WHO IS ELIGIBLE
Employees in full-time and part-time 20 plus hour positions are eligible for benefits under the County’s Section 125 Benefit Plan, subject to collective bargaining agreement provisions, if applicable. Coverage is effective on the first of the month following 60 days of employment in a benefit eligible position. If you have questions about eligibility, contact Employee Benefit Services at 954-357-6700 or email email@example.com.
ELIGIBLE FAMILY MEMBERS
Spouse: Your legal spouse
Domestic Partner: Your registered domestic partner (specials rules apply, see page 51)
Children: From birth through the end of calendar year in which child turns age 26:
- Your natural children, legally adopted children and children placed in the home for the purpose of adoption in accordance with chapter 63, Florida Statutes
- Your stepchildren, provided you are still married to the children’s parent
- Your foster children, provided child is placed with you prior to attaining age 18
- Your children for whom you have established legal guardianship under chapter 744, Florida Statutes, or court ordered temporary custody
- Your children with a qualified medical support order requiring you to provide coverage
Children of covered dependent children (grandchildren):
- Can be covered through the end of the month in which the grandchild turns 18 months of age if the parent was covered under the plan at the time of birth and remains covered during the 18 months.
- Single and incapable of self-care, dependent on employee for support due to physical or mental disability
- Disability must occur before child eligibility ceases due to age
- The treating physician provides documentation supporting the mental or physical disability while the dependent is still covered under your plan. You must submit the documentation to your health insurance company upon request for review and confirmation. Disability status is verified at least every five years. If you fail to provide the required documentation or your dependent no longer meets eligibility requirements, you may be liable for medical and prescription claims or premiums back to the date you enrolled.
Over Age Dependents*: Children ages 26 to 30 if:
- They are unmarried, and
- They have no dependents of their own, and
- They are dependent on you for financial support, and
- They live in Florida or attend school in another state, and
- They have no other health insurance, and
- You pay an additional monthly premium.
*Note: If a child is covered under the Over Age Dependent provision and you cancel their coverage due to a qualifying event, the Over Age Dependent is not eligible to again be covered under this provision unless the child was continuously covered by other creditable group coverage without a gap of more than 63 days. Documentation of prior coverage will be required. If a child covered under this provision becomes a parent, the newborn will not be covered under the plan and the child/parent’s coverage will terminate at the end of the birth month. Only the child/parent will be offered COBRA coverage.
NOTE: Employee must notify Employee Benefit Services within 31 days of a divorce or dissolution of a domestic partnership or any other action that causes the dependent to not meet the eligibility guidelines. Upon loss of eligibility the dependent can no longer remain under the group insurance plan and will be offered continuation coverage at 102 percent of the full cost under COBRA. If you experience a relevant qualifying event, it is your responsibility to notify Employee Benefit Services within 31 days of the event. Beyond 31 days, the employee is responsible both legally and financially for any claims and/or expenses incurred as a result of any dependent(s) who continue to be enrolled who no longer meet the County’s eligibility requirements.
DEPENDENT ELIGIBILITY AND DOCUMENTATION REQUIREMENTS
Dependents must have an established legal relationship to the employee or spouse/domestic partner to be covered under a County benefit program. The types of documentation accepted are:
Copy of Official Registered Marriage certificate (religious certificate not acceptable)
Copy of Domestic Partnership Registration Certificate issued by Broward County
Child(ren)* see below
Copy of Official State Birth certificate(s) AND Copy of Official Registered Marriage certificate
Copy of Official State Birth certificate(s) AND Copy of Domestic Partnership Registration Certificate
Child(ren) of Domestic Partner
Copy of Legal Guardianship/Custody document from Courts or Copy of Foster Care documentation from Courts
Child(ren) under Legal Guardianship, Custody or Foster Care
Copy of Legal Guardianship/Custody document from Courts or Copy of Foster Care documentation from Courts
Child(ren) adopted or in the process of adoption
Copy of Legal adoption documentation showing relationship to employee and placement in employee’s home or Adoption Certificate issued through Courts
*Grandchild(ren) OR other children not related
Copy of Official State Birth certificate of child(ren) AND Copy of Guardianship/ Adoption/Custody/Foster care document from Courts
Section 817.234, Florida Statutes clearly states that any person who knowingly and with the intent to injure, defraud or deceive any insurer, files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree. Recognition of any such person committing such fraud will be subject to appropriate action by Broward County and/or the insurance carrier.
OVER AGE DEPENDENT (CHILD AGE 26 BUT LESS THAN 30 ON 01/01/2013) DOCUMENTATION OF STUDENT STATUS OR FINANCIAL SUPPORT
Employees will be required to sign an Over Age Dependent Affidavit and provide supporting documentation indicating whether the dependent is a student or financially dependent upon the employee.
|Over Age Dependent is a Student
||Over Age Dependent is Financially Dependent|
1. Over Age Affidavit, and
|1. Over Age Affidavit, and|
2. Proof of student status which must include pre-printed by the educational institution ALL of the follwoing:
- Name of school/college/university
- Name of dependent
- Date(s) of semester showing enrollment for January 2012
|2. Proof of residence|
Current driver’s license showing a Florida address
WHEN CAN I ENROLL?
You can enroll yourself and your eligible dependents:
- Upon employment in a benefit-eligible position or attaining benefit eligibility status. Coverage is effective on the first of the month following completion of initial 60-day eligibility period
- Upon experiencing a relevant qualifying event, within 31 days of the date of the event (coverage will be effective the first of the month after Employee Benefit Services receives the completed paperwork)
- During the annual Open Enrollment in the fall of each year
IF I CHOOSE NOT TO ENROLL IN BENEFITS FROM THE COUNTY AND NEED THEM LATER, HOW DO I ENROLL?
If you have benefits from another group plan and waive coverage in the County plans, but then lose your other coverage, you will have 31 days from the qualifying event (the loss of your other benefits) to elect coverage and provide documentation. If there is no prior coverage, you may only enroll if you experience a relevant qualifying event, such as marriage, domestic partner registration or birth.
MAKING CHANGES DURING THE PLAN YEAR
Under certain circumstances, you may be permitted to make changes to your benefit elections during the plan year, such as additions, deletions and cancellations, depending on whether you experience an eligible qualifying event (change in status) as determined by the IRS Code, Section 125. If you experience a qualifying Change in Status, the election changes must be requested within 31 days from the qualifying event date (60 days for a newborn or adoption) and the change must be consistent with the type of event. Based on the event, you may add or delete dependents to your existing coverage however you cannot change your medical or dental plan to another plan type or carrier. Change in Status events include, but are not limited to:
- Marriage or divorce
- Registration or dissolution of Domestic Partnership
- Death of a dependent (60 days)
- Birth or adoption (60 days)
- Legal guardianship
- Change in a dependent’s eligibility
- Change in employment status for you or your dependents
- Change from part-time to full-time employment status or vice versa
- Going on unpaid leave:
- Family and Medical Leave and Job Protected Leave
- Authorized leave without pay
- Workers’ Compensation disability leave
- Military leave
When and how to request a Change In Status: Contact Employee Benefit Services at 954-357-6700 or email firstname.lastname@example.org in advance of the event, but no later than 31 days from the date of the event.
Documentation supporting the Change In Status/Qualifying Event must be submitted with the Enrollment/Change Form. Requests made later than 31 days from the date of the event will not be approved (exception: newborn babies and adoptions; requests must be made within 60 days of the birth/placement for adoption).
Effective date of the change in coverage due to a Change in Status/Qualifying Event: Coverage becomes effective on the first of the month following the date the paperwork and documentation is received and approved by Employee Benefit Services. (Exception: The only qualifying event changes that will be made retroactive are: birth*, adoption or foster care placement.)
* Your newborn child is not automatically enrolled by your employer or group health plan. You must add your newborn dependent within 60 days, even if your current coverage includes Employee and Children, or Employee and Family coverage.
Coverage ends on the last day of the month in which the Change in Status/Qualifying Event occurred in most situations. Supporting documentation is required and must be submitted to Employee Benefit Services within 31 days of the Change in Status date.
Loss of other Group coverage midyear: You can enroll in a County health plan midyear if you have lost other group insurance coverage. Supporting documentation of the loss of coverage is required and must be submitted to Employee Benefit Services within 31 days of the loss of coverage date.
If you experience a relevant Change in Status/Qualifying Event, it is your responsibility to notify Employee Benefit Services within 31 days of the event. Beyond 31 days, the employee is responsible both legally and financially for any claims and/or expenses incurred as a result of any dependent(s) who continue to be enrolled who no longer meet the County’s eligibility requirements.
Open Enrollment is a period of time, determined by the County, during which you are allowed to make changes to your pretax benefits (health, dental, vision and Flexible Spending Accounts) for the following plan year. Annual elections are irrevocable unless experiencing a qualifying event. All benefit eligible employees are required to reenroll each year during open enrollment. The County’s Open Enrollment for pretax benefits is held annually during the last quarter of the calendar year to allow eligible employees to:
- enroll in or disenroll from health, dental or vision coverage
- change health or dental insurance companies or plans
- enroll or remove dependents from health, dental or vision plans without a relevant Change in Status/ Qualifying Event
- start, stop or change deductions to a Section 125 Flexible Spending Account (Medical Expense or Dependent Day Care)
Note: If planning on retiring in 2013, the elections made during open enrollment or through a change in status, will be plans available for continuation. Retirees cannot elect or enroll in health, dental or vision coverage if not enrolled as an active employee at the time of retirement.
No other County benefits are subject to Open Enrollment restrictions. Other benefits can be elected or changed at any time during the year. Changes made during Open Enrollment go into effect the following January 1.
What should I do if my spouse/domestic partner’s Open Enrollment is before or after my Open Enrollment? This situation is a “qualifying event.” It is highly recommended that you complete open enrollment with Broward County. Upon showing us proof of enrollment in another open enrollment plan within 31 days of the effective date of the new plan, we may allow you to make a change to your County enrollment. If you miss your 31 day opportunity, you will have to wait until another qualifying event or open enrollment occurs. To make the best decision, contact Employee Benefit Services with your questions.