8 Colo. Code Regs. § 1502-1-12
Current through Register Vol. 48, No. 1, January 10, 2025
Rule 8 CCR 1502-1-12 - HEALTH CARE PROGRAMRule 12 describes requirements for enrollment and payment of premiums for the Health Care Program. For the purposes of Rule 12, the term "member" shall include DPS members and the term "retiree" shall include DPS retirees.
12.10EnrollmentEnrollment in the Health Care Program is subject to receipt by the Association of the prescribed enrollment form(s).
A. Enrollment When First Eligible (1) Enrollment of Benefit Recipients (a) Service retirees and reduced service retirees may enroll themselves and any eligible dependents for whom coverage is desired within 30 days after the date of the first benefit payment.(b) Survivor benefit recipients and disability retirees may enroll within 30 days after the date of the first benefit payment.(c) A surviving cobeneficiary who was not enrolled in the Program may enroll within 30 days after the date of death of the retiree. Coverage and requisite premium deductions will continue for a cobeneficiary whose coverage was in effect at the death of the retiree unless the cobeneficiary requests cancellation of coverage.(2) Enrollment of Spouses Not Receiving Benefits(a) The surviving spouse of a retiree who elected Option 1, or a DPS retiree who elected a single life annuity, must notify the Association in writing within 30 days after the date of death of the retiree in order to continue the coverage which was in effect at the death of the retiree.(b) The divorced spouse of a retiree must notify the Association in writing within 30 days after the date of the divorce in order to continue the coverage which was in effect at the time of the divorce.(c) For purposes of Section 24-51-1204(1)(b), C.R.S., a single life annuity underthe DPS benefit structure shall include Option A, Option B, and Option D.(3) Enrollment of New Dependents (a) Newborn or newly adopted children may be enrolled within 30 days after the date of birth or adoption. Other children may be enrolled within 30 days after the date they become qualified as described in 24-51-1204(1)(a), C.R.S.(b) Spouses may be enrolled within 30 days after the date of marriage or civil union.(c) Dependent parents may be enrolled within 30 days after the date they become dependent parents as described in 24-51-101(14), C.R.S.B. Enrollment Upon Loss of Other Coverage Benefit recipients and others eligible for coverage who are not enrolled in the Health Care Program may enroll within 30 days after loss of other coverage.
C. Enrollment Upon Reaching Medicare Eligibility (1) Benefit recipients and others eligible for coverage may enroll in the Health Care Program within 30 days after their Medicare effective date.(2) Persons enrolled in the Health Care Program may change coverage from one health plan sponsored by the Program to another within 30 days after reaching Medicare eligibility.D. Open Enrollment A period of open enrollment shall be held annually. Benefit recipients may enroll themselves and their eligible dependents during the annual open enrollment period.
12.20Payment of Health Care Premiums by Benefit RecipientsPremium payments made by benefit recipients shall be made through deduction from the benefit payment or by direct payment.
A. Deductions from Benefit Payments The portion of the monthly premium paid by the benefit recipient shall be deducted from the benefit payment, unless the portion of the premium to be paid by the benefit recipient exceeds the amount of the benefit payment.
B. Direct Payment If the portion of the premium to be paid by the benefit recipient exceeds the amount of the benefit payment, the benefit recipient shall make direct payments.
12.25Conditions for Direct Payment of Health Care PremiumsDirect payment of premium amounts may be made on a monthly or quarterly basis. The Association shall bill the benefit recipient, the surviving spouse or the divorced spouse for the direct payments.
A. Requirements for Timely Payments Direct payments are due prior to the month for which coverage is being purchased in accordance with the timeline as determined by the Association.
B. Cancellation Due to Non-Payment Payments not made within 30 days of the due date shall result in cancellation of coverage effective at the end of the last month for which premium payments were made.
12.30Health Care Premiums for Benefit Recipients Who Have Multiple Benefit SegmentsWhen a retiree suspends his or her service retirement or reduced service retirement benefits and builds one or more separate benefit segments pursuant to Section 24-51-1103 (1.5) or 24-51-1726.5, C.R.S., whichever is applicable, the service credit in all benefit segments shall be added together by the Association for the purposes of determining payment of premium subsidies for the Health Care Program.
38 CR 23, December 10, 2015, effective 1/1/201639 CR 23, December 10, 2016, effective 1/1/201740 CR 04, February 25, 2017, effective 4/1/201740 CR 24, December 25, 2017, effective 2/1/201841 CR 14, July 25, 2018, effective 9/1/201841 CR 20, October 25, 2018, effective 1/1/201942 CR 20, October 25, 2019, effective 1/1/202043 CR 21, November 10, 2020, effective 1/1/202144 CR 20, October 25, 2021, effective 1/1/2022