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Medical & Dental Eligibility

Medical & Dental Eligibility

Medical & Dental Plan: Eligibility & Required Documentation

Dentist working on computer

Spouses, children to age 26, and children under legal guardianship to age 18, are eligible for coverage under the Manatee YourChoice Health Plan. There are very specific criteria and required documentation that must be met for eligibility. Read More to determine whether your dependent(s) is eligible.

DUE DATES:

A new hire's enrollment into the health plan, along with dependent(s) and supporting documentation must be completed by the assigned due date to guarantee benefits and to receive medical/dental ID cards.

A Family Status Change must be submitted using the enrollment system, including uploading supporting documents, within 31 days of the change for marriage, divorce, and loss or gain of other coverage, or 60 days for birth or adoption of a child, or loss or gain of a state-funded program.

Is my Spouse eligible?

Your spouse is eligible if his/her name is included on the marriage certificate. Required Document: Marriage Certificate.

Is my natural child to age 26 eligible regardless of residency, student status, or marital status?

Your natural child is eligible if he/she is under the age of 26*. In order for your child to be a natural child, your name must appear on the birth certificate or other legal document that establishes paternity. Required Documents: Birth Certificate, and/or applicable documentation.

Is my stepchild eligible?

Your stepchild is eligible if he/she is under the age of 26*.
Required Documents: Stepchild's Birth Certificate with Spouse as parent and Marriage Certificate.

Is my adopted child or child under guardianship/custodianship eligible?

Your adopted child is eligible if he/she is under the age of 26.
Required Documents: Court Order of Legal Adoption.

Your child under guardianship/custodianship is eligible if he/she is under the age of 18.
Required Documents: Court Order signed by a judge authorizing custody or guardianship.

Is my disabled child eligible?

Your disabled child is eligible if he/she was a dependent on the plan before the age of 26 and became incapable of working, due to a disability, before reaching the age of 26 and is financially dependent on you.
Required Documents: Birth Certificate and Provide Proof from a physician on incapacity and dependency as requested by the Plan Administrator.

Is my grandchild eligible?

Your grandchild is eligible if he/she was born to a covered dependent and is living with you and is financially dependent on you.
Required Documents: Birth Certificate of Dependent Child, Birth Certificate of Grandchild
NOTE: Insurance is available until the last day of the month in which the child reaches 18 months or the child's parent is no longer a qualified dependent under the plan, or if the grandchild no longer resides with the employee, whichever comes first.

Is my Dependent Child from age 26-30 years old Eligible?

Your Dependent Child from age 26 to 30 is eligible for an additional medical premium if he/she is:

  • a resident of the state of Florida or is a student full/part time and
  • is unmarried with no dependents and
  • does not have other private insurance coverage or is not entitled to benefits under the Social Security Act and is
  • not on military duty. Required Documents: Birth Certificate, Proof of Enrollment from school's Registrar Office.

*Coverage is available through the end of the month the child turns age 26 (18 if under guardianship).

Documentation Required on Eligible Dependents
GENERAL STANDARDS FOR DETERMINING WHETHER A DOCUMENT IS VALID:
  • Document must be issued by a governing agency (Country, State, County, and/or Court)
  • A commemorative certificate published by a church or hospital is not acceptable.
  • Document must be signed by an authorized agent
  • Judge, Clerk, Physician, etc.
  • Document must have dependent's name clearly displayed
  • Document must have the covered employee's name clearly displayed or the document should be easily traced to a subsequent document that does display the covered employee's name
  • Document must clearly display the date of the life event (birth, marriage, divorce, adoption, etc.)
WHERE CAN YOU OBTAIN COPIES?
Birth Certificate
Florida State Records in Manatee County:

Record Request can be handled at the Manatee County Department of Health Office of Vital Statistics: 410 6th Ave East, Bradenton, FL 34208-1928 * (941) 748-0747 x1222
http://www.doh.state.fl.us/planning_eval/vital_statistics/birth_death.htm

Court Orders/Divorce Decrees/Marriage Certificates

Manatee County Record Request can be handled by the Clerk of the Circuit Court Recording Division: 1115 Manatee Ave W, Bradenton, FL 34205 * (941) 749-1800 * M-F 8:30am-5pm

Out of State Documents:

May be obtained for a fee at: www.vitalrec.com