Employees out on an approved leave of absence without pay may elect to continue or cancel their benefits while on leave.  To make an election to continue or cancel benefits, employees should complete a “Leave of Absence Acknowledgement” form, prior to going on leave, which can be obtained from their Benefits Office.

Employees, who wish to continue benefits while on leave without pay, should contact the Payroll Office at 974-7955 to make payment arrangements. Employees, who wish to cancel their insurance while on leave without pay, will have thirty-one (31) days from the date they return from leave to re-enroll in benefits. If an employee does not re-enroll within 31 days of their return from leave, they will not be eligible to re-enroll in benefits until the next Open Enrollment period.

Please contact the Division of Human Resources Benefits Office at 974-2970 if you have any questions.

USF employees enrolled in benefits offered through the State Group Insurance Program have appeal and grievance rights as specified in Florida Statutes, Florida Administrative Code, and plan documents.  It is important to note that the rights originate with the individual and not an agency or employing entity. 

The following is provided as a summary of the specified steps and procedures to be followed:

Eligibility and Enrollment Appeals

For an Enrollee or Active Employee who desires to contest a decision by the Department of Management Services (DMS) or People First, the Benefits Administrator, regarding enrollment, eligibility, effective date, insurance premiums, deduction for an insurance coverage or benefit, or deductions or reimbursement made for Expense Reimbursement Plans, the following process is applicable:

1. The Enrollee or Active Employee must request a reconsideration of a    decision or intended decision in writing, providing additional documentation to People First. This will be considered a Level I Appeal and is to be mailed to:

   People First Service Center
   Benefits Administration - Appeals
   P.O. Box 6830
   Tallahassee, FL 32314

2. People First, after reconsideration, will provide a written notice to the Enrollee or Active Employee of the decision or intended decision resulting from the Level I Appeal within 30 days.  

3. Should the Enrollee or Active Employee receive an unfavorable ruling and wish to pursue the matter further, they must request a reconsideration of a decision or intended decision in writing, providing additional documentation.  This will be considered a Level II Appeal, and is to be mailed to:       

   Department of Management Services
   Division of State Group Insurance
   P.O. Box 5450
   Tallahassee, Florida 32314-5450

4. The Division of State Group Insurance, after consideration, will provide a written notice to the Enrollee or Active Employee of the decision or intended decision resulting from the Level II Appeal within 2 – 3 weeks.

5. Enrollees or Active Employees who desire to contest the decision or intended decision pursuant to Chapter 120, Florida Statues, shall submit a petition for an administrative hearing.  Such petition must be received by the Department within twenty-one (21) calendar days after notice of the decision or intended decision is received by the Enrollee. Petitions are to be mailed to:

   Office of General Counsel
   Department of Management Services
   4050 Esplanade Way
   Tallahassee, FL 32399-0949

6. Enrollees or Active Employees who dispute the facts upon which the Department's decision is based, shall submit a request for formal hearing that sets forth the facts in dispute and complies with the requirements of Rule 28-106.201, Florida Administrative Code.

7. Enrollees or Active Employees who do not dispute the facts upon which the Department's decision is based, shall submit a request for an informal hearing that complies with the requirements of Rule 28-106.301, Florida Administrative Code.

Coverage Appeals - PPO

For an Enrollee who desires to contest a decision by the Department's third party administrator regarding coverage for benefits and services provided through the State Employees' PPO Plan, the following process is applicable:

1. The Enrollee must first request a reconsideration of the coverage decision in writing from the third party administrator within 90 days of the denial of benefits.  This will be considered a Level I Appeal and are to be mailed to:

   For benefits or claims other than prescription drug claims:
   Blue Cross and Blue Shield of Florida, Inc.
   P.O. Box 2896
   Jacksonville, FL 32232-0079 

   For prescription drug claims:
   Caremark Inc.
   Appeals Department, MC 109
   P.O. Box 52084
   Phoenix, AZ 85072-2084

2. Upon receipt of an unfavorable written reconsideration decision from the third party administrator, an Enrollee who desires to further contest the decision must file a written request with the Department within sixty (60) calendar days of receipt of the decision. Such request must set forth the basis upon which the Enrollee disputes the decision, and must include a copy of the notice from the third party administrator plus any medical or other documentation in support of the Enrollee's position.  This will be considered a Level II Appeal and is to be mailed to:

   Department of Management Services
   Division of State Group Insurance
   Post Office Box 5450
   Tallahassee, Florida 32314-5450

3. The Division of State Group Insurance will provide a written notice to the Enrollee of the decision or intended decision regarding the Level II Appeal.

4. Enrollees who desire to contest the Department's decision or intended decision pursuant to Chapter 120, Florida Statues, shall submit a petition for an administrative hearing.  Such petition must be received by the Department within twenty-one (21) calendar days after notice of the decision or intended decision is received by the Enrollee. Petitions shall be sent to:

   Office of General Counsel
   Department of Management Services
   4050 Esplanade Way    
   Tallahassee, FL 32399-0949

5. Enrollees who dispute the facts upon which the Department's decision is based, shall submit a request for formal hearing that sets forth the facts in dispute and complies with the requirements of Rule 28-106.201, Florida Administrative Code.

6. Enrollees who do not dispute the facts upon which the Department's decision is based, shall submit a request for an informal hearing that complies with the requirements of Rule 28-106.301, Florida Administrative Code.

Coverage Appeals – HMOs and/or Supplemental Insurance Plans

For an Enrollee or Active Employee who desires to contest a decision by a Health Maintenance Organization plan or a supplemental insurance plan, the following process is applicable:

1. The Enrollee or Active Employee must request a reconsideration of a decision or intended decision in writing, providing additional documentation directly from the health plan or supplemental vendor.  A copy of each HMO’s brochure can be accessed on the People First website.

2. Each HMO and vendor has its own grievance process and procedures which are spelled out in either its Certificate of Coverage or brochure which follow requirements contained in Florida Statute.

All provide for written notification of results, as well as the process for escalating the grievance beyond the HMO or supplemental vendor