Florida Administrative Code › 60 - DEPARTMENT OF MANAGEMENT SERVICES › 60P - Division of State Employees' Insurance › Chapter 60P-1 - STATE GROUP INSURANCE PROGRAM › Section 60P-1.003 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
For the purpose of administering the State Group Insurance
				  Program, the following words and terms shall have the meaning indicated:
(1) "Administrator" means the Department of
				Management Services, hereinafter referred to as "Administrator" or
				"Department."
(2) "Appeal" means
				the filing of a petition pursuant to Rule
				 60P-1.004, F.A.C, and the
				proceeding that results from such filing.
(3) "Cancellation" means the loss of
				coverage, with a right of reinstatement, caused by a failure to pay the
				required premiums for two consecutive months.
(4) "Continuation coverage" means coverage
				that is identical to the coverage provided under the Health Program to active
				employees which must be offered to qualifying employees and dependents in
				accordance with the Consolidated Omnibus Budget Reconciliation Act
				(COBRA).
(5) "Conversion plan"
				means a standard policy as is issued by the servicing agent to direct payment
				subscribers at applicable rates then in effect. An insured shall have the right
				to apply directly to the servicing agent in writing within thirty-one (31) days
				of the termination date of coverage under the Program.
(6) "Coverage" means the provision of plan
				benefits to a subscriber and eligible dependents.
(7) "Eligible children" shall mean the
				subscriber's own children, legally adopted children or children placed in the
				subscriber's home for the purpose of adoption in accordance with Chapter 63,
				F.S., stepchildren for whom the employee or retiree is financially responsible,
				or any other children for whom the subscriber has established legal
				guardianship in accordance with Chapter 744, F.S., foster children, or any
				other unmarried children for whom the subscriber has been granted court-ordered
				temporary or other custody. Such children are eligible for coverage as follows:
(a) From their date of birth to the end of
				the month in which their nineteenth (19th) birthday occurs;
(b) From their nineteenth (19th) birthday to
				the end of the calendar year in which their twenty-fifth (25th) birthday
				occurs, if they are dependent upon the subscriber for support and are either
				living with the subscriber or enrolled in any school, college or university
				which provides training or educational activities, and which is certified or
				licensed by a state or foreign country.
(c) Such children who are mentally or
				physically disabled shall be eligible to continue coverage after attainment of
				the above age limits and while the subscriber's family coverage is in effect
				provided such children are incapable of self-sustaining employment by reason of
				such mental or physical disability and chiefly dependent upon the subscriber
				for support and maintenance.
(d)
				Such children who are over the above age limits at the time of the subscriber's
				enrollment in the Program, and who are mentally or physically disabled, shall
				be eligible for coverage if they are incapable of self-sustaining employment by
				reason of such mental or physical disability and chiefly dependent upon the
				employee or retiree for support and maintenance.