Dependent Verification | 2021 Plan Year | 2020 Plan Year | Additional Plan Documents

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Dependent Verification Requirement

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All employees and retirees who elect to enroll their spouse or dependent children in the District's group health plan (medical, dental or vision) are required to provide documentation verifying their dependent's eligibility for coverage under the District's group health plan.  Click on the links below for additional information.   

• Dependent Verification Guidelines for Group Health Plan
• Documentation Upload Instructions
• Tax Return Transcript (Instructions on how to request your transcript)
• Working Spouse Waiver Form

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2021 Group Health Plan

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Medical:  Florida Blue

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• 2021 Florida Blue Reference Guide
• 2021 Pharmacy Reference Guide
• 2021 Behavioral Health Reference Guide
• Getting Started Guide 
• 2021 Medical Plan Comparison Chart
• 2021 Basic HMO Plan
• 2021 Standard PPO Plan
• 2021 Premium HMO Plan 

Dental:  Delta Dental

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• 2021 Delta Dental Reference Guide
• Delta Care Schedule A
• PPO Plan Certificate of Coverage

Disability: Unum

• 2021 UNUM Reference Guide
• Unum Disability

Flexible Spending Accounts:  Health Equity (formerly WageWorks)

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• 2021 Health Equity Reference Guide
• Quick Start Guide
• Mobile App
• Medical FSA Carry Over
• Medical FSA Form
• Dependent Care FSA Form

Legal:  ARAG

• Summary of Benefits 
• Legal Mobile App
• Legal Insurance

Life:  Minnesota Life / Securian 

• 2021 Minnesota Life Reference Guide
• Certificate of Coverage

Vision:  Davis Vision

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• 2021 Davis Vision Reference Guide
• Benefit Summary 2020
• Mobile App 
• Benefit Summary 2021
• Option 1 - Designer 2021
• Option 2 - Premier Platinum Plus 2021
• Option 3 - Premier Platinum Plus (2) pair 2021

Voluntary/Ancillary Benefits:  Allstate

• 2021 Allstate Reference Guide
• 2021 Accident Brochure
• 2021 Cancer Protection
• 2021 Critical Illness Brochure
• 2021 Hospital Indemnity 
• Term to Age 100 Life Insurance
• 2021 Allstate Disclosure

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2020 Plan Year

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• Benefits Reference Guide

Medical:  Florida Blue

• 2020 Medical Plan Comparison Chart
• Summary of Benefits and Coverages
  • Basic HMO
  • Premium HMO
  • Standard PPO

Life:  Cigna/LINA

• Group Term Life Conversion Application
• Accidental Death & Dismemberment Conversion Application 
• Beneficiary Designation Form 

Voluntary/Ancillary Benefits:  Allstate

• 2020 Accident Protection 
• 2020 Cancer Protection 
• 2020 Critical Illness Brochure
• 2020 Hospital Indemnity
• Term to Age 100 Life Insurance

Additional Plan Documents

• Affordable Care Act
• Privacy Notice