Benefits

Medical FAQs

• Who is eligible?
• What is the cost to maintain insurance coverage while I am on an approved leave of absence (LOA)?
• May I delete dependents while in a no pay status?
• When does my insurance become effective as a new hire?
• May I go to the doctor on the effective date of my insurance?
• Are there any pre-existing condition exclusions?
• What happens if my dependent's last name differs from mine?
• My parent lives with me and I am the sole support, may I add him/her to my insurance?
• I included my dependent on my application for insurance coverage but the plan does not show him covered. Is there a problem?
• My divorce decree specifies that I am responsible for providing insurance coverage for my ex-spouse. May he/her continue group coverage?
• How much time do I have to add my new dependent to my insurance?
• May I delete my dependent(s) from my insurance?
• How may I receive a MetLife dental provider listing?
• When should I expect to receive an ID card from Optix vision plan?
• May I continue my insurance benefits if I terminate employment?
• May I borrow from my life insurance policy?

Who is eligible?

• Any full-time regular Miami-Dade County employee in an eligible class, who has completed 90 days of employment
• Any part-time employee who consistently works at least 60 hours bi-weekly and has completed 90 continuous days of employment.

What is the cost to maintain insurance coverage while I am on an approved leave of absence (LOA)?

The premium you are responsible for depends on the type of leave. If your leave is illness related, i.e. Family Medical Leave (FMLA), disability, worker’s compensation, maternity etc., you will only be responsible for paying the bi-weekly insurance contributions that are usually withheld from your paycheck. If your leave is other than illness related, i.e. educational, suspension, personal etc., you will be responsible for paying both the bi-weekly employee and County contributions. Your departmental personnel representative should provide you with an LOA informational package, billing notice and remittance form. Contact your departmental personnel representative (DPR) for further information.

May I delete dependents while in a no pay status?

You may delete your dependents by submitting the appropriate status change forms, to the Benefits Administration Unit, within 45 days of being in a no pay status.

When does my insurance become effective as a new hire?

Coverage for full-time employees become effective the first day of the month following or coincident to 90 days of employment, providing the appropriate application(s) is received by the Benefits Administration Unit prior to that date.  Part-timers must consistently work at least 60 hours bi-weekly for 90 consecutive days to be eligible for coverage. A completed beneficiary designation form must be submitted to enroll for group life and/or optional life benefits.  Employee must be actively at work for group life and optional life to be effective.

May I go to the doctor on the effective date of my insurance?

Yes. However, have the provider call the insurance company to verify coverage since your name may not appear on the monthly list the health plan provides to the doctor’s office.

Are there any pre-existing condition exclusions?

No. Medical, dental and/or vision coverage are guaranteed provided you enroll during your initial eligibility period or grace period, during the annual open enrollment period, or you qualify under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

What happens if my dependent's last name differs from mine?

You must provide the insurance company with proof of the dependent’s relationship to you, such as a marriage certificate, birth certificate or court order, to the health plan.

My parent lives with me and I am the sole support, may I add him/her to my insurance?

No. Your parent may not be enrolled for group insurance benefits under any circumstance.

I included my dependent on my application for insurance coverage but the plan does not show him covered. Is there a problem?

If your dependent’s last name differs from yours, the plan must receive proof of dependent eligibility prior to enrolling.

My divorce decree specifies that I am responsible for providing insurance coverage for my ex-spouse. May he/her continue group coverage?

No. Your ex-spouse does not qualify to continue insurance coverage through the active group.  However, he/she maybe eligible for COBRA coverage for up to 36 months providing the Benefits Administration Unit is advised within 60 days from the date of the divorce.  Coverage is identical to benefits provided to active employees.

How much time do I have to add my new dependent to my insurance?

The status change forms must be received in the Benefits Administration Unit within 45 days of acquiring the dependent through birth (60 days for newborns), marriage, adoption or placement for adoption.  If proof of the event is not available at the time the status change forms are submitted, it must be provided as soon as available.

May I delete my dependent(s) from my insurance?

Yes. Providing you satisfy a qualifying event and the Benefits Administration receives the completed status change forms within 45 days from the event. Examples of qualifying events, which allow you to delete dependent(s), are divorce, death, marriage of dependent child, beginning of spouse’s employment, unpaid leave of absence etc. If proof of the event is not available at the time the status change forms are being submitted, it must be provided to the Benefits Administration Unit as soon as possible. 

How may I receive a MetLife dental provider listing?

You may request a dental listing by calling MetLife at (800) 845-1870 or visiting their website www.metlife.com.

When should I expect to receive an ID card from Optix vision plan?

Optix does not issue ID cards. If you are enrolled in the Optix Plan, you may receive services from any of the participating providers. You also have the option of utilizing the services of a provider of your choice, then file a claim and be reimbursed according to the schedule of benefits.

May I continue my insurance benefits if I terminate employment?

You will be eligible to continue medical, dental and vision coverages under COBRA for up to 18 months.  You will be notified of your COBRA rights upon termination. If you are enrolled for group life or optional life insurance you will be able to purchase a conversion policy upon termination. You will receive the COBRA notice automatically when the termination is processed in the payroll system. Make sure your department updates your address, if applicable, in the payroll system.

May I borrow from my life insurance policy?

No.The life insurance policy is a term policy and there is no cash value.

Back to Top Page Last Edited: Mon Sep 19, 2011 4:02:42 PM