Compilation of Rules and Regulations of the State of Georgia › Department 478 - RULES OF THE STATE PERSONNEL BOARD › Chapter 478-2 - FLEXIBLE BENEFITS PROGRAM › Rule 478-2-.05 - Effective Date of Coverage

Current through Rules and Regulations filed through June 27, 2024
(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)
(a) When the absence without pay is
			 twelve (12) or less months and the employee continued premiums and health care
			 spending contribution for continuous coverage during the leave without pay
			 period, the employee shall have an opportunity to make selections in accordance
			 with the Open Enrollment provisions. (06-28-90/07-01-90)
(b) When the absence without pay is less than
			 six (6) months and the employee did not pay the insurance premiums and health
			 care spending account contributions, the employee will be provided an
			 enrollment period. The employee can re-instate options by paying the delinquent
			 insurance premiums and health care spending account contributions. The employee
			 who chooses not to re-instate options shall be subject to all conditions for
			 enrollment of a current employee, such as medical underwriting, pre-existing
			 conditions and late entrant limitations. (06-28-90/07-01-90)
(c) When the absence without pay is six (6)
			 or more months and the employee did not pay the insurance premiums and health
			 care spending account contributions, coverages will be terminated in accordance
			 with the Failure to Pay Premium provision. The employee shall be offered an
			 opportunity to re-enroll in the same manner as is allowed during the open
			 enrollment period. The employee shall be subject to all conditions for
			 enrollment of a current employee, such as medical underwriting, preexisting
			 conditions and late entrant limitations. (06-28-90/07-01-90)