Rule 111-4-1-.06 - Changes in Coverage and Option(1)Open Enrollment Period and Retiree Option Change Period. The Open Enrollment period and Retiree Option change period shall be a minimum period of fifteen (15) days and shall begin no earlier than October 1 and shall end no later than November 15 of each year. The Commissioner shall announce the dates of the periods each year. Eligible Employees, enrolled Retirees and Extended Beneficiaries shall be given an opportunity to make the changes in Coverage election as reflected in the following paragraphs. (a)Active Employees. Eligible Active Employees, eligible Employees on Approved Leave of Absence Without Pay and Extended Beneficiaries shall be given an opportunity to enroll or change Coverage during the Open Enrollment period.(b)Retirees. During the Retiree Option Change Period, enrolled Retirees shall be given an opportunity to change Coverage Option to any Option for which the Retiree is eligible.(2)Returning Employee from an Approved Leave of Absence. An eligible Employee who did not continue Coverage during an Approved Leave of Absence Without Pay which included the Open Enrollment period shall be offered the opportunity to enroll, discontinue, or change Coverage within fifteen (15) calendar days of the date the Employee returns to work.(3)Qualifying Event During a Period of Ineligibility. When an Employee loses eligibility for Coverage and subsequently resumes eligibility for Coverage within the same Plan Year, and a Qualifying Event under these regulations occurs during the period of ineligibility, the Employee shall have the opportunity to request a change in Coverage election for the remainder of the Plan Year that is consistent with that Qualifying Event. The request to change Coverage election must be received by the Administrator within thirty-one (31) calendar days following the date the Employee resumes eligibility through an Employing Entity. The effective date of the requested action shall be consistent with the new employment provisions of these regulations. The Administrator shall request supporting documentation to demonstrate the Qualifying Event has occurred. Failure to fully document the occurrence of the Qualifying Event within the allotted time shall result in reversal of the new Coverage election and restoration of the Employee's former Coverage election.(4)Retired Employee's Discontinuation of Coverage. An Enrolled Retired Employee may discontinue Coverage for him or herself at any time. A discontinuation may be made by advance notice to the Administrator or by failing to timely pay required Premiums. Once a Retired Employee discontinues Coverage for him or herself, the discontinuation is permanent except as described below. (a)TRICARE Supplemental Coverage. If a Retired Employee discontinues SHBP Coverage and elects TRICARE Supplemental Coverage, which is offered by the Administrator, the Retired Employee may re-enroll in SHBP Coverage during the next Retiree Option Change Period as long as he or she has maintained continuous coverage under either SHBP Coverage or TRICARE Supplemental Coverage.(b)Termination of Medicare Advantage Coverage by CMS. If a Retired Employee's Medicare Advantage coverage is terminated by CMS due to enrollment in another plan or failure to pay Medicare Part B premiums, the Retired Employee will be automatically enrolled in another SHBP Option in accordance with the procedures of the Administrator, and will be charged the required Premiums.(c)Employment as an Active Employee. If a Retired Employee who has discontinued Coverage becomes employed as an Active Employee, he or she may re-enroll in the SHBP as an Active Employee. An Enrolled Retired Employee may discontinue Coverage for a Dependent at any time. A discontinuation of Coverage for a Dependent will be permanent except as described below.
(d)PeachCare for Kids Coverage. If a Retired Employee discontinues SHBP Coverage for a Dependent child and enrolls that Dependent child in PeachCare for Kids, the Retired Employee may re-enroll the Dependent child in SHBP Coverage during the next Retiree Option Change Period as long as the Dependent child has maintained continuous coverage under either SHBP Coverage or PeachCare for Kids.(e)Qualifying Event. If an Enrolled Retired Employee discontinues Coverage for a Dependent and experiences a qualifying event described in Internal Revenue Service Regulation 1.125.4, subsection (6) below will apply and the Retired Employee may be able to re-enroll the Dependent.(5)Reinstatement of Employee Across Plan Years. If an Employee was reinstated to employment for a period of time inclusive of the applicable Open Enrollment period, the Employee shall be offered the opportunity to enroll or change Coverage within fifteen (15) calendar days of the return to work.(6)Qualifying Event Coverage Changes.(a) A Member shall be eligible to make a change in coverage or tier on account of the qualifying events set forth, and in the manner described, in Internal Revenue Service Regulation 1.125-4, so long as the Member and the Employing Entity (if applicable) satisfy requirements established by the Administrator. This subsection does not apply to a Retired Employee who has discontinued SHBP coverage for him or herself. In general, requests to enroll, change, or discontinue coverage must be received by the Administrator no later than thirty-one (31) calendar days following the qualifying event. Requests to enroll newly eligible Dependent children must be received by the Administrator no later than ninety (90) calendar days following the qualifying event. Requests to make election changes as a result of death must be received by the Administrator no later than ninety (90) calendar days following the qualifying event. Where necessary to comply with federal law, election changes may be accepted within the deadline established by the law. The effective date of the Coverage election shall be the first of the month following receipt of the request, unless otherwise noted in Internal Revenue Service Regulation 1.125-4. The Administrator shall request supporting documentation to demonstrate the Qualifying Event has occurred. Failure to fully document the occurrence of the Qualifying Event within the allotted time shall result in reversal of the Coverage election and restoration of the Member's prior Coverage election.(b)Additional Changes Permitted for Retirees. An enrolled Retiree may change to any Option to which the Retiree is eligible upon occurrence of one or more of the following events, provided the request is received by the Administrator within thirty-one (31) calendar days following the Qualifying Event: at the time of retirement; at the time that the annuity amount to be received from a state supported participating retirement system becomes insufficient to satisfy the Option premium; at the time that the Retired Member becomes eligible for Medicare coverage; or, subject to approval by the Centers for Medicare and Medicaid Services, at the time the enrolled Retiree requests in writing to move from his or her current Option to a Medicare Advantage plan offered by the same Third Party Administrator.(c) Married enrolled Retirees may change Tier in order to become individual Enrolled Members at any time when no individuals other than the Spouse are enrolled in the Coverage. The change in Coverage will be effective within two (2) calendar months following the requested change.(7)Documentation. The Administrator may require documentation that a Qualifying Event permitting enrollment, change or discontinuation of Coverage has in fact occurred outside the annual enrollment period. When required, documentation appropriate to the event will be specifically described and must be received by the Administrator within the allotted time. Failure to document appropriately or within the allotted time shall result in the reversal of the requested Coverage action and restoration of the Member's prior Coverage.Ga. Comp. R. & Regs. R. 111-4-1-.06
O.C.G.A. Secs. 20-2-295, 20-2-881, 20-2-894, 20-2-897, 20-2-911, 20-2-922, 45-18-1et seq., 50-18-72, 50-18-94, Internal Revenue Code Section 125 - Family and Medical Leave Act of 1993 (FMLA), Consolidated Omnibus Budget Reconciliation Act (COBRA), IRS Code Section 125, Health Insurance Portability and Accountability Act (HIPAA), Child Support Performance and Incentive Act, U.S.E.R.R.A.
Original Rule entitled "Changes in Coverage and Option" adopted. F. Apr. 19, 2005; eff. May 8, 2005.Amended: ER. 111-4-1-0.1-.06 adopted. F. June 13, 2005; eff. June 16, 2005, as specified by the Agency.Amended: Permanent Rule adopted. F. Sept. 15, 2005; eff. Oct. 5, 2005.Repealed: New Rule of same title adopted. F. Jan. 22, 2007; eff. Feb. 11, 2007.Amended: F. May 25, 2007; eff. June 14, 2007.Amended: F. May 1, 2009; eff. May 21, 2009.Amended: F. Oct. 16, 2009; eff. Nov. 5, 2009.Amended: F. Jan. 17, 2012; eff. Feb. 6, 2012.