2023 Florida Statutes › Title XXXVII - Insurance › Chapter 641 - Health Care Service Programs › Part I - Health Maintenance Organizations (Ss. 641.17-641.3923) › 641.31072 - Special enrollment periods.

641.31072 Special enrollment periods.—
(1) A health maintenance organization that issues a group health insurance policy shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the contract, or a dependent of such an employee if the dependent is eligible but not enrolled for coverage under such terms, to enroll for coverage under the terms of the contract if each of the following conditions is met:
(a) The employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent. For the purpose of this section, the terms “group health plan” and “health insurance coverage” have the same meaning ascribed in s. 2791 of the Public Health Service Act.
(b) The employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health maintenance organization, if applicable, required such a statement at such time and provided the employee with notice of such requirement and the consequences of such requirement at such time.
(c) The employee’s or dependent’s coverage described in paragraph (a):
1. Was under a COBRA continuation provision or continuation pursuant to s. 627.6692, and the coverage under such provision was exhausted; or
2. Was not under such a provision and the coverage was terminated as a result of loss of eligibility for the coverage, including legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment, or the coverage was terminated as a result of the termination of employer contributions toward such coverage.
(d) Under the terms of the contract, the employee requests such enrollment not later than 30 days after the date of exhaustion of coverage described in subparagraph (c)1., or termination or employer contribution described in subparagraph (c)2.
(2) For dependent beneficiaries, if:
(a) A group health maintenance organization contract makes coverage available with respect to a dependent of an individual;
(b) The individual is a participant under the contract, or has met any waiting period applicable to becoming a participant under the contract, and is eligible to be enrolled under the contract but for a failure to enroll during a previous enrollment period; and
(c) A person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption,
the health maintenance organization shall provide for a dependent special enrollment period described in subsection (3) during which the person, or, if not otherwise enrolled, the individual, may be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if such spouse is otherwise eligible for coverage.
(3) A dependent special enrollment period under subsection (2) shall be a period of not less than 30 days and shall begin on the later of:
(a) The date dependent coverage is made available; or
(b) The date of the marriage, birth, or adoption or placement for adoption described in paragraph (2)(c).
(4) If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective:
(a) In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received.
(b) In the case of a dependent’s birth, as of the date of such birth.
(c) In the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.
History.—s. 26, ch. 97-179.