Benefits Forms: Enrollment, Changes, Beneficiary Designations & More
Benefits Election Forms and Rates
Active Employees:
Benefits Change Form
Adult Dependent Child 26- to 30-Years-Old
City of Fort Lauderdale employees may obtain medical coverage for their 26- to 30-year-old adult dependent children who do not have medical insurance coverage. This coverage complies with Florida Statute 627.6562. The premium for an adult dependent child is deducted post-tax. The premium for an adult child is deducted post-tax and is also in addition to the base medical premium (deducted pre-tax).
Eligibility restrictions under the Florida Statute for 26- to 30-year-old adult dependent children are all of the following:
- The child is dependent upon the covered employee for support,
- The child is living in the household of the covered employee, or the child is a full or part-time student,
- Child is unmarried and does not have dependents of their own
- Is a resident of Florida or, if out-of-state, is a full or part-time student; and,
- Does not have any other health insurance coverage (including Medicare)
2026 Adult Child Verification Form(PDF, 313KB)
Benefits Bridge Individual Healthcare Plan
Employees also have the option to obtain individual medical coverage for their adult dependent child through the ACA Marketplace. The City's voluntary benefits broker, FBMC, provides a Benefits Bridge program to assist employees, and their covered dependents, with finding and enrolling in individual coverage alternatives. Please see flyer for more details and contact information.
For enrollment information please call the City Benefits Office at 954-828-5160.
Deferred Compensation Retirement Plans
Domestic Partner Forms
Biometrics/Health Screening Verification Forms
Smoking/Tobacco Use Affidavit
Wellness Incentive Program
For Federation of Public Employees Group Not Enrolled in a Medical Plan with the City Only
For Eligible Employees Enrolled in a City Medical Plan as a Dependent/Spouse/DP of Another City of Fort Lauderdale Employee