Sapiro Law Office

State of Florida Disability Retirement Claims

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 by selecting family coverage. Eligible dependents include:

Your legal spouse
Your natural children, legally adopted children and children placed in the home for the purpose of adoption in accordance with Chapter 63, Florida Statutes
Your stepchildren
Your foster children
Your children for whom you have established legal guardianship, Chapter 744, Florida Statutes, or court-ordered temporary custody
Your children with a qualified medical support order requiring you to provide coverage
A newborn dependent of a covered dependent – a newborn child born to your dependent while he or she is covered under your health insurance plan. You must add the newborn within 60 days of the birth. Coverage may remain in effect for up to 18 months or until your dependent becomes ineligible

Dependents Eligible for Coverage

In accordance with 60P, Florida Administrative Code, children must meet specific eligibility requirements to be covered under State Group Insurance plans.

Children from birth through the end of the calendar year in which they turn age 26.
For an additional monthly premium, children ages 26 to 30 as over-age dependents if:
They are unmarried, and
They have no dependents of their own, and
They are dependent on you for financial support, and
They live in Florida or attend school in another state, and
They have no other health insurance.
Children with permanent mental or physical disabilities after they reach age 26 if:
They are unmarried, and
They are enrolled in a State Group Insurance health plan before they turn age 26, and
They are incapable of self-sustaining employment because of mental or physical disability, and
They are dependent on you for care and financial support.

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 or if you must mail in payment post-tax. Call the People First Service Center for more information.

Coverage for Children with Disabilities

If you have a child over the age of 26 with a mental or physical disability who meets the above eligibility criteria at the time you first enroll in the State Group Insurance Program, you may enroll that child in your plan.

The treating physician must provide documentation supporting the mental or physical disability while the dependent is still covered under your plan. You must submit the documentation to your health insurance company upon request for review and confirmation. Disability status is verified at least every five years. If you fail to provide the required documentation or your dependent no longer meets eligibility requirements, you may be liable for medical and prescription claims or premiums back to the date you enrolled.

Surviving Spouse

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 be continuous.

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.

If I can be of assistance to you, or a family member, please send me an email or call my disability law practice at (786) 242-4146.