Who Is Eligible?
State officers or state employees can 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 received retirement benefits immediately after retirement, or maintained
continuous coverage under the Program from termination until receiving retirement benefits; or
- Retired before January 1, 1976, under any state retirement system and are not eligible to receive any Social Security benefits.
Dependents Eligible for Coverage
If you are enrolled in the State Group Insurance plans, you may also cover your eligible dependents. You must:
- Register your dependent online in People First; and
- Select the correct family coverage tier for each plan that is to cover your dependents; and
- Enroll each dependent in the appropriate plan; and
- 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. The amount of financial support you provide determines if the monthly premium for coverage comes out of your paycheck pretax (active employees only) or if you must mail in payment post-tax. Call the People First Service Center for more information.
Surviving spouses are also eligible for coverage. The term “surviving spouse” means the widow or widower of:
- A deceased state officer, state employee or retiree if the spouse was covered as a dependent at the time of the participant's death.
- An employee or retiree who died before July 1, 1979.
- A retiree who retired before January 1, 1976, under any state retirement system and who is not eligible for any Social Security benefits.
The surviving spouse and dependents, if any, must have been covered at the time of the participant’s death. To enroll, the surviving spouse has 60 days to notify
the People First Service Center of the death and 31 days to enroll after receipt of the enrollment package. Coverage is effective retroactively once the enrollment
form and premiums have been received. Coverage begins the first of the month following the last month of coverage for the deceased; in other words, coverage must
Coverage for surviving spouses ends on the first of the month following remarriage; however, they are eligible to continue coverage under COBRA for a limited time, provided they provide a copy of the marriage certificate within 60 days of the marriage.
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.
- 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 spouse’s 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.
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.)