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 firstname.lastname@example.org.
ELIGIBLE FAMILY MEMBERS
Spouse*: Your legal spouse (opposite or same-sex)
Domestic Partner*: Your registered domestic partner (specials rules apply)
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’s eligibility ceases due to age
Disability status is determined based on receipt of disability determination by Social Security. 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 of enrollment or change no longer disabled per Social Security.
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.
* Working Spouse/Domestic Partner (DP) Surcharge: Employees enrolling their spouse or domestic partner in 2015 will be required to complete a Working Spouse/DP Affidavit indicating whether their spouse/DP is employed. If employed, and if health coverage is available through their employer, a $20 bi-weekly surcharge will be applied.
** 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 the Employee Benefit Services Section 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 the Employee Benefit Services Section 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
Documents written in a language other than English must be accompanied by a certified translation.
- 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:
Spouse (opposite or same-sex)
Copy of Official Registered Marriage certificate (religious certificate not acceptable if married in the United States of America)
Copy of Domestic Partnership Registration Certificate issued by Broward County and proof of residing in the same residence – submit one item from List A and one item from List B:
||Driver’s licenses showing the same address
Mortgage, lease, deed showing both names
Utility bills showing both names
|Current statement from a joint bank account showing both names|
Designation of the partner as holding power of attorney for health care decisions for each other
Current joint insurance policy (auto, property or homeowner’s insurance)
Credit card(s) with the same account number for both names
Child(ren)* see below
Copy of Official State Birth certificate(s) (birth cards not acceptable, must show employee as parent)
Copy of Official State Birth certificate(s) (birth cards not acceptable, must show employee as parent)
Child(ren) of Domestic Partner
Copy of Official State Birth certificate(s) AND applicable Domestic Partner documentation as indicated above
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 Courtss
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 01/01/2015) – 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 ALL of the following (pre-printed by the educational institution):
Name of school/college/university
Name of dependent
Date(s) of semester showing enrollment for January 2015
|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 the Employee Benefit Services Section 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 the Employee Benefit Services Section at 954-357-6700 or email email@example.com 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 the Employee Benefit Services Section. (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 the County or group health plan. You must add your newborn dependent through the Employee Benefit Services Section 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 the Employee Benefit Services Section 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 the Employee Benefit Services Section 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 the Employee Benefit Services Section 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 (Health Savings Accounts contributions can be changed at any time during the year) and after-tax prepaid legal plan, personal income protection plans and life insurance, for the following plan year. Annual pretax 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 and specified after-tax benefits is held annually during the last quarter of the calendar year to allow eligible employees to:
- enroll in or disenroll from health, dental, and/or vision
- enroll in prepaid legal coverage
- enroll in personal income protection plans
- enroll in or change life insurance coverage (subject to plan restrictions)
- change health or dental insurance 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 (Health Care or Dependent Day Care)
Note: If planning on retiring in 2015, the elections made during open enrollment, or through a change in status prior to retirement for health, dental and vision, will be the only plans available for retiree continuation of coverage. 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 after-tax 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 the Employee Benefit Services Section with your questions.