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Benefits Forms for Enrollment, Changes, Beneficiary Designations and More

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Benefits Election Forms and Rates

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.

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)

Enrollment information is available online or by calling the City Benefits Office at 954-828-5160.

Benefits Change Forms

Cigna Forms (Medical, Pharmacy, Dental)

Deferred Compensation Retirement Plans

Nationwide 457 Enrollment/Change Forms

ICMA 457/401 Enrollment Forms

Domestic Partner Forms

Biometrics/Health Screening Verification Form If Using a Practitioner Not in the Cigna Network

Health Risk Assessment (HRA) Questionnaire

Address Change Form

Smoking/Tobacco Use Affidavit

Term Life Insurance

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

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