Overage Dependent Rules
Benefit Eligible Dependent Requirements
-
Your legal spouse as defined by Federal law
-
Your dependent children, until the end of the year they turn age 26, regardless of marital, financial, or student status including:
•Your biological children, legally adopted children or stepchildren;
•Children for whom you have been appointed legal guardian;
•Children for whom you have been court ordered to provide coverage (QMCSO); and
•Children of a currently enrolled dependent (e.g., your grandchild) who may be enrolled in the medical plan for 18 months from birth only if born on the plan.
•Spouses of dependent children are NOT covered -
Your dependent children, age 26 until the end of the year they turn 30, who meet all of the following criteria:
•Unmarried with no dependent children of their own;
•A resident of Florida, or a full-time or part-time student;
•Not enrolled in any other health coverage; and
•Not entitled to Medicare. -
Your dependent child with a disability may be covered after age 26 if:
•They are enrolled in the plan before they turn age 26;
•They are mentally or physically disabled and incapable of self-sustaining employment;
•They are chiefly dependent on you for care and financial support; and
•They are unmarried.
Dependent Documentation
Proof of Dependent Eligibility documents must be provided within 30 days of enrollment. If not, your dependent(s) will be retroactively terminated. Dependent documentation may be uploaded in primeBENEFITS.
Why do I have to provide documentation for my dependents?
Volusia County Schools must satisfy state and district audit requirements regarding our group health plan, which includes obtaining proof that all dependents enrolled in our health plan are eligible for coverage based on the plan’s eligibility rules.
Providing appropriate documentation on your part may protect you from penalties associated with section 831.01, Florida Statutes and Subscriber Fraud.
Examples of who is NOT covered:
- Boyfriends and girlfriends
- Ex-spouses and ex-stepchildren
- Dependents for whom you have not provided proof
- Parents and siblings
- Unmarried partners