Department of Management Services

Dependent Eligibility Verification

To ensure accountability in the state group insurance program, effective July 1, 2018, the Division of State Group Insurance (DSGI) will be requesting documents as part of a monthly quality assurance review to confirm that an employee’s newly added dependents are eligible for insurance coverage. This process applies to new hires, marriages, births and other life events during the year as allowed by a qualifying status change (QSC) event. All employees who add new dependents during these QSC events will receive the documentation request. Documentation requests will be generated through People First and sent via email from the PeopleFirstNoReply@ngahosting.com email to the employee’s notification email in People First.  If the employee does not have a notification email, a letter will be mailed to the employee’s address on file.  You can view a Sample QA email (Adobe PDF Document 206.85 KB) and Sample QA letter (Adobe PDF Document 490.78 KB) from NGA for reference.

If employees do not send the required documents within 60 days from the date of the request or if their documents do not prove dependent eligibility, insurance coverage on the dependents in question will be removed prospectively.

  

Definition of an Eligible Dependent

As a reminder, an eligible dependent is defined as:

Your spouse — The person to whom you are legally married.

Your child — Your biological child, child with a qualified medical support order, legally adopted child, or child placed in the home for the purpose of adoption in accordance with applicable state and federal laws through the end of the calendar year in which he/she turns age 26.

Your stepchild — The child of your spouse for as long as you remain legally married to the child’s parent through the end of the calendar year in which he/she turns age 26.

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 through the end of the calendar year in which he/she turns age 26.

Legal guardianship — A child for whom you have legal guardianship in accordance with an Order of Guardianship pursuant to applicable state or federal laws or a child for whom you are granted court-ordered temporary or other custody through the end of the calendar year in which he/she turns age 26.

Your over-age dependent — After the end of the calendar year in which he/she turns 26 through the end of the calendar year in which he/she turns 30 – if he/she is unmarried, has no dependents of his/her own, is a resident of Florida or a full- or part-time student, and has no other health insurance.

Your over-age dependent with a disability — Your covered child with intellectual or physical disabilities. This child may continue health insurance coverage after reaching age 26 and while remaining continuously covered in a State Group Insurance health plan, or the child was over the age of 26 at the time of your initial enrollment. The child must be incapable of self-sustaining employment because of the intellectual or physical disability, and be dependent on you for care and financial support.

Newborn child of a covered dependent — A newborn dependent of a covered dependent – a newborn child born to a dependent while the dependent is covered under the Plan.  The newborn must have been added within 60 days of the birth. Coverage may remain in effect for up to 18 months of age as long as the newborn’s parent remains covered.

Children of law enforcement, probation, or correctional officers — Children of law enforcement, probation, or correctional officers who were killed in the line of duty and who are attending a college or university beyond their 18th birthday.

Surviving spouse and dependents — 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 death; or an employee or retiree who died before July 1, 1979; or a retiree who retired before January 1, 1976, under any state retirement system who is not eligible for any Social Security benefits. Upon remarriage, the widow or widower is no longer considered a surviving spouse. A surviving spouse shall report remarriage within 60 days of the remarriage. The surviving spouse and dependents, including any eligible children of a surviving spouse, if any, must have been covered at the time of the enrollee’s death and the coverage must have been continuous.

         

REQUIRED DOCUMENTS

All required documents MUST contain the date (including year), employee’s name, and dependent's name. Personal information such as income information listed on the tax transcript and social security information (except in the case of a disabled child or a spouse if you filed as Married Filing Separate) may be marked out for confidentiality purposes.

    

FOR SPOUSE:

  • If married less than 12 months and you and your spouse have not filed a federal income tax return as married, you will need to submit a copy of your government-issued marriage certificate, OR
  • If you and your spouse have been married for 12 or more months, a Tax Return Transcript of your most recently filed federal income tax return showing you filed as married, either jointly or separately. The tax return transcript is the only official record of the tax return that you filed with the IRS.  A copy of your tax return (Form 1040) will not be sufficient.  The Form 1040 can be falsified and is not an official record of what was filed with the IRS. You can request a copy of your transcript from the IRS at www.irs.gov/individuals/get-transcript or by calling the IRS at 800-908-9946.   Please submit ONLY the first page, showing yours and your spouse’s names or the last four digits of their Social Security number and tax filing period.  All other information should be marked out. If you are unable to obtain your transcript, please contact the Division of State Group Insurance.

    

FOR CHILDREN UP TO AGE 26:

  • For a child, stepchild, or adopted child : A copy of the child’s government-issued birth certificate or adoption certificate naming you or your spouse as the child's parent. Please note the document must list the first and last name of the child and parent(s).
  • For a child in your custody or under your guardianship : A copy of the court order naming you or your spouse as the child’s legal guardian or custodian.
  • For a foster child : A copy of the records showing you or your spouse as the dependent’s foster parent.
  • For a newborn child of a covered dependent up to age 18 months :  A copy of the newborn’s government-issued birth certificate listing your covered dependent as the birth parent.

 

FOR UNMARRIED CHILDREN AGE 26 UP TO AGE 30*:

  1. A copy of the child’s government-issued birth certificate or adoption certificate naming you or your spouse as the child's parent. Please note the document must list the first and last name of the child and parent(s); OR a copy of the court order naming you or your spouse as the child’s legal guardian or custodian; AND
  2. A copy of the Affidavit of Adult Child (Adobe PDF Document 93.45 KB), AND
  3. One of the following documents: 
    • A document confirming the child’s enrollment as a student in the current Spring, Summer, or Fall semesters.  The document must include the name of the child, the name of the school, and the school term; OR
    • A bill or statement in the child’s name that is dated within the past 60 days and is mailed to the child at a Florida address.

* If you are covering a stepchild or a child for whom your spouse has legal guardianship, you must also provide documentation of your current relationship to your spouse, as requested above.

         

FOR DISABLED CHILDREN AGE 26 AND OLDER:

  • A copy of the child’s government-issued birth certificate or adoption certificate naming you or your spouse as the child's parent. Please note the document must list the first and last name of the child and parent(s); OR a copy of the court order naming you or your spouse as the child’s legal guardian or custodian, AND
  • A Tax Return Transcript of your most recently filed federal tax return listing:
    • The child’s name and the last four digits of the child’s Social Security number; AND
    • The child as your tax dependent.

     The tax return transcript can be obtained from www.irs.gov/individuals/get-transcript or by calling the IRS at 800-908-9946.

  

              

Questions? Read our Frequently Asked Questions (Adobe PDF Document 217.47 KB)

Qualifying Status Change Matrix  (Adobe PDF Document 565.34 KB)