Section I - Employee Agreement
When you participate in the County benefit program, you are making the following automatic affirmations:
- You authorize the County to deduct premiums for the benefits elected or rolled over for the plan year.
- You certify that the information you supplied on the online enrollment system or Benefit Enrollment/Change Form and other benefit documents is true and complete to the best of your knowledge.
- You understand that health, dental and vision insurance premiums and Flexible Spending Account contributions will be pre-taxed to the extent possible and that your income subject to federal income tax and Social Security withholding (FICA) will be reduced, and that this may slightly affect your Social Security benefits in the future. If insuring an Over Age Dependent between the ages 26 and 30, or a Domestic Partner or child/children of a Domestic Partner, a portion of your premium attributable to their coverage will be deducted on an after-tax basis and you will pay imputed income on the portion of the County subsidy provided to offset the cost of the health plan.
- You acknowledge that you cannot stop or change benefits paid for on a pre-tax basis during the plan year unless you experience a relevant qualifying event.
- You agree to provide documentation evidencing dependent status, domestic partner status or student/financial status for any person covered under a County insurance plan within 31 days of a request for such verification. Failure to supply any requested documentation may cause the individual to be removed from coverage retroactive to the enrollment date, making you responsible both legally and financially for repayment of all subsidies and claims incurred by the ineligible dependent. Other action may be imposed as appropriate.
- You understand that a Section 125 Flexible Spending Account (Health Care and Dependent Care) can be used only to reimburse payment of eligible expenses incurred during the plan year while participating in the plan, and that any amount remaining in either spending account that is not used during the plan year will be forfeited. Funds in one spending account cannot be used to reimburse expenses covered by another account. Expenses for which you are reimbursed cannot be claimed on your income tax return. As Over Age Dependent children ages 26 to 30 and domestic partners or children of a domestic partner do not meet the IRS definition of dependent, their coverage is not eligible for pre-tax consideration or reimbursement through either type of Section 125 Flexible Spending Account, Health Reimbursement Account under a Consumer Driven Health plan or Health Savings Account under a High Deductible Health Plan.
- You understand and agree that the County and the third party FSA/HRA/HSA administrator will not incur any liability resulting from your failure to read all rules pertaining to benefit enrollment or to sign or accurately complete the Enrollment/Change Form. You also understand that elections for benefits on a pretax basis are irrevocable and cannot be changed after the established deadline date. Subsequent changes can only be made upon experiencing a relevant qualifying event.
- You agree for yourself and covered members of your family and others covered under County insurance plans to be bound by the benefits, deductibles, coinsurance, copayments, exclusions, limitations, eligibility requirements and other terms of the plan contracts, agreements and plan documents for the plans in which you enrolled.
- You understand that Broward County, Division of Human Resources, Employee Benefit Services Section, shall collect your Social Security number as allowed under section 119.071(5)(a)2, Florida Statutes, for the following purpose: to match, verify and retrieve benefit plan information as well as for the purpose of payment and audit of premiums collected. You are being provided notice of this activity pursuant to section 119.071(5)3, Florida Statutes.
- You understand that a Mandatory Insurer Reporting Law (Section 111 of Public Law 110173) requires group health plan insurers, third party administrators and plan administrators or fiduciaries of self-insured/self-administered group health plans to report, as directed by the secretary of the Department of Health and Human Services, information that the secretary requires for purposes of coordination of benefits. The law also imposes this same requirement on liability insurers (including self-insurers), no-fault insurers and workers’ compensation laws or plans. Two key elements that will be required to be reported are SSNs (or HICNs) and EINs. In order for Medicare to properly coordinate Medicare payments with other insurance and/or workers’ compensation benefits, Medicare relies on the collection of both the SSN or HICN and the EIN, as applicable.
- Florida Statute 817.234 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. Any person committing such fraud will be subject to appropriate action by Broward County and/or the insurance carrier.