The Issue Whether Respondent engaged in conduct proscribed by the Insurance Code as is particularly set forth in the Administrative Complaint filed December 7, 1993.
Findings Of Fact During times material, Respondent, Nelson Speer Benzing, was licensed with Petitioner, Department of Insurance and Treasurer, as a life insurance and as a life and health insurance agent. During times material, Respondent was an employee of U.S. Savings Trust Management (herein USSTM). During times material, Respondent was never appointed with Petitioner to represent Wisconsin National Life Insurance Company (herein Wisconsin). However, Respondent did attend a workshop sponsored by Wisconsin. At some time prior to March 5, 1992, Respondent met with George Cantonis, President of Mega Manufacturing, Inc. (herein Mega) in order to obtain Cantonis' permission to make a sales presentation to Mega's employees. Cantonis granted Respondent permission to make a sales presentation to Mega's employees. On March 5, 1992, Respondent made a sales presentation to Mega's employees. The purpose of said presentation was to enroll the employees of Mega in a "savings plan" offered by USSTM. The presentation lasted approximately 15- 30 minutes. Employees were told that the plan, as presented, incorporated an insurance savings plan which had a "liquid" component as well as a long term savings component. At no time during this sales presentation did Respondent explain to employees of Mega that he was a licensed life insurance agent. During the course of his presentation, Respondent described USSTM's product variously as an "insurance saving plan", as an "investment in insurance companies" and as a "retirement savings plan". At no time during the presentation did Respondent specifically state that he was selling life insurance. At the conclusion of the presentation, Respondent enrolled all interested employees in USSTM's plan. During the enrollment procedure, Respondent told the employees to complete portions of at least three documents which included a form entitled "Employee History", a Wisconsin's life insurance application, and an employee payroll deduction authorization. Cantonis enrolled through the above procedure and signed a blank Wisconsin National Life Insurance application. Subsequent to the group sales presentation, Respondent made a similar presentation to Tina Netherton, Mega's office manager, who was working in the office and answering the telephone. At the conclusion of the presentation to Netherton, she enrolled in the plan and also signed a blank Wisconsin National Life Insurance application pursuant to instructions from Respondent. Both Netherton and Cantonis believed that the "savings plan" consisted of both a short term "liquid cash element and a long term investment". Neither were aware that they had purchased life insurance. Both Netherton and Cantonis had, in their opinion, adequate life insurance at the time of Respondent's sales presentation, and would not have purchased additional life insurance if they had been told (by Respondent) that they were purchasing life insurance. Both Netherton and Cantonis executed beneficiary designations on their belief that such was needed so that disbursements, if any, could be made to their designee in the event of their death. Approximately three weeks after enrollment, Netherton and Cantonis received brochures from USSTM which acknowledged their enrollment and detailed the benefits of the "savings plan". The brochure advised that Netherton and Cantonis had enrolled in an insurance "savings plan" and failed to state that they had purchased life insurance. Cantonis and Netherton attempted to withdraw funds from the liquid portion of the plan and were unable to do so. Four to five months after their enrollment, Cantonis and Netherton received life insurance policies from Wisconsin. Pursuant to the insurance applications, Cantonis and Netherton were issued Wisconsin life insurance policy numbers L00566485 and L00566483, respectively. Cantonis and Netherton maintained their Wisconsin policies in order to realize some gain from their overall loss in dealing with Respondent and USSTM. At the time that Respondent made his presentation to Mega's employees and officials, he had never before made sales presentations in order to enroll employees in plans offered by USSTM. Respondent's general manager, Vincent Radcliff, was the agent of record of Wisconsin. The insurance application and policies issued to Cantonis and Netherton were signed by an agent other than Respondent. Respondent's supervisor, Vincent A. Radcliff, III, was disciplined by Petitioner and Respondent cooperated with the Petitioner in investigating the complaint allegations filed against his supervisor, Radcliff. Respondent was first licensed by Petitioner on November 15, 1989. Respondent has not been the subject of any prior disciplinary actions by Petitioner.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that: Petitioner enter a Final Order suspending Respondent's life and health insurance licenses for a period of three (3) months. It is further RECOMMENDED that Petitioner order that Respondent engage in continuing education respecting the manner and means of soliciting on behalf of insurance companies, and to the extent that he completes the required courses within an acceptable time frame, that the suspension be suspended pending the outcome of Respondent's satisfactory completion of such continuing education courses. 1/ RECOMMENDED this 1st day of July, 1994, in Tallahassee, Leon County, Florida. JAMES E. BRADWELL Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of July, 1994.
The Issue Whether as a matter of fact Petitioner enrolled in an employer-sponsored health care benefits plan within 60 days of her full-time employment with the Department of Revenue? If not, whether a problem with the online registration system resulted in Petitioner not being timely enrolled in a health care benefits plan? The resolution of these two issues will result in a determination of the ultimate issue: whether Petitioner is entitled to enrollment in an employer-sponsored health care benefits plan for the 2015 Plan Year.
Findings Of Fact Petitioner, Her New Hire Date, and the 60-Day Window Petitioner, Denise Morrow, is currently a full-time employee (FTE) of the Florida Department of Revenue. Since childhood, she has been enrolled in a federally supported specialized health insurance program. Full-time employment may jeopardize the specialized health insurance coverage, and, at the hearing, Petitioner alluded to an ongoing investigation that could lead to its loss. It may be inferred from Petitioner's testimony that whatever the outcome of an investigation, her specialized health insurance coverage had not yet been discontinued as of the time of hearing because of her FTE status with the Department of Revenue. Sometime between November 14 and November 17, 2014,1/ Petitioner was hired as a computer programmer analyst with the Department of Revenue in FTE capacity. A new hire benefits package was sent to Petitioner on November 19, 2014. Petitioner received it. Prior to the hire, Petitioner had been a part-time OPS employee with Florida State University (the "University"). In her OPS capacity, she was not allowed to work 30 hours or more in any week. Were she to do so, Petitioner believed it could lead to her being considered entitled to FTE health insurance benefits and would threaten her specialized health insurance coverage. Consequently, Petitioner's work weeks at the University were 29 hours and a fraction of a 30th hour at most. Petitioner's employment at the University overlapped her FTE employment with the Department of Revenue until February 14, 2015. During the time of the overlap, from mid-November 2014 through February 14, 2015, Petitioner had two active People First ID numbers. From the moment of hire, Petitioner had 60 days (the 60-Day Window) in which to enroll in the employee health insurance program. The 60-Day Window lasted until January 13, 2015, if she was hired on November 14, 2014, and until January 16, 2015, if she was hired on November 17, 2014. If Petitioner did not enroll in an employee health insurance program within the 60-Day Window then, absent a QSC after her hire, Petitioner lost the ability to obtain employee health insurance benefits until the next open enrollment program from October 19 through November 6, 2015. Should she enroll in an employee health insurance program in the October/November 2015 open enrollment period, the enrollment would be effective on January 1, 2016. The records of DSGI do not show that Petitioner enrolled in the employee health insurance program during the 60-Day Window. Unless a QSC subsequent to hire occurs, if Petitioner's Level II appeal is not granted, she will not be eligible to receive benefits from the employee health insurance program until January 1, 2016, and only then if she enrolls during the 2015 open enrollment period. Petitioner contends she enrolled in the employee health insurance program in late November 2014 and that if DSGI records do not show enrollment, it must be due to computer error. At stake in this proceeding is whether Petitioner will receive any employee health insurance benefits for the entirety of the period of her FTE employment with the Department of Revenue from November 2014 through December 31, 2015. Online Administration Employee health insurance benefits are administered by a private contractor, Northgate Arinso, through an online system called "People First." An employee who applies for enrollment can use the online system and can call People First to assist in the process. If an employee has difficulties with the online system, People First will assist with enrollment by telephone and will make the computer entries into the system on the employer's behalf. Petitioner's 60-Day Window was close in time to the 2014 open enrollment period, but it was outside the period; the 60-Day Window commenced after open enrollment had closed. When an employee is eligible for benefits, an overlay is placed on the employee's home page on the People First online system. The overlay requests that the employee complete an address verification process and a dependent certification process prior to health insurance enrollment. Once the processes for address verification and dependent certification are completed, a message that thanks the employee appears on the computer screen. The "thank you" message clears the way for the employee to either commence with enrollment by clicking an "Enroll Now" box or defer the opportunity to enroll by clicking in an "Enroll Later" box, which closes the program. If an employee defers and decides later to enroll, access to the enrollment pages can be gained on the employee's People First home page. The employee can use a drop down box entitled "Health & Insurance" with the subheading, "Change My Benefits." Or, if there has been a QSC event, the employee can use the "Health & Insurance" home page with an icon denominated "Change My Benefits" icon to make changes. The enrollment process requires an employee to select a health plan, agree to the premium amount to be collected from paychecks, and certify that the information entered is true and correct. The final step in enrollment has two parts: entry of the employee's People First password and clicking the "Complete Enrollment" box. So long as the employee has entered all the required information, clicking on the "Complete Enrollment" box finalizes the enrollment. Upon completion of enrollment, a benefits confirmation document is generated. An employee can print the document immediately for record keeping. Additionally, the benefits confirmation statement is mailed by People First to the employee's address of record supplied through the address verification entered by the employee. A record of the mailing of the confirmation of benefits document is maintained by People First as part of its business records in a correspondence history for the individual employee. The completion of enrollment is reflected also in an audit of the moments the employee gains access to the People First online system. The audit is not ordinarily available; it must be requested. Any telephone contact with an employee is maintained through a log of call notes. Online Activity and the 30-Day Reminder Letter An audit of Petitioner's activity in the People First online system under both of her People First ID numbers shows that Petitioner entered the "Change My Benefits" screen 20 times during the 60-Day Window. She entered the "Change My Benefits" screen twice on November 19, 2014. The following day, November 20, 2014, she again entered the "Change My Benefits" screen twice. Her online activity on November 20, 2014, included completion of the address verification process used to ensure receipt of communications from People First, insurance companies, and her employer, the Department of Revenue. The address verification "thank you" from People First is noted in the People First correspondence log for Petitioner kept at the Department of Revenue. Petitioner did not begin enrollment in health insurance benefits on November 20, 2014. In order to leave the system with the intent of foregoing enrollment at that time and deferring until later, she was required to click the "Enroll Later" box and close the program after the address verification was completed. The audit does not show that Petitioner commenced the enrollment process on or before November 20, 2014. (Petitioner's testimony is consistent on this point. She testified that she did not enroll when she accessed the online system several times prior to when she claims she eventually enrolled, some unspecified date in late November 2014.) Petitioner gained access to the "Change My Benefits" screen twice on November 21, 2014, and twice on November 24, 2014. The entry onto the screen twice in each of the four days in November (November 19, 20, 21, and 24) that the audit shows Petitioner visited the "Change My Benefits" page is consistent with her testimony that she toggled between her University People First screen and her Department of Revenue People First screen each time she entered the "Change My Benefits" screen. Petitioner testified that she completed enrollment in an employee health benefits plan on a date she could not recall in late November 2014. (The date, presumably, would be November 21 or 24, the two dates she accessed the "Change My Benefits" page in November after her first two visits to the page.) Failure to recall the date is understandable given the number of times she accessed the page over the six-day period from November 19 through November 24. But, in addition to not remembering the date, Petitioner could not recall the plan that she selected. She testified that under the listings of plans by each company there were numerous plans from which to choose and she could not remember the exact plan that she selected. While this failure to recall (whatever the plan's complexities) is of more concern than failure to recall the date, her testimony contained a greater failure of recall. She did not remember the company that she selected either. A 30-day reminder letter is sent out by People First to employees who have not confirmed benefit selections within the first 30 days of eligibility. The People First correspondence history shows a 30-day reminder letter was created for Petitioner on December 17, 2014, and was sent to her on December 18, 2014. Petitioner confirmed that she received the 30-day reminder letter. The form reminder letter begins with a sentence in bold that reads, "Time to choose your state insurance benefits is running out!" Respondent's Ex. 3. The letter goes on to declare the recipient eligible for insurance benefits through the State Group Insurance Program, to provide details about when and how to enroll on the website, to give online site information of where detailed information may be obtained to make educated decisions, and to refer to enclosed documents about other benefits information. The closing of the letter states, "Finally, if you have any questions about how to enroll, make payments or use People First, please give us a call at (866) 663-4735. TTY users call (866) 221-0268. We are open Monday through Friday, from 8:00 a.m. to 6:00 p.m. Eastern Time." Id. Petitioner did not present any evidence that she attempted to reach People First at the telephone number provided in the 30-day reminder letter during the 60-Day Window. Nor did she present any evidence that she attempted to get assistance from People First in any other manner or from the Department of Revenue personnel office or its human resource officer during the time period critical to enrollment. But she was concerned, she alleged, about the status of her enrollment after the time she claimed to have completed enrollment–-late in November. Petitioner testified her efforts to ensure enrollment were by continued access to the "Change My Benefits" page. Whatever the purpose, the audit confirms more visits by Petitioner to the page. It reveals 12 post-November 2014 visits: twice on December 1, 2014; twice on December 2, 2014; twice on December 3, 2014; twice on December 4, 2014; twice on January 5, 2015; and twice on January 12, 2015. Other than the 12 visits to the "Change My Benefits" page in December 2014 and January 2015, four of which occurred after receipt of the 30-day reminder letter, Petitioner took no action to verify that she had been enrolled in a health plan until more than two weeks after the 60-Day Window had expired. On February 3, 2015, Petitioner contacted People First about her enrollment status. When Petitioner was informed that she was not enrolled, she began the appeal process which ultimately was elevated to a Level II appeal before DSGI. DSGI Action Respondent denied Petitioner's Level II appeal for enrollment outside of the 60-Day Window because she had not had a QSC event subsequent to hire and because there was no information or record in the People First online system to support Petitioner's assertion that she had completed enrollment. The records do not contain the identity of a plan in which she sought enrollment. The records do not contain a benefits confirmation statement. The audit demonstrates that "Change My Benefits" was viewed by Petitioner, but never changed. Premiums were never taken from Petitioner's pay check. Petitioner claims that if the system does not show her to have enrolled, it is because there were flaws in the system or a malfunction that caused her enrollment to be lost. The People First online system is reviewed for possible computer malfunctions or errors every 15 days with corrections being made upon discovery. No errors were found in Petitioner's files during these routine reviews.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Management Services, Division of Group State Insurance, enter a final order denying Petitioner's request to enroll in the State Group Insurance Program and affirming its denial of her Level II appeal. DONE AND ENTERED this 16th day of October, 2015, in Tallahassee, Leon County, Florida. S DAVID M. MALONEY Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 16th day of October, 2015.
The Issue The issue presented for decision in this case is whether Petitioner’s claim of additional life insurance benefits should be paid or denied.
Findings Of Fact The State of Florida Group Insurance Program (the Program) is a benefit available to State of Florida officers, employees, and retirees. The Division of State Group Insurance (DSGI) is an administrative unit located within the Department of Management Services. The life insurance policy at issue in these proceedings is part of the Program which is administered by DSGI. At the time of his retirement, March 1, 1998, William King and his wife resided at 4159 Stratford Way, Jacksonville, Florida 32225 (the Stratford address.) Mr. and Mrs. King moved from the Stratford address in May 1999 to 12830 Muirfield Boulevard N., Jacksonville, Florida 32225 (the Muirfield address.) Mr. King died on September 25, 2010. At the time of his death, Mr. King was a retired state employee with life insurance coverage through the Program. At the time of his death, Mr. King resided at the Muirfield address. Mary H. King is the widow of William King, and the named beneficiary to Mr. King's life insurance policy provided through the Program. DMS has contracted with Northgate Arinso (Northgate), formerly Convergys, Inc., to provide human resources management services, including assisting in the administration of employee benefits. Northgate primarily performs these tasks through an on-line system known as "People First." People First became the system of record for DSGI benefits data, including addresses, on January 1, 2005. Prior to that, the system of record for DSGI was the COPES system. However, People First does not administer the State of Florida retirement pension program. Prior to January 1, 2000, life insurance coverage for retirees was $1,500, with a premium of $4.20 per month. Effective January 1, 2000, the coverage for retirees was increased to $10,000, and the premium continued to be $4.20 per month. The Open Enrollment Guide for Plan Year 2000 notified all current life insurance plan participants that they must re- enroll for the life insurance program, and that failure to do so would result in those retirees no longer receiving life insurance benefits. Because the retirees' response to the 1999 Open Enrollment was poor, DSGI developed a letter dated November 10, 1999, to provide the retirees another chance to enroll, as opposed to their losing life insurance coverage as of January 1, 2000, due to lack of response. By letter dated November 10, 1999, DSGI sent a letter to Mr. King notifying him of the above-referenced increase in retiree life insurance coverage from $1,500 to $10,000 effective January 1, 2000. The November 10, 1999 letter informed retirees that they had to complete a new enrollment form in order to continue retiree group life insurance coverage. This November 10, 1999 letter was addressed to the Muirfield address. In this effort to get a better response to the reenrollment requirement, DSGI created a file with names and social security numbers and provided that to the Division of Retirement (DOR). DOR then provided DSGI with a disk containing the addresses for those persons from the DOR database. The November 10, 1999 letter, including the one sent to Mr. King, used the addresses furnished by DOR. Although the DOR address database was used to mail the letter dated November 10, 1999, no change was made to the DSGI database (which, at that time, was COPES), for those retirees whose addresses were different in the DOR database. Later mailings by DSGI were to the addresses of record in the DSGI/COPES system. A change of address notification card dated August 10, 1999, regarding Mr. King's change of address from the Stratford address to the Muirfield address is in evidence. It is not clear from the face of the change of address form as to whether this was sent to DSGI or to DOR. Two months later, DSGI sent another letter to retirees informing them that they were enrolled in the life insurance plan but required them to submit an enclosed form to indicate a decision either to decline the coverage or to provide beneficiary coverage. This letter was dated January 12, 2000, and was mailed to the Stratford address, Mr. King's former address. Several of Mr. King's State of Florida Statements of Retirement Benefit Payments are in evidence and reflect that the payment of $4.20 was regularly deducted from Mr. King's monthly retirement benefit for State life insurance, including the monthly statement dated January 31, 2000. The monthly retirement benefits statements were mailed to the Muirfield address by DOR. Sandi Wade is a benefits administrator for DSGI. According to Ms. Wade, the cost of retiree life insurance was supplemented in the past with funds from a trust account, thereby reducing the premium charged to retirees. In 2006, DSGI determined that the funds used to augment the retirees' benefits from years 2000 through 2007 would be depleted after 2007. DSGI then determined that the current life insurance premium of $4.20 would support a benefit of $2,500, and that the premium to continue $10,000 of life insurance coverage would be $35.79 per month. This resulted in a change in the life insurance options available to retired employees. By letter dated July 31, 2006, DSGI informed retired state employees of this change in a letter which read in pertinent part: Dear Retiree: RE: State of Florida Life Insurance * * * The upcoming annual open enrollment period will provide you with three (3) options regarding your life insurance coverage. You should carefully examine all options and the information provided in your Open Enrollment packet, which will be mailed prior to Open Enrollment, to decide which choice best suits your unique circumstances. Effective January 1, 2007, the three (3) life insurance options available will be: A $2,500 benefit for a monthly premium of $4.20 A $10,000 benefit for a monthly premium of $35.79 Terminate life insurance coverage (precludes participants from re-enrolling for the product in the future.) Consistent with our practice in previous years, should you not participate in the Open Enrollment process, or make no change to your life insurance election, you will continue to be enrolled with retiree life insurance coverage. Your default election will be the $2,500 benefit, with its associated premium. If there is a desire to modify your open enrollment life insurance election, requests for changes to your life insurance coverage enrollment will be accepted through Friday, January 19, 2007. * * * This notice in advance of open enrollment is being provided in order that you will have additional time to consider all options available to you. Life insurance choices are important decisions. Mike Waller, an employee of DSGI, maintains benefits data for People First/DSGI. In July 2006, Mr. Waller was asked to prepare a file containing the names and mailing addresses of all retirees who were covered by life insurance. He created a file used in a mail merge to send all retirees a copy of the July 31, 2006 letter. In preparing the file containing the mailing addresses of retirees covered by life insurance in July 2006, Mr. Waller used the addresses of record from the benefits data he maintained. In July 2006, the address of record in the DSGI database for Mr. King was the Stratford address, and was included in the mailing addresses file. Mr. Waller prepared the file and on July 3, 2006, delivered it to Dick Barnum and Thomas Lockridge. Thomas Lockridge delivered the file to Laura Cutchen, another employee of DSGI. DSGI contracted with Pitney Bowes to mail the July 31, 2006 letter to 29,392 retired state employees. After obtaining copies of the letter from the print shop of DSGI, Ms. Cutchen delivered the letters and the file containing names and addresses of retirees to Pitney Bowes to assemble. Pitney Bowes provided the envelopes, assembled the letters (inserting them in each of the 29,392 envelopes), and addressed the letters by ink jet. The letters were delivered to the U.S. Post Office, accompanied by Ms. Cutchen. The State of Florida first class mailing permit had been applied to each envelope. The July 31, 2006 letter was mailed to Mr. King at the Stratford address. The return address on the envelope containing the July 31, 2006 letter was DSGI, 4050 Esplanade Way, Suite 215, Tallahassee, Florida 32399-0949. Janice Lowe is employed by DSGI and has been for over 32 years. Her duties include assisting retirees with insurance issues. According to Ms. Lowe, DSGI received numerous returned letters as undeliverable. These undeliverable letters were processed by Ms. Lowe. If the returned envelope showed a different address on a yellow sticker applied by the U.S. Postal Service, the letter was re-mailed to that address. However, if the returned envelope did not provide a different address, DSGI accessed the DOR database to determine whether there was another address for the retiree to whom the returned letter was addressed. Each time a name was accessed on the DOR system, DSGI printed that Retirement Benefit Information screen showing the address in the DOR database. If the address in the DOR database was different from the address in the DSGI database, the original envelope and letter were placed in another envelope and mailed to the retiree at the address from the DOR database. A copy of each retirement print screen that was accessed by Ms. Lowe was printed and inserted alphabetically into binders. The presence of a DOR print screen indicates that the initial letter was returned as undeliverable and processed as described above. From each retirement screen that was accessed, Ms. Lowe typed the name of the retiree and DOR address in a format used for address labels. Once she had typed a full page of names and addresses, she printed those onto mailing labels and put the new labels on envelopes. She then placed the July 31, 2006 letter and original envelope that had been returned into the new envelope bearing the newly created address label. There is a DOR print screen for Mr. King, thereby indicating that the letter to him dated July 31, 2006, and mailed to the Stratford address, had been returned to DSGI, and was processed as described above. Ms. Lowe re-mailed the July 31, 2006 letter to Mr. King at the Muirfield address on or about October 13, 2006. A copy of the address label used to mail this to Mr. King is in evidence. This label reflects the Muirfield address. The letters mailed by Ms. Lowe were mailed first class. The return address printed on the envelopes was the State of Florida, Division of State Group Insurance, P.O. Box 5450, Tallahassee, Florida 32314-5450. When one of the letters as prepared and mailed by Ms. Lowe was returned to DSGI, Ms. Lowe stapled the letter to the DOR print screen for that retiree. The retirement print screen that Ms. Lowe printed for Ms. King does not contain a letter that was returned, indicating that the envelope with the Muirfield address, mailed in October 2006, was not returned to DSGI as undeliverable. Although Ms. Lowe re-mailed the letter using the Muirfield address, she did not change Mr. King's address in the DSGI database, and does not have access that would allow her to do so. Prior to Convergys assuming responsibility for the administration of benefits, DSGI maintained benefits information in the COPES system. When Convergys assumed responsibility for the management of benefits on January 1, 2005, the benefits information from COPES was imported into the Convergys/People First system. For reasons that are not entirely clear, People First and DOR do not share databases and each maintains its own database of names and addresses. This results in two divisions (DSGI and DOR) of the same state agency (DMS) using different databases. Each year, DSGI holds an open enrollment period as required by section 110.123(3)(h)5., Florida Statutes. Open enrollment is that period of time once a year, as identified by DSGI, during which participants in the state group insurance programs, including retirees, may change, add, or cancel participation in the insurance plans offered. Prior to open enrollment, DSGI mails to each employee and retiree participating in the state group insurance program a package that explains the benefits and options that are available for the next year. There is a copy of correspondence from DSGI addressed to Mr. King regarding open enrollment for 2001. This correspondence was mailed to Mr. King at the newer Muirfield address. It states in part, "The Annual Enrollment Period begins on September 11, 2000 and ends on October 11, 2000." This correspondence contained a copy of a return postcard addressed to DSGI and also contained the statement "Detach this postcard and mail to DSGI by 9-22-00 to obtain the desired information." It is unclear from the record how the Muirfield address was used at this point in time when the DSGI database still reflected the Stratford address for Mr. King. DSGI maintains that its database reflected that the DSGI address of record for Mr. King was the Stratford address until February 8, 2011, after the death of Mr. King. The 2006 Open Enrollment period for the 2007 plan year ran from September 19, 2006, through October 18, 2006. During Open Enrollment for Plan Year 2007, the People First Service Center was charged with the responsibility of sending open enrollment packages to State of Florida employees and retirees. The Open Enrollment packages for Plan Year 2007 were mailed by People First using the U.S. Postal Service. People First mailed Mr. King's Open Enrollment 2007 package on September 3, 2006, to the older Stratford address. The Open Enrollment package mailed to Mr. King on September 3, 2006, contained Mr. King's 2007 Benefits Statement; a letter from John Mathews, former Director of DSGI; Information of Note; a Privacy Notice; and the 2007 Benefits Guide. The 2006 Open Enrollment package for year 2007 also included a document entitled, "State Group Insurance Program- Information of Note" which reads in pertinent part: RETIREE LIFE INSURANCE For Plan Year 2007, those currently enrolled with retiree life insurance may elect to retain the current $4.20 premium for a benefit of $2,500, retain the current benefit of $10,000 for a premium of $35.79, or cancel coverage. If no change is made during open enrollment, participation will continue at the $4.20 premium level. Prior to the benefits change effective January 1, 2007, Mr. King paid a monthly premium of $4.20 for $10,000 in life insurance coverage. This amount was deducted from his retirement benefit monthly payment. This amount continued to be deducted from his retirement benefits following the change in January 2007 until December 2007 when the amount deducted increased to $7.41. In any event, no election to pay the increased premium of $35.79 was received by DSGI for Mr. King. This is not surprising since Mr. King did not receive the Open Enrollment package informing him of the right to make this election as it was mailed to the Stratford address. For those retirees who did not make a timely election pursuant to the Open Enrollment notice sent in 2006 for Plan Year 2007, the death benefit automatically became $2,500, effective January 1, 2007, for the monthly premium of $4.20. Throughout the years, the Benefits Guides and newsletters sent from DSGI have informed program participants of their responsibility to maintain current addresses with DSGI, including reminders to notify both DOR and DSGI in writing if there was an address change. Neither DGSI nor DOR notifies the other of receipt of address change. A change of address of one division of DMS does not automatically change the address in another as the two divisions have separate databases. While it is beyond the scope of this proceeding to evaluate the fact that these two divisions of the same state agency do not share databases, it is noted that DOR serves a larger population of persons. That is, the database of the DOR consists of all retirees that participate in the Florida Retirement System, including retirees of various local government agencies and educational entities. Deductions were made monthly for state life insurance premiums until Mr. King's death in September 2010. No evidence demonstrated that Mr. King informed DSGI in any way that he desired to maintain his $10,000 life insurance benefit.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Department of Management Services enter a Final Order denying Petitioner's request for an increase in life insurance benefits. DONE AND ENTERED this 4th day of October, 2011, in Tallahassee, Leon County, Florida. S BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 4th day of October, 2011. COPIES FURNISHED: Sonja P. Mathews, Esquire Department of Management Services Office of the General Counsel 4050 Esplanade Way, Suite 160 Tallahassee, Florida 32399 James C. Cumbie, Esquire The Cumbie Law Firm, P.A. Post Office Box 40066 Jacksonville, Florida 32203 Jason Dimitris, General Counsel Department of Management Services 4050 Esplanade Way, Suite 160 Tallahassee, Florida 32399-0950
