STATE OF FLORIDA DEPARTMENT OF MANAGEMENT SERVICES CHRISTINA L. COUNCE, Petitioner, Final Order No. DMS — 12-0004 v. OGC #11-22813 STATE OF FLORIDA, DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE, Respondent. / FINAL ORDER THIS MATTER came before Clifford A. Taylor, the Secretary’s designated Presiding Officer for the Department of Management Services (Department) on December 5, 2011, in Tallahassee, Florida in accordance with the provisions of section 120.57(2), Florida Statutes. Petitioner, Christina L. Counce, appeared by telephone. The Division of State Group Insurance (Division) of the Department was represented by Sonja Mathews, Assistant General Counsel. FINDINGS OF FACT 1. The Petitioner, Christina L. Counce, requested consideration from the Division of State Group Insurance to allow her to add dependent coverage to her newborn child (the Child). 2. The Child was born on May 18, 2011. 3. The Petitioner is employed with the Taylor Correctional Institution and is covered in an individual PPO health insurance plan, not a family plan. 4. The Florida Administrative Rule 60P-2 states that an individual may elect to add dependent coverage for the birth of a child within thirty-one (31) days of the date of birth, however federal guidelines state that the time is sixty (60) days. Filed January 13, 2012 4:38 PM Division of Administrative Hearings 5. The deadline for an election to add health coverage for the Child under Federal guidelines was July 17, 2011. 6. The records from the Division’s Contractor, People First, indicate that a facsimile was received on June 16, 2011 which included a copy of the birth certificate of the Child of the Petitioner. The facsimile transmission verification report indicates that only two pages were received. The facsimile cover page made a reference to QSC/Birth of a Child [see Respondent’s Exhibit 4]. 7. A QSC is an acronym for a qualified status change. A qualified status change is an event which allows an employee who is enrolled a Florida health care plan, to make a change in the plan. Examples of qualified status changes are the birth of a child, death or marriage. 8. The Petitioner testified that she had also faxed a copy of a completed a change of plan form with the cover sheet and the birth certificate and that she had made the election online. This allegation was not made prior to the hearing. An online audit was ordered from People First to indicate whether any such registration was attempted. The audit revealed that the benefits choices were viewed either by or on behalf of the Petitioner, but no change of benefits was made. 9. The Division of State Group Insurance created the health insurance plans under a pre-tax benefit program [see § 110.161, Florida Statutes and 26 U.S.C. § 125 (2000), Cafeteria Plans}. 10. The Petitioner timely filed a request for an informal hearing on September 20, 2011. CONCLUSIONS OF LAW il. The Department is the state agency charged with regulating and administering the State Group Insurance Program pursuant to § 110.123, et seg., Florida Statutes and the administrative rules promulgated thereunder. 12. The Department has jurisdiction over the subject matter and the parties in this matter pursuant to section 110.123, Florida Statutes. 13. The burden of proof, absent a statutory directive to the contrary, is on the party asserting the affirmative of an issue [see Dep’t of Transp. v. J W.C. Co., Inc., 396 So.2d 778 (Fla. 1" DCA 1981)]. Accordingly, it is Petitioner’s burden to demonstrate that the Division erred in denying her request to add her newborn child to her health coverage. 14. There has been no competent substantial evidence to support that an election to add coverage for the Child was made during the sixty days after the birth of the child. The sixty day requirement to add newborn coverage preempts the lesser time period under Florida Law [see Vreeland v. Ferrer, 71 So.3d 70 (Fla 2011)]. 15. Changes to the pre-tax plan can only be made during specified times such as open enrollment, marriage, death, or the birth of a child. If the Division allowed an election outside of the time allowed to make a change, the tax status of the plan would be in jeopardy and a tax consequence to the State of Florida and to the enrollee could occur. Having considered the pleadings, the argument of counsel and the Petitioner, the findings of fact and conclusions of law herein, and being fully advised in the premises, it is hereby, ORDERED AND ADJUDGED: 1. Petitioner’s request to overturn the decision by the Division of State Group Insurance is hereby DENIED. 2. This Final Order shall become effective on the date of filing with the Agency Clerk of the Department of Management Semviges. DONE AND ORDERED this a day of January, 2012. JON P. MILES, Secretary 3 \. Copies furnished to: Ms. Christina Counce 103 E] Pasado Drive Perry, FL 32347 Ms. Sonja Mathews, Esq. Office of General Counsel Department of Management Services 4050 Esplanade Way Tallahassee, Florida 32399-9050 NOTICE OF RIGHT TO APPEAL Unless expressly waived by a party such as in a stipulation or in other similar forms of settlement, any party substantially affected by this final order may seek judicial review by filing an original Notice of Appeal with the Agency Clerk of the Department of Management Services, and a copy, accompanied by filing fees prescribed by law, with the Clerk of the appropriate District Court of Appeal. The Notice of Appeal must be filed within thirty (30) days of rendition of this order, in accordance with Rule 9.110, Fla. R. App. P., and section 120.68, Florida Statutes. Certificate of Clerk: Filed in the office of the Clerk of the Department of Management Services on this lath day o , 2012. gency Clerk

Docket for Case No: 11-000970