Who Is Eligible?

Retiree

You are eligible for the health insurance plan if you were a state officer or state employee and:

• retired 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, as long as you:
• were covered by the health insurance plan at the time of your retirement and you begin receiving retirement benefits immediately after you retired, or
• maintained continuous coverage under the state plan from termination until receiving retirement benefits
• retired before January 1, 1976, under any state retirement system, and you are not eligible to receive any Social Security benefits.

Surviving Spouse

You are eligible for the health insurance plan if you are the surviving spouse of:

• an employee or retiree and you were enrolled in the health insurance plan as a dependent when the employee or retiree died
• an employee or retiree who died before July 1, 1979
• a retiree who retired before January 1, 1976, under any state retirement system, and you are not eligible to receive any Social Security benefits and you have not remarried.
  
  
• Coverage ends on the first of the month following your remarriage.

COBRA Participant

You are eligible for the health insurance plan for a specified period of time if you qualify to continue coverage after leaving the state under the terms of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Dependents

If you enroll, you may also cover your eligible dependents for medical, dental, prescription drug and vision coverage by selecting family coverage under those options when you enroll. Eligible dependents include your:

• Spouse.
• Unmarried children through the end of the month in which they reach age 19.
• Unmarried children age 19 through the end of the calendar year they reach age 25 if they depend on you for more than 50% of their financial support and live with you or are enrolled in any school, college or university certified or licensed by a state or foreign country.
• Mentally or physically disabled children who have reached the age limits but are incapable of self-sustained employment and dependent on you for more than 50% of their financial support.
• Child's newborn child for 18 months after the child's birth, or until your child who is the infant's parent no longer qualifies as your dependent.

Over-age Children

Covered in Family Tier: Children, from age 19 through the end of the calendar year when the child turns 25, are covered within in the existing family if they:

• Are dependent on you for financial support, and
• Either live with you or are a full-time or part-time student

Optional Over-age Coverage: For health insurance only, coverage for children age 19 through the end of the calendar year when the child turns 30 may be purchased at an additional premium for dependent children that:

• Are not married,
• Have no dependents (i.e. children, domestic partner),
• Are not provided or otherwise have available other major medical health insurance, and
• Either live in Florida or are a student in another state.

Coverage for optional over-age children is not automatic. You must enroll these children in an individual policy through People First. By enrolling these children you agree to pay premiums, for the entire plan year, through payroll deductions.

• Your premium payments may qualify for pre-tax treatment (if, for example, you provide more than half of their support). This means your premium payments are deducted from your wages before taxes. You must certify that your optional over-age child qualifies as a tax dependent for health coverage purposes at the time of enrollment.
• If your optional over-age child does not qualify for pre-tax treatment, your premiums must be paid with post-tax dollars (the premium is deducted from your paycheck after taxes).

Coverage may continue for your over-age dependent as long as you are a state employee or retiree, or until the end of the calendar year in which they reach age 30. When your dependent loses eligibility, he/she will be eligible to purchase a COBRA policy.

The premium for Over-Age Dependent coverage is $XXX.

Health Savings Accounts (HSAs) - Special Eligibility Rules

Retirees, surviving spouses and COBRA participants who are not Medicare-eligible and enroll in a Health Investor PPO or HMO may open an HSA through the state plan as long as the people they cover under the Health Investor medical plan do not have:

• Medical coverage through a spouse's employer, Medicare, Medicaid or any other medical plan, other than the hospital, cancer or intensive care coverage available through the state's supplemental plans.
• A healthcare flexible spending account that covers medical expenses.

See How to Enroll for additional information.