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City of Tallahassee
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Retirees

Frequently Used Forms

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  • Name/Address Change Form
  • Direct Deposit Form
  • Beneficiary Designation Form
  • W‐4P Withholding Certificate for Pension or Annuity Form
    • To submit W4P for Pension Select, please email Payroll
  • Discontinue Health Insurance
  • Non‐Taxable Pension Payment

Information on Plans, Dependents and Domestic Partners

  • Medical and Voluntary Benefit Plans
  • Benefit Providers Contact List and Age Limits
  • Important Definitions of Legal Dependents, Domestic Partners & Over-Age Dependents
  • Domestic Partnership For Retirees Affidavit
  • Domestic Partnership Termination Affidavit
  • Summary of Federal and State Regulations Impacting Employee Benefits

Medical Plans

Important Information on Medical Plans

Coverage Changes: If you discontinue/cancel medical coverage on or after your retirement date, you are eligible to re-join the City's medical plan during the annual enrollment period - or if you experience a qualifying event - as long as you provide proof of continuous coverage from another medical plan provider from time of https://app.sitio.ai/scan?url=https://app.sitio.ai/website-data/assets/173/www.talgov.com/employment/retire_retirees#:~:text=cancellation-,cancelation,-1%20/2 through time of re-application. This applies only to you (the retiree), and not to the https://app.sitio.ai/scan?url=https://app.sitio.ai/website-data/assets/173/www.talgov.com/employment/retire_retirees#:~:text=cancellation-,cancelation,-1%20/2 of coverage for any dependents. (Note: The Internal Revenue Service defines a qualifying event as any event that affects your benefits coverage or your dependent's benefits coverage.)

Taxable Premiums: Once you leave the City, insurance premiums deducted from monthly pension payments are taxable and will be included in the amount on which Federal Income Tax Withholding is calculated. Premiums for domestic partners, domestic partner dependents and over-age dependents are deducted on an after-tax basis and may be subject to taxes. (Please seek the guidance of a tax professional if needed.)

Pension Protection Act of 2006: This legislation allows "eligible retired public safety officers" to elect to exclude from gross income certain deductions made from your Pension Plan to pay for "qualified health insurance premiums." The exclusion is limited to the amount of annual premiums paid up to $3,000.

FL Blue/CHP Rates and Benefits
  • Medical Rate Schedule
  • Medical Rate Two Year Comparison
  • Medical Rates for Over-Age Dependents
FL Blue
  • FL Blue Website
  • FL Blue Summary of Benefits and Coverage
  • FL Blue Summary for Covered Services
  • FL Blue Notice of Special Enrollment Rights
  • FL Blue Enrollment Form
  • FL Blue Dependent Verification Form
  • FL Blue Prior/Concurrent Coverage Affidavit
  • FL Blue Status Change Form
  • FL Blue Medicare Summary of Benefits
  • FL Blue Medicare Advantage Enrollment Form
  • FL Blue Medicare Coverage for Retirees FAQs
Capital Health Plan
  • CHP Website
  • CHP Summary of Benefits
  • CHP Enrollment Form
  • CHP Status Change Form
  • CHP Physician List
  • CHP Over-Age Dependent Enrollment Form
  • CHP Medicare Advantage Made Easy Brochure
  • CHP Medicare Advantage Summary of Benefits
  • CHP Medicare Advantage Schedule of Copayments
  • CHP Medicare Advantage Enrollment Form
  • Helpful Videos
    • Medicare Made Easy
    • Connect to Care - ER vs. Urgent Care vs. Amwell

Additional Medical Programs and Forms

Florida Blue (FL Blue)

Florida Blue Member Guides

Blue Options Benefit Booklet
Blue Options PPO Guide
Blue Options Plan Document
Notice of Creditable Coverage
FL Blue Provider Search

Care Programs

FL Blue Center Care & Service
FL Blue Care Member Flyer
FL Blue Care Centrix
FL Blue "Better You Care" Overview
FL Blue Member Videos
FL Blue Healthy Addition
FL Blue Compare Medical Costs - Know Before You Go
FL Blue Personal Care Service-Care Consultant

Discount Programs

FL Blue Discount Programs
FL Blue Blue365 Product Overview Handout
FL Blue Blue365 Resources for Better Health
FL Blue Blue365 Staying Healthy Just Got Less Expensive

Pharmacy Information

FL Blue Medication Guide
FL Blue Medication Guide Update-Open
FL Blue Pharmacy (RX) Mandatory Generic Substitution FAQs
FL Blue Pharmacy (RX) Responsible Steps Program FAQs
FL Blue Prime Mail Pharmacy Service

Preventative Care Guidelines

FL Blue Preventative Care Guidelines
FL Blue New Direction Member Flyer

National / International Coverage

FL Blue Care Outside Florida
FL Blue National and International Coverage Comparison Chart
FL Blue Blue Card Brochure

Compliance / Privacy
FL Blue PHI Release Form

Capital Health Plan (CHP)

Capital Health Plan is a comprehensive medical plan called a Health Maintenance Organization, or HMO. Unlike traditional insurance, which pays claims after care is rendered, this plan arranges in advance with physicians and hospitals to provide care to its members and pays them directly for their services. By controlling unnecessary or inappropriate care, it can afford to offer a more comprehensive range of benefits than many traditional insurance plans.

Residency Requirement: To be eligible for membership you must live in the CHP Service area (Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty or Wakulla Counties). If you move out of the service area, you are not allowed to continue coverage with CHP. However, you have the option at that time of changing to FL Blue.

CHP Member Guides

CHP Plan Document
CHP Notice of Creditable Coverage
CHP Provider Search

Care Programs

CHP Urgent Care Website
CHP Urgent Care Brochure

Discount Programs

CHP Health & Fitness Reimbursement
CHP Community Weight Loss Options

Pharmacy Information

CHP Medication Guide
CHP LabCorp FAQs
CHP LabCorp Map
CHP PrimeMail Rx Delivery Brochure

Preventative Care Guidelines

CHP Preventive Health
CHP Preventive Care Guidelines

National / International Coverage

CHP Away from Home Brochure
CHP Worry Free Travel

Compliance / Privacy

CHP Special Enrollment Rights
CHP PHI Release Form

Voluntary Plans

Important Information on Voluntary Plans

Coverage Cancellation: Retirees with the City of Tallahassee are allowed to continue their voluntary benefit plans with ARAG, Davis Vision, Delta Dental, and MetLife after retirement provided they were enrolled when they retired. Please be aware that if you decide to cancel an existing policy, you will not be allowed to join in the future.

Coverage Changes: A retiree may only continue the voluntary benefit plans they were enrolled in and approved for at retirement (exceptions: MetLife Accidental Death, MetLife Long Term Disability and the Health Care Spending Account are not continued at retirement). Retirees may only continue the coverage level they were enrolled in at retirement; therefore they cannot add dependents or increase the amount of coverage for their voluntary benefits after retirement. A retiree may drop a dependent or decrease the amount of their benefit; however, these changes are permanent and cannot be undone at later date.

Taxable Premiums: Once you leave the City, insurance premiums deducted from monthly pension payments are taxable and will be included in the amount on which Federal Income Tax Withholding is calculated.

Dependents: It is your responsibility to notify the Retirement Office if any dependent on a policy has reached the age at which they are no longer eligible for coverage.

Legal Insurance
  • ARAG Legal Website
  • ARAG Plan Summary
  • ARAG Rate Schedule
Dental
  • Guardian Website
  • Guardian Plans
  • Guardian Benefits Hotline
  • Guardian Dental Certificate
  • Dental Rate Schedule
  • Dental Member Status Change
  • Transition of Dental Treatment in Progress
Vision
  • Davis Vision Website (Client Code 3671)
  • Davis Vision Plan
  • Davis Vision Rate Schedule
  • Vision Member Status Change
MetLife
  • MetLife Your Benefit Plan
  • MetLife Plan Booklet
  • MetLife Will Preparation
  • MetLife Beneficiary Designation Form
  • MetLife Change Request Form
  • MetLife Rate Schedule
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