Frequently Asked Questions
Full time employees are eligible to participate in benefits on the 91st day following their date of hire. (1)
- Your lawful spouse; or
- Your domestic partner; and
- Any child of yours who is:
- Less than 26 years old.
- 26 years old, but less than 30, unmarried, enrolled in school as a full-time student and primarily supported by you.
- From 26 years until the end of the calendar year in which the child reaches the age of 30, provided the child is unmarried and does not have a dependent of his own, is a Florida state resident or a full-time or part-time student, and is not covered under a plan of their own or entitled to benefits under Title XVIII of the Social Security Act. CIGNA may require such proof at least once each year until the end of the calendar year in which he attains age 30; and
- Who is 26 or more years old, and primarily supported by you and incapable of self-sustaining employment by reason of mental or physical handicap. Proof of the child’s condition and dependence may be required to be submitted to the plan as a condition of coverage after the date the child ceases to qualify above. However, if a claim is denied, proof must be submitted by the Employee that the child is and has continued to be mentally or physically handicapped.
- A child includes a legally adopted child, including that child from the date of placement in the home or from birth provided that a written agreement to adopt such child has been entered into prior to the birth of such child. Coverage for a legally adopted child will include the necessary care and treatment of an Injury or a Sickness existing prior to the date of placement or adoption. A child also includes a foster child or a child placed in your custody by a court order from the date of placement in the home. Coverage is not required if the adopted or foster child is ultimately not placed in your home. If your Domestic Partner has a child, that child will also be included as a Dependent. It also includes:
- a stepchild or a child for whom you are the legal guardian;
- a child born to an insured Dependent child of yours until such child is 18 months old.
Benefits for a Dependent child or student will continue until the last day of the calendar year in which the limiting age is reached.(1)
You must submit the benefits enrollment form within 45 days of your hire date. If you need to schedule an appointment with a member of the Employee Benefits Team, please contact the Human Resources Department at 305-673-7524. If the 45 day deadline is not satisfied, a member of the Employee Benefits Division will contact you prior to your benefit eligibility date which takes place on the 91st day following your date of hire. If you fail to submit a completed enrollment form by your benefit eligibility date, the final deadline for submitting the benefits enrollment form will take place 30 days after the benefit eligibility date. If this final deadline is missed and the Employee Benefits Team does not receive a completed enrollment form or signed waiver from you, your next opportunity to enroll will be during the plan’s annual open enrollment period during the month of August with coverage effective the following October, unless you experience a qualifying life event.
You must notify the Employee Benefits Team of a qualifying life event within 45 days (60 days to add newborns, adoption, or placement for adoption). (1)
Qualifying life events include:
- Acquiring a new Dependent. If you acquire a new Dependent(s) through marriage, birth, adoption or placement for adoption, you may request special enrollment for any of the following combinations of individuals if not already enrolled in the Plan: Employee only; spouse only; Employee and spouse; Dependent child(ren) only; Employee and Dependent child(ren); Employee, spouse and Dependent child(ren). Enrollment of Dependent children is limited to the newborn or adopted children or children who became Dependent children of the Employee due to marriage.
- Loss of eligibility for State Medicaid or Children’s Health Insurance Program (CHIP). If you and/or your Dependent(s) were covered under a state Medicaid or CHIP plan and the coverage is terminated due to a loss of eligibility, you may request special enrollment for yourself and any affected Dependent(s) who are not already enrolled in the Plan. You must request enrollment within 60 days after termination of Medicaid or CHIP coverage.
- Loss of eligibility for other coverage (excluding continuation coverage). If coverage was declined under this Plan due to coverage under another plan, and eligibility for the other coverage is lost, you and all of your eligible Dependent(s) may request special enrollment in this Plan. If required by the Plan, when enrollment in this Plan was previously declined, it must have been declined in writing with a statement that the reason for declining enrollment was due to other health coverage. This provision applies to loss of eligibility as a result of any of the following:
- divorce or legal separation;
- cessation of Dependent status (such as reaching the limiting age);
- death of the Employee;
- termination of employment;
- reduction in work hours to below the minimum required for eligibility;
- you or your Dependent(s) no longer reside, live or work in the other plan’s network service area and no other coverage is available under the other plan;
- you or your Dependent(s) incur a claim which meets or exceeds the lifetime maximum limit that is applicable to all benefits offered under the other plan; or
- the other plan no longer offers any benefits to a class of similarly situated individuals.
- Termination of Employer contributions (excluding continuation coverage). If a current or former Employer ceases all contributions toward the Employee’s or Dependent’s other coverage, special enrollment may be requested in this Plan for you and all of your eligible Dependent(s).
- Exhaustion of COBRA or other continuation coverage. Special enrollment may be requested in this Plan for you and all of your eligible Dependent(s) upon exhaustion of COBRA or other continuation coverage. If you or your Dependent(s) elect COBRA or other continuation coverage following loss of coverage under another plan, the COBRA or other continuation coverage must be exhausted before any special enrollment rights exist under this Plan. An individual is considered to have exhausted COBRA or other continuation coverage only if such coverage ceases: due to failure of the Employer or other responsible entity to remit premiums on a timely basis; when the person no longer resides or works in the other plan’s service area and there is no other COBRA or continuation coverage available under the plan; or when the individual incurs a claim that would meet or exceed a lifetime maximum limit on all benefits and there is no other COBRA or other continuation coverage available to the individual. This does not include termination of an Employer’s limited period of contributions toward COBRA or other continuation coverage as provided under any severance or other agreement.
- Eligibility for employment assistance under State Medicaid or Children’s Health Insurance Program (CHIP). If you and/or your Dependent(s) become eligible for assistance with group health plan premium payments under a state Medicaid or CHIP plan, you may request special enrollment for yourself and any affected Dependent(s) who are not already enrolled in the Plan. You must request enrollment within 60 days after the date you are determined to be eligible for assistance. (1)
Employees who elect to maintain health and/or dental coverage for their child after the end of the calendar year in which age 26 is attained will be required to pay 100% of the single plan premium for that covered child. For example, if employee John Smith requests to continue health coverage for his 27 year old daughter in addition to covering his spouse, his biweekly premium deductions under the Cigna OAP In-Network health plan (for January 2018) will be:
Health deduction one: OAP In-Network, Employee Plus One: $236 (biweekly)
Health deduction two: OAP In-Network, 100% Premium for 27 year-old child: $354 (biweekly)