PERMANENT final adoption
Subchapter 1. General Provisions
87:10-1-2. Definitions [AMENDED]
Subchapter 13. Eligibility Requirements
87:10-13-3. Termination of participation [AMENDED]
Oklahoma State Employees Benefits Council; 74 O.S.2001 §1366(B)
March 1, 2011 through March 31, 2011
March 31, 2011
March 31, 2011
Submitted to Governor:
March 31, 2011
Submitted to House:
March 31, 2011
Submitted to Senate:
March 31, 2011
May 3, 2011
Failure of the Legislature to disapprove the rules resulted in approval on May 27, 2011
May 27, 2011
July 11, 2011
SUPERSEDED EMERGENCY ACTIONS:
28 Ok Reg 433
INCORPORATIONS BY REFERENCE:
These permanent administrative rules are identical to and supersede emergency rules approved by Governor Brad Henry on December 27, 2010. These rules are necessary to bring the administrative rules that govern the administration of the State’s flexible benefits plan into compliance with the Patient Protection and Affordable Care Act, Public Law 111-148, enacted March 23, 2010, and the Health Care and Education Reconciliation Act, Public Law 111-152, enacted March 30, 2010, as implemented at 26 CFR 54.9815–2714, 29 CFR 2590.715–2714, 45 CFR 147.120, as published on May 13, 2010, in Volume 75, Number 92, Federal Register, 27122.
These permanent administrative rules revise Subchapters 1 and 13 of Chapter 10 of Title 87 of the Oklahoma Administrate Code. Chapter 10 serves as the "Plan Document" for the administration of the flexible benefits plan for active Oklahoma state employees. These revisions are necessary to prevent the “Plan Document” from being in violation of federal law referenced above. Said revisions are limited to changes to the definition of “dependent” and striking a reference to “student status,” which is no longer applicable.
Craig A. Cates, Executive Manager, Agency & Regulatory Affairs and Human Resources, Oklahoma State Employees Benefits Council, 120 North Robinson Avenue, Suite 1100, Oklahoma City, Oklahoma 73102, 405-609-3440
PURSUANT TO THE ACTIONS DESCRIBED HEREIN, THE FOLLOWING RULES ARE CONSIDERED FINALLY ADOPTED AS SET FORTH IN 75 O.S., SECTION 308.1(A), WITH AN EFFECTIVE DATE OF JULY 11, 2011:
SUBCHAPTER 1. GENERAL PROVISIONS
The following words or terms, when used in this Chapter, shall have the following meanings unless the context clearly indicates otherwise, and wherever appropriate, the singular shall include the plural, the plural shall include the singular, and the use of any gender shall include the other gender.
"Account" means a record keeping account established on the books of the Plan Administrator.
"Act" means the Oklahoma State Employees Benefits Act, 74 O.S. Supp 1992, Section 1361 et seq.
"Authorized Submission Procedure" means an acceptable method of submitting enrollment and/or change documents which may include submission via electronic transmissions to the Plan Administrator.
"Board" means the Oklahoma State and Education Employees Group Insurance Board.
"Cafeteria plan" means an employer-maintained benefit plan under which participants are employees and the participants may choose between cash and nontaxable benefits, as defined in Internal Revenue Code Section 125(d) and regulations promulgated thereunder.
"Change in Status" means a change that a participant may be allowed to make during a Plan Year provided that the change is based on prevailing IRS guidance, is allowed by the Plan Administrator, and complies with all eligibility rules and consistency requirements.
"COBRA" means the Consolidated Omnibus Budget Reconciliation Act of 1985 as it applies to an employee’s right to continue certain coverage under the Flexible Benefits Plan.
"Dependent" means the primary member's spouse (if not legally separated), including common law. Dependents also include a member's unmarried or married natural born child, a step child, an adopted child, or a foster child up to the child's
twenty-fifth [25th]twenty-sixth [26th] birthday, regardless of residence, provided that the member is primarily responsible for the child's support or a child under legal guardianship . This includes a stepchild or child who lives with the member in a regular parent-child relationship, or a child living with the member in a normal parent-child relationship where the member has adopted the child, or has been appointed guardian by a court. It also includes a stepchild who does not live with the member, when the primary member's spouse is covered by the Plan and has been ordered by a court to provide health insurance for his/her children, regardless of residence. A child may also be covered regardless of age if the child is incapable of self-support because of mental or physical incapacity that existed prior to reaching age twenty-five twenty-six . Coverage is not automatic and must be approved with a review of medical information. A disabled dependent deemed disabled by Social Security does not automatically mean that this disabled dependent will meet the Plan requirements. [74 O.S.Supp.2006, §1303(13)].
"Effective date of the plan" means January 1, 1990 or as restated.
"Employer" or "Employing agency" has the same meaning as "Participating employer" as defined in Section 1363(14) of Title 74.
"Enrollment period" means the period of time, as determined and announced by the Plan Administrator each Plan Year during which eligible employees shall make an election of benefits. The period of time shall end no later than thirty (30) days before the beginning of the Plan Year for which the elections are to be effective.
"Entry date" means the first day of the Plan Year except for an employee who first satisfies the requirements for eligibility during the Plan Year (including rehired employees), in which case the entry date shall be the first day of the month next following the satisfaction of the application requirements for eligibility, in accordance with 87:10-3-1.
"FMLA" means the Family and Medical Leave Act of 1993.
"Flexible Benefits Plan" means the Flexible Benefits Plan authorized pursuant to the State Employees Flexible Benefits Act as modified by the provisions under the State Employees Benefits Act.
"Flexible Benefits Plan Rules" means the rules promulgated by the Plan Administrator to implement and administer the State Employees Flexible Benefits Plan.
"HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
"Internal Revenue Code" means the Internal Revenue Code of 1986 of the United States, 26 USC, I et seq. as amended from time to time.
"Irrevocability Rule" means the rule that requires an enrollment election in any Plan benefit to remain in force throughout the entire Plan Year.
"Period of coverage" means the Plan Year during which coverage of benefits under the Flexible Benefits Plan is available to a participant. An employee who becomes eligible to participate during a Plan Year may participate for a period lasting until the end of that Plan Year. In this case, the interval commencing on the employee's entry date and ending as of the last day of eligibility for that Plan Year.
"Permitted Exception" means an exception allowed to the Irrevocability Rule by the Plan. Any changes based on these exceptions must be on account of and correspond with the underlying event.
"Plan Administrator" means the Oklahoma State Employees Benefits Council.
"QMCSO" means a Qualified Medical Child Support Order.
"Statutory nontaxable benefit" means a benefit provided to a participant under the Flexible Benefits Plan, the value of which is not included in the participant's gross income by a specific provision in the Internal Revenue Code and is permissible under the Flexible Benefits Plan in accordance with Section 125 of the Internal Revenue Code.
"USERRA" refers to the Uniformed Services Employment and Reemployment Rights Act of 1994.
SUBCHAPTER 13. ELIGIBILITY REQUIREMENTS
87:10-13-3. Termination of participation
(a) A participant will cease participation in the Flexible Benefits Plan as of the earliest of the following events:
(1) The last day of the month of termination of employment with the employer; or
(2) The last day of the month the participant ceases to be eligible to participate in the Flexible Benefits Plan; or
(3) The date of termination of the Flexible Benefits Plan.
(b) Benefit plan coverage shall terminate as follows:
(1) For termination as a result of voluntary election, the coverage shall terminate on the last day of the month of receipt and approval of a valid change form at the offices of the Plan Administrator.
(2) For termination of coverage as a result of ineligibility
other than the loss of student status, the coverage shall terminate on the last day of the month of the event causing the loss of eligibility.
(c) No vendor, including the Board, shall terminate coverage on any participant unless authorized by the Plan Administrator.