Department of Management Services

Dependent Eligibility Verification Phase II

The Division of State Group Insurance (DSGI) is contracting with a private company to audit whether your dependent(s) are eligible to participate in the State Group Insurance Program. The audit will begin on December 1, 2017. You must respond to any requests for documentation to verify the eligibility of your dependent(s). More details will be provided in your Open Enrollment package which you will receive in October 2017. 

An amnesty period will occur through November 30, 2017. If you remove ineligible dependents from coverage before December 1, 2017, you will be held harmless for past claims of ineligible dependents. You may remove ineligible dependents at any time by calling People First at 866-663-4735 or online during Open Enrollment from October 16, 2017 through November 3, 2017.  

For more information, please see the Dependent Eligibility Verification Audit FAQs (Adobe PDF Document 217.47 KB).

Eligible Dependents are:

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.