Guide For Group Administration - Florida Blue
Guide for GroupAdministrationHelpful information forcoordinating employeehealth care benefits
Table of ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1HIPAA-AS Privacy Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Completing Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Eligibility Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Enrollment Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Coordination of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Miscellaneous Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Time-Saving Health Resources . . . . . . . . . . . . . . . . . . . . . . . . . .20Time-Saving Benefit Administrator Resources . . . . . . . . . . . . .21The BlueCard Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Termination of an Individual’s Coverage . . . . . . . . . . . . . . . . .23Continuation of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Premium Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Contact InformationFlorida Blue Website Address:FloridaBlue.comMembership & Billing: ATTN: Membership & BillingFlorida BlueP.O. Box 44144Jacksonville, FL 32231-4144Premium Payments:Florida BlueP.O. Box 660299Dallas, TX 75266-0299Express Mail Deliveries: ATTN: Corporate Cash ReceiptsFlorida Blue4800 Deerwood Campus Parkway DCC1-3Jacksonville, FL 32246-6498Refer to Florida Blue/Florida Blue HMOmember ID card for the appropriatecustomer service telephone number.ii
IntroductionThis guide explains Eligibility and Membership,Employee Changes, Applications and thePayment Remittance process. Your Sales/ServiceRepresentative, Agent or your Service Advocate canreview any instructions with you.Thank you for selecting Florida Blue and/or FloridaBlue HMO for your health care Coverage needs. Thisguide contains information to help you administer yourgroup health care Coverage program.When you see the words “we” or “us” appearing inthis guide, they refer to Florida Blue or Florida BlueHMO. The words “you” or “your” refer to the GroupAdministrator or the individual who has been assignedthe duties of group administration. Other terms youwill see used in this guide are:This employer guide may be used for any small group(1-50) or large group (51 ) health care product soldby Florida Blue/Florida Blue HMO which includes:any Health Maintenance Organization (HMO) BlueCare products; Preferred Provider Organization(PPO) - BlueChoice and BlueOptions; PPO andExclusive Provider Organization (EPO) - BlueSelectand BlueOptions (Small Group only). C overed Employeethis means an eligible employee who meetsand continues to meet all applicable eligibilityrequirements and who is enrolled and actuallycovered under the Group Master Policy (withFlorida Blue/Florida Blue HMO) other than as aCovered Dependent.Sometimes Florida Blue HMO’s procedures vary fromFlorida Blue’s procedures. For this reason, this guidemay contain different instructions for different productofferings. Where instructions vary, the guide willexplain which product the instructions apply to. Covered Dependentthis means an eligible dependent who meetsand continues to meet all applicable eligibilityrequirements and who is enrolled and actuallycovered under the Group Master Policy (withFlorida Blue/Florida Blue HMO) other than as aCovered Employee. Group Master Policy(Group Plan/Group Contract)this means the written document and any applicableapplication forms, schedules and endorsementswhich are evidence of, and are, the entire agreementbetween the group and Florida Blue/Florida BlueHMO whereby Coverage and/or benefits will beprovided to Covered Employees and CoveredDependents.Note: This guide does not replace or override the information contained within the Group Master Policy. This guide does not cover informationabout ancillary products such as life, dental, long-term care or vision insurance Coverage.In order for a Florida Blue Representative to talk to, give information to, or accept information from a group, the Group Administrator’s name (orBenefit Administrator – BA) must be on file with Florida Blue. If there is a change in a BA or you need to add a BA’s name, please submit a letter(on letterhead, signed by the Decision Maker) to your Service Advocate. If there is a change in Decision Maker, please contact your Florida BlueSales Representative. If you or your employees have questions other than enrollment issues, please contact Florida Blue’s customer service.1
HIPAA-AS PrivacyComplianceIf you are a self-funded group health plan and/orcreate or receive PHI other than as the law permitsfor enrollment/disenrollment and summary levelinformation, you may have additional responsibilitiesin order to meet HIPAA-AS requirements. A selffunded group health plan may delegate some ofits requirements to a third party like Florida Blue orFlorida Blue HMO but cannot defer all the risk andis ultimately responsible for its own Privacy Rulecompliance. The sharing of PHI will depend on thecontractual arrangement that is in place betweenyour group and Florida Blue/Florida Blue HMO.The Privacy Rule of the Health Insurance Portabilityand Accountability Act-Administrative Simplification(“HIPAA-AS”) considers health plans as “coveredentities” that must comply with the Privacy Rule.Health Plans include health, dental, vision, andprescription drug insurers, health maintenanceorganizations (“HMOs”), Medicare, Medicaid,Medicare Advantage, Medicare Part D, Medicaresupplement insurers, and long-term care insurers.Health plans also include group health plans thatprovide or pay the cost of medical care. A grouphealth plan is established, by virtue of law, throughthe plan documents. As a group health plan, you maybe accountable for complying with the HIPAA-ASPrivacy Rule. The degree to which your group healthplan is subject to the law depends on whether youremployer provides health benefits solely through aninsurance contract with a health insurer issuer, such asFlorida Blue, or an HMO, such as Florida Blue HMO,and whether or not the employer group creates orreceives Protected Health Information (PHI) otherthan as allowed under the HIPAA-AS Privacy Rule.This information does not intend to dispense legaladvice. If you are uncertain how the Privacy Ruleapplies to your organization’s group health plan,please read the Privacy Rule and seek legal counselas necessary. If you would like more informationabout the Privacy Rule, you can obtain information athttp://www.hhs.gov/ocr/privacy/index.htmlIf you are a fully insured group health plan thatprovides health benefits through an insurance orHMO contract with Florida Blue or Florida BlueHMO and do not create or receive PHI other thanas permitted under the law, you may rely on yourrelationship with Florida Blue or Florida Blue HMO tomanage your Privacy Rule compliance requirements.The sharing of PHI between Florida Blue/FloridaBlue HMO and the group health plan is limited toenrollment/disenrollment information and summaryhealth information in order for you to obtain premiumbids for providing health Coverage through yourgroup health plan, or to modify, amend, or terminateyour group health plan. The Privacy Rule compliancerequirements that Florida Blue and Florida Blue HMOmay manage include, as an example, distribution of aPrivacy Notice, managing requests for a PHI address,access to records, amendment requests, handlingprivacy complaints, and, through our Privacy Office,applying Florida Blue’s policies and procedures to allmatters involving PHI that we administer for our fullyinsured group health plan customers.2
Completing FormsWhen an employee initially enrolls or makes changesto existing group health Coverage, the first step isto fill out the appropriate forms. There are severalforms you will need to keep on hand. Forms may beordered by contacting your local Florida Blue office.A list of pertinent forms follows. Unless otherwisenoted, these forms may be used for both Florida Blueor Florida Blue HMO products.Form Name1. Employee Enrollment Application22095 (Page 14)2. Employee Change Application22411 (Page 16)3. Important Information Regarding Your SpecialEnrollment Rights15741 (Page 17)4. Group Administrator Reorder Form8222 (Page 4)*Note: This reorder form is for individual formsonly. If you need to reorder Enrollment Packagesand Schedules of Benefits, etc., please contactyour Sales Representative.Please be advised forms are subject to change.Please verify with your Sales/Service Representative,Service Advocate or Agent regarding changes orupdates to the forms.Some forms may be obtained on our website atwww.FloridaBlue.com.3
Reorder FormGROUP ADMINISTRATOR REORDER FORMPlease use this Group Administrator Reorder form for ordering additional forms. (A listing offrequently used forms in on the previous page.)I. InstructionsA. Order forms 1 to 2 weeks before your current supply is depleted.B. Order a supply of forms that will last you 1 to 2 months.C. Identify the quantity and the type of forms that you need by completing section II below.The form number shown on the form(s) that are being requested must be written on thisreorder form.D. Compete section III below with the complete name, address, city, state and zip code ofthe company/facility that is to receive the form (s). Also, indicate the name of theperson who is to receive the forms(s).E. Return this reorder form to:ATTN: Materials ManagementFlorida BlueP.O. Box 1798Jacksonville, FL 32231-0014or FAX to: (904) 791-6993F. Who may we contact if we have a questions concerning your order?Name:Phone Number:II. Quantity Form #III. Ship forms to: (No P.O. Boxes Please)8222-0115 CC4
Eligibility InformationEligibility RequirementsTypes of CoverageEligibility is determined and effective dates areassigned upon completion of the eligibility waitingperiod. The Coverage Effective Date will be the1st or 15th (your bill date) of the following monthafter the employee completes the eligibility waitingperiod, unless otherwise specified in the GroupApplication. The Employee Enrollment Applicationmust be received within 30 days of the enrollmenteffective date.A Coverage code is assigned to each CoveredEmployee for the Coverage selected. Listed beloware the Coverage codes and a description for each:01 – Employee02 – Employee/Family03 – 2 Person (Employee and 1 dependent,either spouse/domestic partner or child)*04 – Employee/Child*06 – Employee/Children*07 – Employee/Spouse or Domestic Partner*If the application is received more than 30 days fromthe enrollment effective date, the employee mustwait to re-apply at the Annual Open Enrollment (ifapplicable) unless due to loss of coverage underHealthy Kids, Children’s Health Insurance Plan (CHIP),or Medicaid, in which case, the employee has 60 daysto re-apply or they may join the group plan if theyexperience a Special Enrollment event as defined bythe Health Insurance Portability and AccountabilityAct (HIPAA). The following are examples of SpecialEnrollment events:These Coverage codes are listed in the “CVG”category on your group invoice.* Only applicable if you have purchased this optionfor your group.1. Involuntary loss of Coverage due to:a. death;b. divorce;c. termination of employment;d. reduction of hours of employment; ore. Coverage termination as a result of terminationof employer contributions;2. marriage;3. birth of a child; and4. adoption or placement for adoption.Please see the Special Enrollment section of thisguide for further information.Note: If a part-time employee has moved to full-timestatus, a Employee Enrollment Application mustbe submitted, including the full-time date of hire.The employee must satisfy the appropriate waitingperiod, unless otherwise specified. 5
How Eligibility is DeterminedA Covered Dependent child may continue coveragebeyond the age of 26, provided he or she is:Covered Employee Eligibility1. Unmarried and does not have a dependent;To be eligible to enroll for Coverage under FloridaBlue or Florida Blue HMO, a person must:2. A Florida resident or a full-time or part-timestudent;1. be a bona fide employee of the Group;3. Not enrolled in any other health coverage policy orplan;2. have a job which falls within a job classification onthe Group Application;4. Not entitled to benefits under Title XVIII ofthe Social Security Act unless the child is ahandicapped dependent child.3. work for the Group at least the weekly number ofhours specified on the Group Application. Parttime, temporary or substitute employees are noteligible;This Coverage will terminate on the last day ofthe month in which the child no longer meets therequirements for eligibility.4. reside in, or be employed in, the service area(BlueCare and BlueSelect products only); andFlorida Blue:5. complete any applicable eligibility waiting periodspecified on the Group Application.Florida Blue’s standard eligibility criteria fordependents are defined as follows:Dependent Eligibility Dependents are covered through the end ofthe calendar year they reach age 30 with noqualifications or coverage restrictions. (Note: Oncea Foster Child is no longer in the “Foster ChildProgram” then he/she is not eligible for coverageunder the Foster Parent.)Federal Law:Health care reform legislation makes coverageavailable to adult children up to age 26 for plan yearsbeginning with a group’s renewal after September23, 2010, no dependent eligibility requirements canapply from newborn to 26. Large groups may have the flexibility to “opt out”and limit dependent coverage to the end of thecalendar year the dependent reaches age 26 withno qualifications or coverage restrictions.State Law:Requires that extended coverage for over ageddependents be offered to the policyholder (group)through the end of the calendar year in which theyreach age 30. No dependent eligibility requirementscan apply on newborns to age 26 (Federal law). Large groups may also elect to provide coverageto age 30, but apply Florida Statute dependenteligibility criteria to dependents between the agesof 27 – 30.Florida’s over age dependent mandate law requiresthat eligibility requirements for dependents betweenages 26 and 30 can only be equal to or less than therequirements stated in the law. Those dependenteligibility requirements are:Note: The term “child” includes the CoveredEmployee’s child(ren), newborn child(ren),stepchild(ren), legally adopted child(ren), or a childfor whom the Covered Employee has been courtappointed as legal guardian or legal custodian.* Ex-spouses are not eligible dependentseven if Coverage is court ordered.6
Dependents on Medical Leaveof AbsenceDependent Eligibility VerificationFlorida Blue/HOI conducts an annual review toverify Coverage for overage dependents. It isthe responsibility of the Group Administratorto terminate these dependents based on theircontractual agreement with Florida Blue. Thepurpose of this verification is to inform the Groupson dependents currently covered by parents orguardians who participate in their employer’s grouphealth plan. Proper maintenance of eligibility assuresthat the dependent will be terminated if no longereligible due to meeting the dependent eligibilityage limit; or continue to be covered under the grouphealth plan, if applicable.A Covered Dependent child who is a full-time orpart-time student at an accredited post-secondaryinstitution, who takes a Physician-certified MedicallyNecessary leave of absence from school, will still beconsidered a student for eligibility purposes underthe Group Master Policy for the earlier of 12 monthsfrom the first day of the leave of absence, or the datethe Covered Dependent would otherwise no longerbe eligible for coverage under this Contract.Retired EmployeesIf your group is not required by Florida law to provideCoverage for retired employees, you must terminatethose retiring employees from your group plan whenthey are no longer eligible for Coverage.Disability StatusFlorida Blue/ Florida Blue HMO will continueCoverage for a Covered Employee’s handicappeddependent child beyond the limiting age, as aCovered Dependent, if the child is eligible forCoverage under the Group Master Policy and isactually enrolled. The dependent child must beincapable of self-sustaining employment by reasonof intellectual disability or physical disability, and bechiefly dependent upon the Covered Employee forsupport and maintenance. The symptoms or causesof the child’s handicap must have existed prior to thechild reaching the limiting age of the Coverage. Thiseligibility shall terminate on the last day of the monthin which the child does not meet the requirementsfor extended eligibility as a handicapped child.Note: It is the Covered Employee’s sole responsibilityto establish that a handicapped child meets theapplicable requirements for eligibility.A physician’s letter, verifying this information, willneed to be mailed to DEV Processing, PO Box 44144,Jacksonville, Florida 32231-9879.7
Enrollment InformationNew EnrollmentEmployee EnrollmentPermanent, full-time employees, as defined byyour Group Master Policy, should complete theEmployee Enrollment Application on the first dayof employment. Applications should be submittedto Florida Blue/Florida Blue HMO at that time. Beadvised the employee’s Effective Date of Coveragewill be determined after the eligibility waiting periodhas been satisfied. Prompt submission will ensurethat your employees receive their ID cards by theireffective date.An individual who is an eligible employee on thegroup’s Effective Date must enroll during the InitialEnrollment Period, unless the employee declinesCoverage. The eligible employee shall become aCovered Employee as of the Effective Date of thegroup. Eligible dependents may also be enrolledduring the Initial Enrollment Period. The EffectiveDate of Coverage for an eligible dependent(s)shall be the same as the Covered Employee’seffective date.If an employee terminates employment prior tocompleting their eligibility waiting period notify us byphone, fax, in writing, or email and we will withdrawthat employee’s application. n individual who becomes an eligible employeeAafter the group’s Effective Date (for example, newlyhired employees) must enroll before or within theirInitial Enrollment Period. The Effective Date ofCoverage for such an individual will be determined inaccordance with the Group Application.Enrollment PeriodsThe enrollment periods for applying for Coverage areas follows:Dependent EnrollmentAn individual may be added upon becoming aneligible dependent of a Covered Employee. Initial Enrollment Period – the period of timeduring which an eligible employee or eligibledependent is first eligible to enroll. It starts onthe eligible employee’s or eligible dependent’sinitial date of eligibility and ends no less than30 days later.Note: Coverage changes should not be deductedfrom, or added to, the group invoice.For adoption, foster children, legal or temporaryguardianship or court order, proper courtdocumentation must be submitted. Notarizedstatements and powers of attorney are not valid. Annual Open Enrollment Period* – an annual30-day period occurring no less than 30 days priorto the group anniversary date, during which eacheligible employee is given an opportunity to selectCoverage from among the alternatives included inthe group’s health benefit program.Newborn Child – To enroll a newborn child who isan eligible dependent, the Covered Employee mustcomplete and submit to you an Employee ChangeApplication. The Effective Date of Coveragewill be the date of birth. You must forward theEmployee Change Application to Florida Blue/FloridaBlue HMO for processing. Special Enrollment Period – the 30-day period oftime immediately following a special event duringwhich an eligible employee or eligible dependentmay apply for Coverage. Special events aredescribed in the Special Enrollment Periodsub-section.* The Annual Open Enrollment Period may not applyto certain groups.8
Grandchild/Dependent of a Dependent – Thedependent parent must have been covered at thetime of birth for the Covered Employee’s grandchildto be covered from the date of birth. Grandchildren(dependent of a dependent) may remain on thecontract, up to 18 months of age, even if thedependent parent terminates.If Florida Blue/Florida Blue HMO receives theEmployee Change Application from you within 30days after the date of birth of the child, then nopremium will be charged for the first 30 days ofCoverage for the newborn child. Therefore, it isimportant to notify your employees to submit theEmployee Change Application to you as soon aspossible after the date of birth of a child becauseFlorida Blue/Florida Blue HMO must receive theform within 30 days of the date of birth in order forthe premium payment to be waived for the first 30days of Coverage. If Florida Blue/Florida Blue HMOreceives the Employee Change Application 31 - 60days after the date of birth, then premium will becharged back to the date of birth.Please refer to the Newborn Child section underDependent Enrollment for enrollment rules andtimelines.Note: Coverage for a newborn child of a CoveredDependent other than the Covered Employee’sspouse will automatically terminate 18 months afterthe birth of the newborn child.If the Covered Employee submits the EmployeeChange Application more than 60 days after thedate of birth and the Annual Open Enrollment hasnot occurred since the date of birth, the CoveredEmployee may still apply for Coverage for thenewborn child. Premium will then be charged backto the date of birth. Section 125 groups are onlyallowed 60 days from the date of birth to submit thechild’s information to Florida Blue/Florida Blue HMOfor enrollment. Otherwise the Covered Employee willhave to wait until open enrollment.Adopted Newborn Child – To enroll an adoptednewborn child, the Covered Employee must completeand submit to you the Employee Change Applicationand a copy of the final adoption decree from thecourt. The Effective Date of Coverage will be thedate of birth, provided a written agreement to adoptthe child has been entered into by the CoveredEmployee prior to the birth of the child. You mustforward the Employee Change Application along witha copy of the final adoption decree from the court toFlorida Blue/Florida Blue HMO for processing.If the Covered Employee submits the EmployeeChange Application more than 60 days after thedate of birth and the Annual Open Enrollment hasoccurred, the newborn child may not be added untilthe next Annual Open Enrollment Period or SpecialEnrollment Period.If Florida Blue/Florida Blue HMO receives theEmployee Change Application within 30 days afterthe date of birth of the adopted newborn child, thenno premium will be charged for the first 30 days ofCoverage for the adopted newborn child. Therefore,it is important to notify your employees to submitthe Employee Change Application to you as soonas possible after the date of birth of an adoptednewborn child because Florida Blue/Florida BlueHMO must receive the form within 30 days of thedate of birth in order for the premium payment tobe waived for the first 30 days of Coverage. If FloridaBlue/Florida Blue HMO receives the EmployeeChange Application 31 - 60 days after the date ofbirth of the adopted newborn child, then premiumwill be charged back to the date of birth. FloridaBlue/Florida Blue HMO may require the CoveredEmployee to provide additional information ordocuments other than the Employee ChangeApplication and a copy of the adoption decree fromthe court which we deem necessary to properlyadminister this provision.The guidelines above only apply to newborns bornafter the Effective Date of the Covered Employee.If a child is born before the Effective Date of theCovered Employee and was not added duringthe Initial Enrollment Period, Florida Blue/FloridaBlue HMO must receive the Employee ChangeApplication within 60 days after the birth of the childand any applicable Premium must be paid backto the Effective Date of Coverage of the CoveredEmployee. In the event Florida Blue/Florida BlueHMO is not notified within 60 days of the birth of thenewborn child, the Covered Employee must submitthe application during an Annual Open EnrollmentPeriod or Special Enrollment Period.9
If the Covered Employee submits the EmployeeChange Application more than 60 days after thedate of birth and the Annual Open Enrollment hasnot occurred since the date of birth, the CoveredEmployee may still apply for Coverage for theadopted newborn child. Premium will then becharged back to the date of birth.final adoption decree from the court within 30 days ofthe date of placement for an adopted child, then noadditional premium will be charged for Coverage ofthe adopted child for the first 30 days of Coverage.In the case of a foster child, the Employee ChangeApplication and applicable court documentation shouldbe sent to Florida Blue/Florida Blue HMO along withthe applicable premium payment for the first 30 days ofCoverage. There is no waiver of premium provision forfoster children.If the Covered Employee submits the EmployeeChange Application more than 60 days after thedate of birth and the Annual Open Enrollment hasoccurred, the adopted newborn child may not beadded until the next Annual Open Enrollment Periodor Special Enrollment Period.If the Covered Employee has not submitted theEmployee Change Application within 30 days ofthe date of placement, the Covered Employeemay still apply for Coverage for an adopted childor foster child. The Employee Change Application,however, must be received by Florida Blue/FloridaBlue HMO within 60 days of the date of placementof the adopted or foster child. This means: (1)the Covered Employee must have completed theEmployee Change Application and submitted it toyou along with a copy of the final adoption decreefrom the court or applicable court documentation;and (2) you have sent the forms to Florida Blue/Florida Blue HMO; and (3) it has been received byFlorida Blue/Florida Blue HMO within 60 days fromthe date of placement of the adopted or fosterchild. Additionally, all premium payments must bepaid back to the date of placement. In the eventFlorida Blue/Florida Blue HMO does not receivethe Employee Change Application before or withinthe 60-day period after the date of placement ofthe adopted or foster child, the Covered Employeewill have to wait to enroll the child during thenext Annual Open Enrollment Period or SpecialEnrollment Period.The guidelines above only apply to adoptednewborns born after the Effective Date of theCovered Employee. If a child is born before theEffective Date of the Covered Employee and was notadded during the Initial Enrollment Period, FloridaBlue/Florida Blue HMO must receive the EmployeeChange Application within 60 days after the birthof the child and any applicable Premium must bepaid back to the Effective Date of Coverage of theCovered Employee. In the event Florida Blue/FloridaBlue HMO is not notified within 60 days of the birth ofthe adopted newborn child, the Covered Employeemust make application during an Annual OpenEnrollment Period or Special Enrollment Period.If the adopted newborn child is not ultimately placedin the residence of the Covered Employee, there shallbe no Coverage for the adopted newborn child. It isthe responsibility of the Covered Employee to notifyFlorida Blue/Florida Blue HMO within 10 calendardays if the adopted newborn child is not placed inthe residence of the Covered Employee.For all children Covered as adopted children, if thefinal decree of adoption is not issued, Coverage shallnot be continued for the proposed adopted child.Proof of final adoption must be submitted to FloridaBlue/Florida Blue HMO. It is the responsibility of theCovered Employee to notify Florida Blue/FloridaBlue HMO if the adoption does not take place. Uponreceipt of this notification, Florida Blue/Florida BlueHMO will terminate the Coverage of the child on thefirst billing date following receipt of the written notice.Adopted/Foster Children – To enroll an adopted orfoster child, the Covered Employee must completeand submit to you the Employee Change Applicationalong with a copy of the final adoption decree fromthe court or applicable court documentation. TheEffective Date for an adopted or foster child (otherthan an adopted newborn child) shall be the date theadopted or foster child is placed in the residence of theCovered Employee in compliance with Florida law. Youmust forward the Employee Change Application anda copy of the final adoption decree from the court orapplicable court documentation to Florida Blue/FloridaBlue HMO for processing. If Florida Blue/Florida BlueHMO receives the Employee Change Application and10
Annual Open Enrollment Period(If Applicable*)If the Covered Employee’s status as a foster parentis terminated, Coverage shall not be continued forany foster child. It is the responsibility of the CoveredEmployee to notify Florida Blue/Florida Blue HMOthat the foster child is no longer in the CoveredEmployee’s care. Upon receipt of this notification,Florida Blue/Florida Blue HMO will terminatethe Coverage of the child on the first billing datefollowing receipt of the written notice.Eligible employees and/or eligible dependentswho did not apply for Coverage during the InitialEnrollment Period or a Special Enrollment Periodmay
Florida Blue P .O . Box 44144 Jacksonville, FL 32231-4144 Premium Payments: Florida Blue P .O . Box 660299 Dallas, TX 75266-0299 Express Mail Deliveries: ATTN: Corporate Cash Receipts Florida Blue 4800 Deerwood Campus Parkway DCC1-3 Jacksonville, FL 32246-6498 Refer to Florida Blue/Florida Blue
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