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Health

State PPO

HMO

Life Insurance

Dental

Vision

Supplemental

   

Who Is Eligible?

Part-time and full-time salaried employees as defined in Section 110.123(2)(c) and (f), Florida Statutes, are eligible for coverage under the State Group Insurance Program. Certain variable hour and OPS employees also qualify for insurance coverage.

Eligibility for health insurance coverage:

  • Salaried employees who work .75 full-time equivalency (FTE) or more and OPS/variable hour employees who work an average of 30 hours or more per week over the defined measurement period are considered full-time and eligible for the state contribution towards the monthly premium.
  • Salaried employees who work less than .75 FTE pay a prorated share of the employer premium based on their FTE plus the employee share.
  • OPS/variable hour employees are eligible for coverage if:
    • At the point of hire, they are reasonably expected to work 30 hours or more per week on average;
    • At the end of their 12-month new hire measurement period, their hours worked averaged 30 hours or more per week;
    • At the end of the 12-month open enrollment measurement period, their hours worked averaged 30 hours or more per week.
  • OPS/variable hour employees who work less than 30 hours per week on average over the defined measurement period and seasonal employees and short-term employees are not eligible for coverage.

Eligibility for life insurance coverage:

  • Salaried employees who work 1.0 FTE are automatically enrolled in the $25,000 basic life insurance and pay no monthly premium. They are also eligible to enroll in optional term life insurance.
  • Salaried employees who work less than 1.0 FTE may enroll in the $25,000 basic life insurance and pay a prorated share of the monthly premium. They are eligible to enroll in optional term life insurance.
  • OPS/variable hour employees who work an average of 30 hours or more each week over the defined measurement period may enroll in the $25,000 basic life insurance and pay the entire monthly premium. They are not eligible for optional term life insurance.
  • OPS/variable hour employees who work less than 30 hours per week on average over the defined measurement period are not eligible for coverage.

In addition, OPS/variable employees who meet the eligibility requirements for health insurance (above) may enroll in:

  • A health savings account (if enrolled in a health investor health plan) and receive the state contribution once the account is correctly established;
  • Dental, vision and other supplemental insurance plans; and
  • A dependent care reimbursement account

Salaried employees may enroll in these benefits, as well as medical or limited purpose medical reimbursement accounts.

 

Spouse Program!

If you and your spouse are active state employees and you are both eligible for health insurance coverage, you may enroll in the Spouse Program and pay a reduced monthly premium.

 


State officers or state employees may continue to participate in the State Group Insurance Program if they retire under a State of Florida retirement system or a state optional annuity or retirement program or go on disability retirement under the State of Florida retirement system. They must have been covered by the Program at the time of retirement and receive retirement benefits immediately after retirement or maintained continuous coverage under the Program from termination until receiving retirement benefits.

Employees thinking of retirement should review the “State Group Insurance Benefits Package for New Retirees,” located under Other Forms, Publications and General Information. Employees that do not continue health and life insurance coverage at the time of retirement will not be allowed to enroll in state health or life insurance at a later date as a retiree.

Dependents Eligible for Coverage

If you are enrolled in the State Group Insurance plans, you may also cover your eligible dependents. You must:

  1. Register your dependent online in People First; and
  2. Select the correct family coverage tier for each plan that is to cover your dependents; and
  3. Enroll each dependent in the appropriate plan; and
  4. Click the Complete Enrollment button in People First.

In accordance with Chapter 60P, Florida Administrative Code, dependents must meet specific eligibility requirements to be covered under State Group Insurance plans. Eligible dependents include:

  • Your spouse – a person of the opposite sex to whom you are legally married. See Section 741.212(3), Florida Statutes.

  • Your child – your biological child, legally adopted child or child placed in the home for the purpose of adoption in accordance with applicable state and federal laws.

  • Your child with a disability – your covered child who is permanently mentally or physically disabled. This child may continue health insurance coverage after reaching age 26 if you provide adequate documentation validating disability upon request and the child remains continuously covered in a State Group Insurance health plan. The child must be unmarried, dependent on you for care and for financial support, and can have no dependents of his/her own.

  • Your stepchild – the child of your spouse for as long as you remain legally married to the child’'s parent.

  • Your foster child – a child that has been placed in your home by the Department of Children and Families Foster Care Program or the foster care program of a licensed private agency. Foster children may be eligible to their age of maturity.

  • Legal guardianship – a child (your ward) for whom you have legal guardianship in accordance with an Order of Guardianship pursuant to applicable state and federal laws. Your ward may be eligible until his or her age of maturity.

  • Your grandchild – a newborn dependent of your covered child. Coverage may remain in effect for up to 18 months of age as long as the newborn'’s parent remains covered.

  • Your over-age dependent – your child after the end of the calendar year in which they turned age 26 through the end of the calendar year in which they reach 30 if they are unmarried, have no dependents of their own, are dependent on you for financial support, live in Florida or attend school in another state, and have no other health insurance.

You may be required to provide documentation for your eligible dependents. If you fail to provide requested documentation, you may be liable for medical and prescription claims or premiums back to the date you enrolled. Fax documentation to (800) 422-3128 or mail it to People First Service Center, P.O. Box 6830, Tallahassee, Florida 32314. Write your People First ID number on the top right corner of each page of your fax or other documentation.


Over-Age Dependent (ages 26-30) Coverage

This individual health coverage for your over-age dependent requires an additional monthly premium and you and your eligible over-age dependent must be enrolled in the same health plan. Call the People First Service Center for more information.


When Coverage Ends

Your coverage in State Group Insurance plans ends:

  • When your employment is terminated. Active employees pay premiums one month in advance, so coverage ends on the last day of the month following the month you terminated employment. For example, if your last day of work is April 23, your coverage ends May 31.
  • The last day of the 12th month of coverage if you are an OPS/variable hour employee and you no longer meet the requirement of working at least 30 hours per week on average.
    (Note: health insurance is guaranteed for 12 months, as long as you remain employed by the state. Life, dental, vision and other supplemental plans end at the same time as health coverage, regardless of the number of months enrolled.)
  • On the last day of the month in which you do not make the required contributions for coverage, including the months when you are on leave without pay, suspension or layoff status. Payment is due the 10th of the month before the month of coverage. For example, payment for July coverage is due June 10.
  • On the last day of the month in which you remarry, if you have coverage as a surviving spouse of an employee or retiree.

If your spouse is enrolled as your covered dependent, your spouses' coverage ends on the last day of the month in which:

  • Your coverage is terminated.
  • You and your spouse divorce - You are required to notify People First within 60 days of the divorce.
  • Your spouse dies.

Your dependent children's coverage ends:

  • On the last day of the month in which your coverage is terminated.
  • The end of the calendar year in which they turn 26 (30 for over-age health coverage).
  • On the last day of the month your dependent no longer meet the definition of an eligible dependent (e.g., if you divorce, you may no longer cover your stepchildren).

When your dependents no longer meet eligibility requirements, their coverage ends the last day of the month they become ineligible, unless otherwise noted above. If your dependents become ineligible for coverage, go to the People First website to remove them from your plans or call the People First Service Center at (866) 663-4735 within 60 days of the ineligibility. Service Center hours are 8 a.m. to 6 p.m. Eastern Standard Time (5 p.m. Central Time). Send required documentation to People First. If you fail to provide the required documentation, you risk paying for more coverage than you need.

Please note: Falsifying documents, misrepresenting dependent status, or using other fraudulent actions to gain coverage may be criminal acts. The People First Service Center is required to refer such cases to the Florida Department of Financial Services Division of Insurance Fraud.

Spouse Program

To enroll in the spouse program, you must complete and sign the Spouse Program Election Form and list all eligible dependents within 60 days of your marriage to another state employee or your employment with the state.

You must enroll in the same health plan, and agree to notify the People First Service Center within 60 days of becoming ineligible for the Spouse Program.

You and your spouse become ineligible for the Spouse Program if:

  • One or both of you end employment with the state, including retirement;
  • You divorce;
  • A spouse dies.

It is your responsibility to notify the People First Service Center if you become ineligible for the Spouse Program. If you fail to do so within 60 days of one of the listed events, you will be liable for claims or premiums back to the date you lost eligibility. Additionally, you may have to pay for a higher level of coverage than you need. For example, you may be required to pay for family coverage instead of individual coverage. Upon notification of ineligibility for the Spouse Program, the People First Service Center adds covered, eligible dependents to the primary spouse's plan, unless you request otherwise.


Chapter 60P, Florida Administrative Code, governs eligibility and enrollment for the State Group Insurance Program. Additionally, our plans fall under Internal Revenue Code (IRC) cafeteria plan guidelines. Consequently, participants are required to stay in the plans they select. Per the IRC, participants can only make changes during Open Enrollment or if they have a Qualifying Status Change (QSC) event, such as a birth, marriage, or change in employment status, only if it results in a gain or loss of eligibility for insurance. (Retirees may decrease or cancel coverage at any time. Those who cancel will not be allowed to reenroll as a retiree.)