The Florida KidCare form is a crucial document that helps determine eligibility for health insurance coverage for children in Florida. It requires information from employers regarding the income of family members applying for KidCare. To get started, fill out the form by clicking the button below.
The Florida KidCare form is a crucial document for families seeking health insurance coverage for their children. It requires information from both the employee and the employer to assess eligibility for the KidCare program. The process begins with the employee completing Section A, where they provide their family account number, authorize the release of employment information, and sign the form. This section is essential as it establishes the employee's consent for their employer to disclose necessary details. Employers then fill out Section B, answering specific questions about the employee's work hours, pay frequency, and gross pay rate. This information helps determine the family's eligibility for KidCare health insurance. If the employee has variable hours or pay, the employer is asked to explain the reasons for these fluctuations. The form concludes with an employer statement affirming the truthfulness of the provided information, emphasizing the importance of accuracy to avoid potential legal consequences. Once completed, the form must be submitted to Florida KidCare at the specified address to ensure timely processing of the application.
FLORIDA KIDCARE
EMPLOYMENT STATEMENT
General Directions: Copy this form and have it completed by each employer that provides income to a family member on the KidCare application. If you provide recent pay stubs, you do not need this form completed.
Complete Section A and submit to employer for completion. Completed form must be returned to Florida KidCare, P O Box 591, Tallahassee, Florida, 32302-0591.
Section A – To Be Completed by Employee
Family Account Number: __________________________
I authorize the release of employment information for the purpose of determining KidCare eligibility.
Employee Signature: _________________________________ Date: ___________________
Employee Name: _____________________________ Employee SSN: __________________
(please print)
Section B – To Be Completed by Employer
Directions: This information is needed to help determine eligibility for KidCare Health Insurance. Please assist us by answering the following questions for the employee listed above, and returning this form to: Florida KidCare, PO Box 591, Tallahassee, Florida, 32302-0591.
(1) Number of Hours Worked Per Week: _______
Number of Days Worked Per Week: _______
(2) How often is the employee paid:
_ Daily
_ Weekly _ Bi-Weekly _ Monthly
_ Twice Monthly
_ Other: _______________
(explain)
(3) Rate of gross pay: $ ___________ per _________________
Hour/Day/Week/etc.
(4)If hours or rate of pay has varied in the above period, please state why (include tip information here): ________________________________________________________________________
______________________________________________________________________________
(5)Employer Statement: What I have written on this form is true to the best of my knowledge. I know that if I give false information on purpose, I may be subject to prosecution for fraud.
_____________________________________
______________________________________
Signature of Employer
Employer’s Title
(________) ___________________________
Name of Employer (please print)
Employer’s Telephone Number
Name of Business
Date Completed
Business Address
City, State, Zip
T24m
Completing the Florida KidCare form requires careful attention to detail to ensure accurate submission. This process involves gathering information from both the employee and the employer. Follow these steps to fill out the form correctly.
What is the Florida KidCare Employment Statement?
The Florida KidCare Employment Statement is a form that helps determine eligibility for KidCare Health Insurance. It collects necessary employment information from employers about a family member applying for KidCare. If recent pay stubs are provided, this form is not required.
Who needs to complete this form?
What information is required from the employee?
The employee must provide their family account number, signature, name, and Social Security number. They also need to authorize the release of their employment information.
What does the employer need to fill out?
The employer must answer several questions regarding the employee's work schedule, payment frequency, gross pay rate, and any variations in hours or pay. Additionally, they must sign the form to confirm the information is accurate.
Where do I send the completed form?
Once completed, the form should be sent to Florida KidCare at P.O. Box 591, Tallahassee, Florida, 32302-0591. Ensure it is mailed promptly to avoid delays in the application process.
What if I have recent pay stubs?
If you provide recent pay stubs, you do not need to complete the Florida KidCare Employment Statement. The pay stubs will serve as sufficient proof of income for the application.
How often should the employer report the hours worked?
The employer needs to report the number of hours worked per week and the number of days worked per week. This information helps determine the employee's eligibility for KidCare.
What happens if the employer provides false information?
Employers must provide accurate information on the form. If false information is given intentionally, the employer may face legal consequences for fraud.
Can I submit the form electronically?
Currently, the form must be printed, completed, and mailed to Florida KidCare. Electronic submissions are not accepted at this time.
What if my employer refuses to complete the form?
If your employer refuses to complete the form, you may need to discuss the situation with them. Alternatively, you can provide recent pay stubs or seek assistance from your local KidCare office for further guidance.
Filling out the Florida KidCare form can be a straightforward process, but many make common mistakes that can delay their application. One major error is failing to provide a complete Family Account Number. This number is crucial for identifying the application and ensuring that the information is processed correctly. Without it, the form may be returned or not linked to the right family.
Another frequent mistake is neglecting to sign the form. The employee's signature is necessary to authorize the release of employment information. If this signature is missing, the form will be considered incomplete. It is essential to double-check that all required signatures are present before submitting the form.
Many applicants also overlook the importance of providing accurate income details. In Section B, employers must fill out specific information about hours worked, pay frequency, and gross pay rate. If any of this information is incorrect or vague, it can lead to misunderstandings about eligibility. It is important for both the employee and employer to review this section carefully.
Additionally, some people forget to include information about variable hours or pay rates. If the employee's hours or pay have changed, this should be clearly explained on the form. Failing to provide this context can result in delays or complications in the eligibility determination process.
Lastly, many applicants do not verify that the form is submitted to the correct address. The completed form must be sent to Florida KidCare at the specified P.O. Box in Tallahassee. Sending it to the wrong location can cause significant delays in processing. Always double-check the mailing address before sending in the form to ensure it reaches the right destination.
When applying for Florida KidCare, several other forms and documents may be required to support the application process. These documents help establish eligibility and provide a comprehensive view of the applicant's situation. Below is a list of commonly used forms that accompany the Florida KidCare application.
Each of these documents plays a vital role in ensuring that the application for Florida KidCare is complete and accurate. By providing the necessary information, families can facilitate the process and improve their chances of obtaining the health coverage they need.
The Florida KidCare Employment Statement serves a specific purpose in determining eligibility for health insurance for children. Several other documents share similarities in their function and structure. Here is a list of ten such documents:
When filling out the Florida KidCare form, it is essential to follow specific guidelines to ensure the process runs smoothly. Below are seven important do's and don'ts to keep in mind.
Following these guidelines can help facilitate the application process for Florida KidCare, ensuring that all necessary information is accurately provided and submitted. This attention to detail can ultimately assist in determining eligibility for health insurance coverage for children.
Understanding the Florida KidCare form can be challenging, and several misconceptions may lead to confusion. Here are eight common misconceptions, along with clarifications to help guide you through the process.
This is not entirely accurate. While Florida KidCare is designed to assist families with limited financial resources, it is available to a broader range of income levels. Eligibility is determined based on various factors, not just income.
In reality, you only need to complete the form for the child applying for coverage. However, if there are changes in household income or employment, updates may be necessary.
This is misleading. If you provide recent pay stubs, you do not need to have the Florida KidCare form completed by your employer. Pay stubs can often provide the necessary information for eligibility assessment.
Employers are not required to complete the form on the spot. They can take the time needed to gather the required information before returning it to you or sending it directly to Florida KidCare.
This is incorrect. The information provided on the Florida KidCare form is confidential and is used solely for the purpose of determining eligibility for health insurance coverage.
Currently, the Florida KidCare form must be submitted by mail. It is important to ensure that the completed form is sent to the correct address to avoid delays in processing.
This is a common misunderstanding. Part-time employees also need to complete the form if they are contributing income to the household. All sources of income are relevant for eligibility determination.
This is not the case. The form must be completed by the employee whose income is being reported. This ensures that the information is accurate and verifiable.
By addressing these misconceptions, families can better navigate the Florida KidCare application process and ensure they receive the support they need.
When filling out and using the Florida KidCare form, it is essential to follow specific guidelines to ensure a smooth application process. Here are some key takeaways to keep in mind:
By following these guidelines, you can help facilitate the determination of eligibility for KidCare Health Insurance for your family. Remember, the process is designed to be straightforward, and assistance is available if needed.