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• I� . City of Cocoa I Employee Benefit Highlights 12020-2021 •0.1 Group Insurance Eligibility oc,0B. The City's grout m5urance clan year 15 Dependent Age Requirements(Continued) 111 October I through Se +.ember 30. Dental Coverage:A dependent child may be covered through end of calendar year in which child turns age 26. Please note:Deductible and annual maximums are January 1 to December 31. Vision Coverage:A dependent child may be covered through end of calendar year in which child turns age 26. Employee Eligibility Employees are eligible to participate in the City's insurance plans if they are full- Disabled Dependents time employees working a minimum of 30 hours per week.Coverage will be Coverage for an unmarried dependent child may be continued beyond age 26 if: effective the 1st of the month following 60 days of employment. For example,if an employee is hired on April11,then the effective date of coveragewill be July 1. • The dependent is physically or mentally disabled and incapable of self-sustaining employment(prior to age 26);and Separation of Employment • Primarily dependent upon the employee for support;and If employee separates employment from the City, insurance will continue • The dependent is otherwise eligible for coverage under the group through the end of month in which separation occurred.COBRA continuation medical plan;and of coverage may be available as applicable by law. • The dependent has been continuously insured Proof of disability will be required upon request.Please contact the Human Dependent Eligibility Resources Division if further clarification is needed. A dependent is defined as the legal spouse and/or dependent child(ren)of the participant or spouse.The term"child"includes any of the following: Taxable Dependents • A natural child A legally adopted child Employee covering adult child(ren) under employee's insurance plan may continue to have the related coverage premiums payroll deducted on a pre-tax • A stepchild basis through the end of the calendar year in which dependent child reaches • A newborn child(up to the age of 18 months)of a covered age 26.Beginning January 1 of the calendar year in which dependent child dependent(Florida) reaches age 27 through the end of the calendar year in which the dependent • A child for whom legal guardianship has been awarded to the child reaches age 30, imputed income must be reported on the employee's participant or the participant's spouse W-2 for that entire tax year and will be subject to all applicable Federal,Social -. - - ; Security and Medicare taxes.Imputed income is the dollar value of insurance coverage attributable to covering each adult dependent child.The imputed Dependent Age Requirements income value per pay period for coverage an overage dependent under the Medical Coverage:A dependent child may be covered through the City's medical plan for the period of October 1,2020—September 30,2021 is end of the calendar year in which the child turns age 26. An over- as follows: age dependent may continue to be covered on the medical plan to Imputed Income Value the end of the calendar year in which the child reaches age 30,if the ' 24 Bi Weekly Deductions Per Pay Period Cost dependent meets the following requirements: Plan Income Value • Unmarried with no dependents;and i Cigna Core Plan S25030 • A Florida resident,or full-time or part-time student;and — -- • Otherwise uninsured;and Note:There is no imputed income if an adult dependent child is eligible to be claimed • Not entitled to Medicare benefits under Title XVIII of the • as a dependent for Federal income tax purposes on the employee's tax return.Overage Social Security Act,unless the child is disabled. Dependent Affidavit must be completed and turned into the Human Resources Division. Please see Taxable Dependents if covering eligible over age dependents. This form can be found in Bentek.Contact the Human Resources Division for further details if covering an adult dependent child who will turn age 17 any time during the upcoming calendar year or for more information. 11 3 0 2016,Gehring Group,Inc.,All Rights Reserved