members shall constitute a quorum. When fewer than ten members have been appointed to the Council, a quorum shall consist of the majority of the members currently serving on the Council. A majority of affirmative votes of the members in attendance is necessary for the transaction of any business or discharge of any duties by the Council. (3-27-97/04-09-97) (7-28-03/7-1-05) |
| (6) | Minutes. The time and place of each meeting of the Council, names of the Council members present, all official acts of the Council, and the votes of each member except when the acts are unanimous shall be recorded in the official minutes of the Council. When requested a Council member's approval or dissent, with the reasons therefor shall be recorded in the minutes. The Commissioner shall cause the minutes to be transcribed and presented for approval or amendment at the next meeting. The minutes or a true copy thereof, certified by a majority of the Council, shall be open to inspection by the departments and the public. (07-30-86/08-08-86) |
| (7) | Participation. The Commissioner and the departments shall have the right to attend or be represented at, and to participate in meetings of the Council, but shall be without voting power. (07-30-86/08-08-86) |
| (8) | Compensation of Members. The Employee
Benefit Plan Council members shall receive no compensation, but shall receive
reimbursement for expenses or an expense allowance per day as follows:
(07-30-86/08-08-86)
|
| (9) |
Functions, Powers and Duties of the Council, The Employee Benefits Plan Council
shall prescribe the general policies by which the Plan shall be administered.
Specific functions of the Council are: (07-30-86/08-08-86)
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| (10) | Functions, Powers, and Duties of the
Commissioner. The Commissioner of Personnel Administration shall be the
Executive Secretary to the Council and shall provide the Council with staff
support and other assistance as necessary in the perfomance of the Council's
duties. He shall employ such personnel as may be necessary to carry out his
duties and responsibilities and is authorized to delegate duties and
responsibilities at his discretion. (Authority O.C.G.A.
45-18-51,
45-18-55)
(07-30-86/08-08-86)
|
| (11) |
Functions, Responsibilities, and Duties of the Departments. Each department or
agency is charged with complying with these regulations. Statements made by the
staff of the departments that are in conflict with these regulations, the
contracted schedule of benefits, or the summary plan document shall not be
binding on the Administrator or Contractor. (Authority O.C.G.A.
45-18-52)
(12-18-90/01-10-91)
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Rule 478-2-.03 General Provisions
| (1) | Applicability. All employees who become eligible for coverage under the Flexible Benefit Plan shall be enrolled or permitted to change coverage type only in accordance with these regulations; all departments covered by the Act shall administer the Plan and any departmental sponsored optional plans in accordance with these regulations. (07-30-86/08-08-86) |
| (2) | Conformity with Federal Requirements. This Plan shall be administered in accordance with the applicable federal laws, including but not limited to the Internal Revenue Code of 1986, as amended, and any other applicable federal laws and the regulations promulgated thereunder. (12-20-88/01-19-89) |
| (3) | Records. The Plan records shall be
maintained as directed by the Commissioner in accordance with the provisions of
the Georgia Records Act and the applicable provisions of Title 33 of the
Official Code of Georgia Annotated. Each department shall maintain the employee
personnel and payroll records in accordance with the Georgia Records Act.
(Authority O.C.G.A.
50-18-94)
(07-30-86/08-08-86)
|
| (4) |
Employee and Department Responsibilities. The employee and department share the
responsibility for assuring that the premium payments and spending account
contributions for the options selected are being accurately deducted or reduced
from the employee's compensation. Both the employee and the department share
the responsibility for assuring compliance with all contractual and
administrative requirements as outlined in the communications materials. The
employee shall not be permitted to change the selected options after the first
of the month in which the deductions or reductions are scheduled, except in
accordance with these regulations. (12-20-88/01-19-89)
|
| (5) |
Employee's Responsibility. The Employee is responsible for the requirements as
outlined below. (12-20-88/01-19-89)
|
| (6) |
Gender and Number. Except when otherwise indicated by the context, any
masculine terminology herein shall also include the feminine, and the
definition of any terms in the singular shall also include the plural.
(07-30-86/08-08-86)
Note: Dates following each paragraph represent (approval/effective) dates. |
Rule 478-2-.04 Eligibility
| (1) | Active State
Employees. Employees who are actively at work, on approved leave with pay other
than personal sickness or disability, or on suspension with pay may participate
in the Flexible Benefit Plan if the employee is a regular full-time employee
who works a minimum of thirty (30) hours per week and whose duties are expected
to require at least nine (9) months of service. Contingent workers of the Labor
Department, employees who are working on a temporary, seasonal, or intermittent
basis, and employees working in a sheltered workshop operated by a county
family and children services, mental health subdivisions or other employing
entities are not eligible to participate in the Program. Eligible employees are
as follows: (03-27-97/04-09-97)
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| (2) | Active Educational System Employees.
Employees, who are not considered temporary or emergency employees, and who are
actively at work or on approved leave with pay, other than sick or disability,
may participate in the Flexible Benefit Plan if the employee receives pay from
one of the educational institutions that has elected to participate in the Plan
and who meets the work requirements, as follows: (12-18-90/01-01-91)
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| (3) | Employees on Leave Without Pay. Active employees who are eligible to participate in the Flexible Benefits Program may continue all insurance options in which enrolled by paying the required after-tax premium during a period of "approved leave of absence without pay" for a period up to twelve (12) months, subject to the conditions in these regulations. An employee will be considered to have one (1) continuous period of leave without pay if the employee returns to work for a period of time, and fails to have three (3) or more consecutive payroll deductions or reductions during the return to work. (03-27-97/04-09-97) |
| (4) | Employees on Suspension Without Pay. Employees who are eligible to participate in the Flexible Benefits Program may continue all insurance options in which enrolled by paying the required aftertax premiums during a period of "suspension without pay" for a period of up to twelve (12) months, subject to the conditions in these regulations. (Authority O.C.G.A. 45-18-50) (06-28-90/07-01-90) |
| (5) | Employees on Military Leave. Military leave is the period of time during which an employee is ordered to military duty or the period, as provided by law, during which an employee is attending military training. Employees who are eligible to participate in the Flexible Benefits Program may continue the coverages and options, consistent with policy and contractual limitations of each benefit option, not to exceeed twelve (12) consecutive calendar months. (03-27-97/04-09-97) |
| (6) | Employees on Military Reservist Activation Leave. Military Reservist Activation Leave is the period of time during which an employee is activated on an emergency basis. Employees who are eligible to participate in the Flexible Benefits Program may continue the coverages and options, consistent with policy and contractual limitations of each benefit option, not to exceed twelve (12) consecutive calendar months. (03-27-97/04-09-97) |
| (7) | Employees on Reduced Working Hours Due to
a Disabilty. Employees who are eligible to participate in the Flexible Benefits
Program, but due to disability are placed on reduced working hours by the
employing entity, may continue the options for which enrolled by paying the
required after-tax premiums during the period of reduced working hours. The
premium payments for coverage shall not exceed twelve (12) calendar months, and
will be subject to the following condition: (03-27-97/04-09-97)
|
| (8) | Retired Employees Enrolled in
the Dental Option. Employees who were eligible to participate and were enrolled
in the dental option of the Flexible Benefits Program at the time of retirement
on or after April 1, 1997, shall be eligible to continue the dental coverage
and option in which enrolled if: (03-27-97/04-09-97)
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| (9) | Surviving Spouse of an Employee Enrolled in the Dental Option. The surviving spouse of a deceased employee may continue dental coverage provided the spouse is immediately eligible to receive a monthly benefit from the Employees Retirement System, Legislative Retirement System, Teachers Retirement System, Public School Employees Retirement System, Superior Court Judges or District Attorney's Retirement System. The spouse may elect coverage as a surviving spouse, or if an active employee, through payroll reduction, but cannot elect double or dual coverage under this provision. (03-27-97/04-09-97) |
| (10) | Surviving Spouse of a Retired Employee
Enrolled in the Dental Option. The surviving spouse of a retired employee may
continue dental coverage provided the retired employee was enrolled in the
family dental option through March 31, 1997, and the spouse is immediately
eligible to receive a monthly benefit from the Employees Retirement System,
Legislative Retirement System, Teachers Retirement System, Public School
Employees Retirement System, Superior Court Judges or District Attorney's
Retirement System. (03-27-97/04-09-97)
|
| (11) | Continuation of Coverage for a Dependent Child of a Deceased Employee. Upon the death of an active or retired employee, an eligible dependent child who was covered under the family dental coverage and is the principal beneficiary under one of the retirement systems may continue coverage consistent with these regulations and the insurance contracts. The dependent child may not be covered under this provision if he is a covered dependent child under another active or retired employee, or is eligible as an active employee. (03-27-97/04-09-97) |
| (12) | Extended Beneficiaries. Persons who meet the definition of Extended Beneficiaries are eligible to participate in the dental options and health care spending account by paying the required aftertax premiums or contributions as established by the Council. (06-28-90/07-01-90) |
| (13) |
Judicial Reinstatement of Employees. Employees who were eligible to participate
in the Flexible Benefits Program who are reinstated to employment by the State
Personnel Board or the judiciary shall have coverage reinstated for themselves
and any eligible dependents in accordance with the following:
(03-27-97/04-09-97)
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Rule 478-2-.05 Effective Date of Coverage
| (1) | Employment. The employee's coverage under the Flexible Benefit Program shall become effective on the first of the month following employment for the full preceding calendar month if he is at work on that date. If he is not at work on that date, coverage will be effective on the date he returns to work. Coverage for eligible dependents will become effective on the date the employee's coverage is effective unless the eligible dependent is hospitalized. If the dependent is hospitalized on the coverage effective date, coverage will become effective the date following dismissal from the hospital. (06-28-90/07-01-90) |
| (2) | Re-employment During the Plan Year. If the employee is reemployed during the same Plan Year during which he previously participated in the Plan, coverage under the Plan shall be re-instated. The department must reactivate payroll and remit premiums and spending account contributions consistent with the options elected by the employee prior to termination, unless a qualifying change in family status occurred during the period of non-eligibility. The employee shall be considered re-employed during the Plan Year if the employee had one or more deductions or reductions prior to employment termination and subsequent re-employment. When the employee is not re-employed on the first workday of a calendar month, coverage may become effective the first of the month following re-employment, provided the agency remits all premiums and spending account contributions. However, in the event that the agency fails to collect payments during the partial month, coverage shall become effective as of the first of the month following re-employment for the full preceding calendar month. The Regulations of the State Personnel Board for Health Benefit Plan shall apply to the health benefits options. (03-27-97/04-09-97) |
| (3) | Change in Coverage. If the employee changes coverage to include eligible dependents based upon acquisition of dependent(s), coverage for the dependents shall become effective on the first of the month following the proper premium payment or dependent care spending account contribution. Changes in the health care spending account contribution amounts are not allowed during the Plan Year. For dependent life insurance and dental insurance, if the dependent is hospitalized on the coverage effective date, coverage will become effective the day following dismissal from the hospital. The Regulations of the State Personnel Board for Health Benefit Plan shall be applied to the health benefits option. If such Board Regulation is in conflict with the Internal Revenue Code or Regulations, the Internal Revenue Code or IRS Regulation will govern. (06-28-90/07-01-90) |
| (4) | Open Enrollment Change. The effective date for new enrollments, a change in coverage amounts or the addition of eligible dependents shall be July 1, provided the employee is at work on that day and/or the contractor has approved insurance based on medical underwriting requirements. The applicable regulation for the health benefit option is outlined in the Regulations of the Sate Personnel Board for the Health Benefit Plan. (06-28-90/07-01-90) |
| (5) | Return from Suspension or an Approved Leave Without Pay Within the Same Plan Year. If the employee is returning from suspension or an approved leave without pay during the same Plan Year in which he previously participated in the Plan, the benefit options and coverages previously selected by the employee will be reinstated. If the employee failed to pay premiums for the insurance options and the health care spending account during the leave without pay, the department shall reduce the employee's salary to collect all premiums and health care spending account contributions for continuous coverage during the period of out-of-pay status, unless circumstances invoke a contractual limitation on coverage. If contractual limitations are invoked, the Administrator shall determine the appropriate premium collection procedures. Benefit adjustments for the health benefits option will go into effect in accordance with the Regulations of the State Personnel Board for Health Benefit Plan. (O.C.G.A. 45-18-52) (12-18-90/01-10-91) |
| (6) | Return From
Suspension or an Approved Leave Without Pay Across Plans Years. If the employee
is returning from suspension or an approved leave without pay in the Plan Year
following the Plan Year in which he previously participated in the Plan, the
following provisions for benefit options and coverages shall apply. (06-28-90/
07-01-90)
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| (7) | Upon Return From Suspension or
Leave Without Pay Greater Than Twelve (12) Months. If the employee is returning
from a suspension or leave without pay of more than twelve (12) months and the
employee paid the appropriate premium amounts for the insurance options, the
employee shall be offered an open enrollment period as a continuing employee.
(12-20-88/01-19-89)
Note: Dates following each paragraph represent (approval/effective) dates. |
Rule 478-2-.06 Changes in Benefit Options and Amounts
| (1) | Open Enrollment Period. Eligible active
employees shall be given an opportunity to enroll or change benefit options
during the open enrollment period. The open enrollment period shall be no
longer than thirty (30) days duration, and shall begin no earlier than four (4)
months preceding the beginning of each plan year. The specific dates and
duration shall be designated by the Commissioner. The open enrollment period
shall be announced in writing to the employees.
Medical underwriting may be required by contract for the insurance options. The applicable regulation for health benefit options is outlined in the Regulations of the State Personnel Board for Health Benefit Plan. Employees on suspension or on an approved leave of absence without pay during the open enrollment period shall not be provided the opportunity to enroll or change coverages during the period. Extended beneficiaries shall be entitled to the same benefit choice in an applicable option of the Plan during the open enrollment period as if he or she were an active employee. (06-28-90/07-01-90) (11-3-05/11-18-05) |
Rule 478-2-.07 Extended Coverage (COBRA)
| (1) | Extended Beneficiary. Persons who lose
coverage under the Plan and who meet certain requirements are eligible to
continue coverage in the enrolled dental option or health care spending
account, as required by federal law or these regulations for the periods
designated by the qualifying event. Plan Year limitations and Plan requirements
of the health care spending account will apply. An Extended Beneficiary shall
have the same opportunities for enrolling eligible dependents and changing
coverage options as active employees. The Flexible Benefits Program will be
administered in compliance with federal law or regulations under the
Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Insurance
Portability and Accountability Act of 1996 (HIPPA). (03-27-97/04-09-97)
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| (2) | Disability under Social Security. Coverage may be extended for an additional eleven (11) months for an extended beneficiary who at any time during the first sixty (60) days of the 18-month COBRA continuation period meets the Social Security definition of disability. Such disability shall be determined under Title II or Title XVI of the Social Security Act. The eleven (11) additional months of coverage applies to the disabled beneficiary and to non-disabled dependents who are entitled to COBRA continuation coverage. In order to be eligible for this additional extension, the beneficiary must notify the Administrator of the determination by the end of the 18-month COBRA continuation period. Additionally, the extended beneficiary must notify the Administrator within thirty (30) days of the date of any final determination that the beneficiary is no longer disabled. (03-27-97/04-09-97) |
| (3) | Departmental Notification Requirements. The employing entity must notify the Administrator of the employee's termination, death, layoff, or reduced hours within thirty (30) days following the event. (12-20-88/01-19-89) |
| (4) | Notice of Divorce, Separation, and Cessation of Dependency. The employee or other qualified beneficiary must notify the Administrator within sixty (60) days of a divorce, legal separation, or a child ceasing to be a dependent under the applicable option of the Plan. Failure to provide such notice to the Administrator within the sixty (60) days will result in the loss of eligibility for extended coverage. (03-27-97/04-09-97) |
| (5) | The Administrator shall notify the extended beneficiary at his last known address regarding extended coverage. The Administrator shall notify of the continuation rights within fourteen (14) days following notification from the employing entity of the employee's death, termination of employment, or reduction of hours. Notice to the employee's spouse other than employee termination or reduction of hours shall be deemed to be notification to all other beneficiaries of the contract. (12-20-88/01-19-89) |
| (6) | The Administrator shall notify the extended beneficiary of his continuation rights at the address specified by the employee within fourteen (14) days following notification from the employee of a divorce, legal separation, or the dependent child's coverage ineligibility as a dependent. (12-20-88/01-19-89) |
| (7) | Extended Beneficiary's Election Period. The extended beneficiary may elect to continue coverage within a period of sixty (60) days following the Administrator's notification to the extended beneficiary or during the sixty (60) days following coverage termination under the appropriate provision. Coverage will be reinstated by payment of the premium retroactively to the coverage termination under the employee's contract. (12-20-88/01-19-89) |
| (8) | Extended Beneficiary's Independent Election. Each beneficiary eligible for extended coverage shall be afforded the opportunity to make an independent election to continue coverage in the enrolled option, provided the beneficiary is not enrolled as an employee, spouse, or dependent. If a beneficiary, either the employee or spouse of a covered employee makes an election to provide coverage for the other extended beneficiary, the election shall be binding on that other beneficiary. An election on behalf of a minor child can be made by the child's parent or legal guardian. An election on behalf of an eligible beneficiary who is incapacitated can be made by the legal representative of the beneficiary. (12-20-88/01-19-89) |
| (9) | Payment for Extended Beneficiary Coverages. The applicable premium for the dental option shall be 102% of the rate furnished by the Contractor and approved by the Council; the applicable contribution for the health care spending account shall be 102% of the employee's elected contribution. An advance monthly premium plus any premiums for retroactive periods of coverage will, however, be requested as a part of the application. Payment for any retroactive periods must be made no later than forty-five (45) days following election to continue coverage. Thereafter, premium payments must be made no later than thirty (30) days following the end of the month for which payments have been received for coverage by the Administrator. (03-27-97/04-09-97) |
| (10) | Multiple Qualifying Events. If additional qualifying events occur which provide for a thirty-six (36) month maximum period during the period when an extended beneficiary is covered, the maximum period of coverage may be extended to a maximum of thirty-six (36) months for a spouse or dependent child, plus any additional months as a result of disability under Title II or Title XVI of the Social Security Act. The maximum period of extended coverage as a result of one or more qualifying events shall begin on the day following termination of coverage as a result of the first qualifying event. (03-27-97/04-09-97) |
| (11) | Limitation for Individuals Added to Coverage of Extended Beneficiary. Individuals enrolled under an extended beneficiary's coverage shall not be eligible to become an extended beneficiary as a result of the enrollment. (12-20-88/01-19-89) |
| (12) | If the Administrator fails to notify the extended beneficiary of the continuation rights within the required time limits as a result of failure of the employing entity to notify the Administrator, any penalty payment required of the Administrator shall be billed to the employing entity who failed to notify the Administrator. (12-20-88/ 01-19-89) |
| (13) | Recovery of Paid Benefits. The
Administrator shall have the right to recover all benefit payments made on
behalf of any ex- tended beneficiary as a result of eligibility termination.
(12-30-88/ 01-19-89)
Note: Dates following each paragraph represent (approval/effective) dates. |
Rule 478-2-.08 Termination of Coverage
| (1) | Termination from Employment. Termination from employment includes resignation, retirement, abandonment of job, release from job, forfeiture of job, and all other types of termination. Extension of a leave of leave of absence longer than twelve (12) months constitutes a termination of coverage for the purposes of the Plan. A period away from work for less than thirty (30) days will not be considered a termination. Insurance and health care spending account coverages will terminate at the end of the month following the month of the last reduction/deduction that was transmitted to the Administrator. This date will normally be the end of the month following the month in which separation or termination of employment occurred. Reasons and conditions for termination of health benefit coverage are outlined in the Regulations of the State Personnel Board for Health Benefits. (06-28-90/07-01-90) |
| (2) | Reduction
of Work Hours. A reduction in work hours beyond the minimum required may result
in a loss of eligibility to continue coverages and options under the Flexible
Benefits Program, except as defined in
478-2-.04(7).
(03-27-97/04-09-97)
|
| (3) | Failure to Return from an Approved Leave Without Pay. If an employee who is on an approved leave without pay fails to return to active employment or is absent more than twelve (12) months, coverage for the insurance options will terminate at the end of the month for which the premium(s) have been paid. Termination of the health benefit option coverage shall be in accordance with the State Personnel Board approved Regulations for Health Benefits. (07-30-86/08-08-86) |
| (4) | Failure to Remit Insurance Option Premium. Failure to remit the applicable insurance option premium amounts while on leave of absence without pay will terminate coverage at the end of the month for which the premium has been paid, unless provisions of section 478-2-.05 apply. When premium amounts are not paid, benefits will not be allowed during the period, unless such is due as a contractual provision of total disability. (Authority O.C.G.A. 45-18-52) (06-28-90/07-01-90) |
| (5) | Failure to Remit Health Benefit Option Premium. If an employee fails to remit the applicable health benefit option premium, regulations promulgated by the State Personnel Board shall dictate how benefits shall be applied and terminated. (Authority O.C.G.A. 45-18-52) (07-30-86/08-08-86) |
| (6) | Termination of Retiree Dental Coverage. A retired employee may discontinue coverage at any time by advance notice to the Administrator, without any entitlement to re-enroll at a later date. Discontinuation of coverage will become effective one (1) calendar month following written notification to the Administrator. (03-27-97/ 04-09-97) |
| (7) |
Termination of Extended Coverage. Extended coverage for each extended
beneficiary shall terminate on the earliest of the following dates:
(12-20-88/01-19-89)
|
Rule 478-2-.09 Plan Benefits
| (1) | Benefit Plan Components. The Council is authorized to establish a flexible employee benefit plan. The plan may provide for deductions or salary reductions for group life insurance, disability insurance, supplemental health and accident insurance, other types of employee welfare benefits, or for salary reductions for health premiums under Georgia Law Article 1 of Chapter 18, Title 45. The Council is further authorized to establish plans in connection with any plans, not implemented for employees on January 1, 1986, and authorized by the United States Internal Revenue Code for the purpose of making efficient use of the tax code. (Authority O.C.G.A. 45-18-52) (07-30-86/08-08-86) |
| (2) | Approval of Optional Plans. The Council is authorized to approve any new optional employee benefit plans or any contracting with new or additional insurers under existing plans that authorize the deduction or reduction of voluntary designated amounts, including insurance, from the salaries of full-time employees after January 1, 1986. Optional programs under the Flexible Benefits Program offered to members of the General Assembly and employees of the General Assembly or any new programs must be approved by and at the discretion of the Legislative Services Committee. (Authority O.C.G.A. 45-18-54) (07-30-86/08-08-86) |
| (3) | Benefit
Components. Benefit components may be designated as pre-tax or after-tax
options. Pre-tax options are those options for which Flexible Dollars are
allowed under the Flexible Benefit Plan Document as amended. After-tax options
are those options for which Flexible Dollars are not allowed under IRC 125 or
for which the Council designates as a required or optional payroll deduction.
After- tax options shall be governed by the enrollment, termination and change
provisions of the Flexible Benefit Plan Document and the Regulations of the
Employee Benefit Plan Council. (06-28-90/07-01-90)
|
| (4) | Interpretation. The Administrator is authorized to interpret the benefit components for contract execution and administration. (07-30-86/08-08-86) |
| (5) | The Employee Benefit Plan Council
reserves the right to modify any benefits, coverages, and eligibility
requirements of the Flexible Benefits Program at any time, subject only to
reasonable advance notice to its participants. When such a change is made, it
will apply as of the effective date of the modification to any and all claims
incurred by participants from that date forward, unless otherwise specified by
the Employee Benefit Plan Council. (03-27-97/04-09-97)
Note: Dates following each paragraph represent (approval/effective) dates. |
Rule 478-2-.10 Request for Plan Component Additions or Modifications
| (1) | Product Providers. Vendors, brokers,
agents, or other product providers shall have an opportunity to file requests
for plan component additions or modifications in accordance with these
Regulations. The request(s) must be filed with the Administrator during the
sixty (60) day period to begin on June 1 of each year. (07-30-86/ 08-08-86)
|
| (2) |
Employees. Employees shall have an opportunity to file requests for plan
component additions or modifications during the sixty (60) day period to begin
on July 1 of each year. Such requests shall be in writing, outlining the
reasons for the requests and any other pertinent information that the employee
wishes to submit. (07-30-86/08-08-86)
|
| (3) |
Report to the Council. The Commissioner shall complete an evaluation report and
present such to the Council no later than the Council meeting during the month
of January. The Council shall make such disposition of the requests as it deems
appropriate. (07-30-86/08-08-86)
Note: Dates following each paragraph represent (approval/effective) dates. |