SECTION 260:40-17-3. Employee election of benefit plans

(a)   Choices of benefit plans shall be made by a new eligible employee within thirty (30) days after date of employment. This thirty (30) day period shall be known as the employee's enrollment period. Each new employee failing to make such a valid election will be deemed to have elected employee-only coverage under the HealthChoice High Option Health Plan, HealthChoice Dental Plan, HealthChoice basic term life policy, and the HealthChoice disability plan.

(b)   Choices of benefit plans shall be made on a Plan Year basis by the eligible employees during the enrollment period as set by the Plan Administrator. The Plan Administrator will establish eligibility requirements for all benefit plan options each year.

(c)   Eligible employees are required to elect medical, dental, life and disability plans except as provided in the following paragraphs. Employees who fail to make a valid election during each designated enrollment period will be deemed to have elected the same plans elected during the most recent enrollment period during which a valid election was made. Where the plan(s) will no longer be available for the upcoming Plan Year, employees will be deemed to have elected HealthChoice High Option Health Plan and/or HealthChoice Dental.

(d)   A former employee who is reemployed by the same participating employer within twenty-four (24) months after the date of termination of previous employment shall not be enrolled for a greater amount of life insurance than the individual had at the time of termination of previous employment with the employer, unless the individual provides satisfactory evidence of insurability. The amount of coverage provided by the employer is specified in the benefit administration procedures or guidelines as adopted by the Plan. In the event of death, the proceeds of this coverage are payable to the beneficiary listed on the most recently signed beneficiary designation subject to the limitations in Title 15. [15 O.S. §178] If no beneficiary form is on file at the EGID, benefits will be paid to the decedent's estate.

(e)   A former active State employee who is reemployed by the State after thirty (30) days from termination will not be eligible to reenroll in vision plans, Health Care Reimbursement Accounts and Dependent Care Reimbursement Accounts throughout the remainder of the current Plan Year unless the employee maintained the Health Care Reimbursement Account under the COBRA provisions.

(1)   An eligible employee who has retired from a branch of the United States military and has been provided with health coverage through a federal plan can elect not to participate in the Flexible Benefits Plan if the following conditions are met prior to the close of each annual enrollment period:

(A)   The employee must provide proof that he or she is retired from a branch of the United States military; and

(B)   The employee must provide proof of health coverage through a federal plan; and

(C)   The employee must make a proper election not to participate in the Flexible Benefits Plan.

(2)   The EBD has the authority to determine the type of information that satisfies the requirements of this subsection.

(3)   An eligible employee making an election not to participate under paragraph (1) of this subsection must make such an election each Plan Year.

(A)   An employee who is eligible to make an election not to participate under paragraph (1) of this subsection and has never previously made an election not to participate under paragraph (1) of this subsection, may, during the enrollment period, enroll in the Flexible Benefits Plan or may make an election not to participate under paragraph (1) of this subsection. If the employee who is eligible to, but has never previously made an election not to participate under paragraph (1) of this subsection, fails to enroll in the Flexible Benefits Plan and fails to make an election not to participate under paragraph (1) of this subsection, the employee will be deemed to have elected coverage that was in effect during the previous Plan Year. Where the plan(s) will no longer be available for the upcoming Plan Year, employees will be deemed to have elected HealthChoice High Option Health Plan and/or HealthChoice Dental.

(B)   An employee who is eligible to make an election not to participate under paragraph (1) of this subsection, and has previously made an election not to participate under paragraph (1) of this subsection, may, during the enrollment period, enroll in the Flexible Benefits Plan, or may make an election not to participate under paragraph (1) of this subsection. If an employee who has previously made an election not to participate under paragraph (1) of this subsection fails to enroll in the Flexible Benefits Plan and fails to make an election not to participate under paragraph (1) of this subsection during the annual enrollment period, the employee will be deemed to have elected employee-only coverage under the HealthChoice High Option Health Plan, the HealthChoice Dental Plan, the HealthChoice basic term life policy, and the HealthChoice Disability Plan.

(4)   Except as provided by the applicable provisions of OAC 260:40-17-4, an eligible employee making an election not to participate under paragraph (1) of this subsection is prohibited from participating in any health plan, dental plan, life plan, supplemental life plan, dependent life plan, and disability plan at any time during the Plan Year for which he or she made the election. Upon re-entry into the state benefits package either through an acceptable midyear event or at the annual Option Period enrollment, benefit options which were declined through the opt-out election by retired military state employees will not automatically be reinstated. The retired military employee must reapply for and be approved through satisfactory evidence of coverage (EOI) before any amounts of Supplemental Life Insurance will again be issued. Only the Basic Life amount (20,000) will be automatically reinstated upon such re-entry. No Guaranteed Issue levels of Supplemental Life will be available.

(5)   Except as provided by the applicable provisions of OAC 260:40-17-4, an eligible employee making an election not to participate under paragraph (1) of this subsection is prohibited from electing coverage for his or her dependents under any health plan, dental plan, life plan, supplemental life plan, dependent life plan, and disability plan prior to or at any time during the Plan Year for which he or she made the election.

(6)   An eligible employee making an election not to participate under paragraph (1) of this section may continue participation in any of the following:

(A)   Benefit plans available under the flexible benefit plan other than a health plan, dental plan, life plan, supplemental life plan, dependent life plan, and a disability plan;

(B)   Health Care Reimbursement Account Option;

(C)   Dependent Care Reimbursement Account Option; and the

(D)   Insurance Premium Conversion Option.

(f)   Each employee who meets the eligibility requirements but fails to make a proper election under the Flexible Benefits Plan shall be deemed a participant in the Flexible Benefits Plan.

(g)   Coverage shall be effective for a new participant beginning on the first day of the month following the participant's first day in an active pay status.

(h)   Eligible employees may elect to cover a dependent under the following insurance plans: health insurance, dental insurance, dependent life insurance, or vision insurance. When one eligible dependent is covered, all eligible dependents must be covered for all plans except the dependent life insurance plan. An eligible employee cannot be enrolled as a principal insured and also as a dependent for any benefit options except dependent life.

(i)   Primary participants electing coverage for eligible dependents cannot enroll the dependents in a benefit plan or a coverage that differs from the benefit plan or coverage chosen by the primary participant.

(j)   In order for an eligible employees to choose health plan coverage under a Health Maintenance Organization (HMO) plan, the eligible employee must reside or be employed within the selected HMO's service area.

[Source: Added at 31 Ok Reg 1358, eff 9-12-14]