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Employee Benefits

20 E. Main St., Suite 600
Mesa, AZ 85201

Hours of Operation

M-Th 7am-6pm
Closed Fridays & Holidays

Contact Information

480-644-2299
benefits.info@mesaaz.gov

Important Documents, Forms & Notices

Plan Document

Benefit Enrollment/Change Form

Qualifying Event/Special Enrollment

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In the event you have a change in your family, you will most likely need to make a relevant change in your benefits coverage, such as adding or dropping a dependent to or from your health plan. But there may also be other actions you need to take or at least consider such as updating your life insurance beneficiaries.  The following information will explain the time frames and steps to follow based on your qualifying event.

Adding Dependents

If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll your eligible dependents, however, you must request enrollment within 31 days of the qualifying event.  You also may be able to enroll yourself and your dependents in this plan if you or your dependents lose coverage with another insurance plan. However, you must request enrollment within 31 days of the date you or your dependent's other coverage ends.

Adding Dependent due to Birth/Adoption

  1. Complete the benefit enrollment form including the plan selections and social security numbers (if available).
  2. Proof of birth (birth certificate/adoption papers) are needed with the Insured's name noted as parent on paperwork.
  3. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.
  • You have 31 days from the date of birth (or placement for adoption, whichever is later) to add the newborn to your benefit plans.
  • Baby will be added to the plan(s) as of the date of birth (or placement for adoption, whichever is later).
  • If 31 days has passed, the baby cannot be added until the next open enrollment effective the first of the following year.
  • Please do not wait for a birth certificate or social security card to add the newborn. An enrollment form to add the newborn/adoption must be submitted before the 31 day deadline.

Adding Spouse (Marriage)

  1. Complete the benefit enrollment form including the plan selections and social security number.
  2. A copy of the marriage certificate is required to add spouse.
  3. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.

  • Insured has 31 days from the marriage date to add spouse to your benefit plans.
  • The change will take effect as of the date of marriage or the first of the month following the marriage date (your choice).
  • If 31 days has passed, the spouse cannot be added until the next open enrollment effective the first of the following year.

Loss of Other Coverage (for example spouse loses coverage at their current employment)

  1. Complete the benefit enrollment form including the plan selections and social security numbers (if available).
  2. A copy of proof of loss of benefit coverage is required to add the new member, additionally a birth certificate, guardianship papers, court documents, child support decree, or marriage certificate to verify relationship to employee/retiree, as may apply.
  3. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.

  • You have 31 days from the qualifying event loss of other coverage to add the new member to your benefit plans.
  • The change will take effect the first of the month following the change. (i.e. loss of coverage June 15, coverage will start with the City of Mesa July 1).
  • If 31 days has passed, the member cannot be added until the next open enrollment effective the first of the following year.


Removing/Dropping Dependents

Retirees may voluntarily drop dependent coverage at any time and must drop ineligible dependents according to the guidelines below.  Active employees may drop dependent coverage during Open Enrollment or due to a qualified change in family status or ineligibility which include:

  • Divorce (provide Benefits with a copy of divorce decree--notify within 31 days)
  • Legal separation (provide Benefits with a copy of legal separation documentation--notify within 31 days)
  • Death of dependent (provide Benefits with a copy of the death certificate)
  • Dependent child aging out (dependent children are eligible until the end of the month in which they are age 26, unless they are disabled. Please refer to the Plan Document for requirements to keep your disabled child on your health plan after they turn age 26--notify within 31 days)
  • Dependent acquires other insurance through their employer (provide Benefits with letter from employer or carrier listing the dependent's name, the type of coverage gained and the effective date of coverage--notify within 31 days)
  1. Complete the benefit enrollment/change form including the plan selections.
  2. Include a copy of the required documentation listed above.
  3. Send all paperwork to the Employee Benefits Office or email paperwork to benefits.info@mesaaz.gov.
  • The change will take effect the first of the month following the qualifying event. (i.e. date of divorce June 15, coverage will terminate with the City of Mesa July 1).
  • Failure to notify within 31 day notification period may eliminate any otherwise available COBRA continuation rights and/or may make you liable for any medical, dental and/or vision claims the ineligible dependent may have incurred.

Removing/Dropping Committed Partner/Children

When Committed Partner (CP) and CP children are no longer eligible for coverage, you must immediately advise Employee Benefits administration to terminate coverage. You can voluntarily drop CP/CP children coverage at any time, even if they otherwise remain eligible under the terms of the Plan. CP/CP children are not eligible for COBRA continuation privileges regardless of why coverage is terminated. However the next opportunity to re-enroll would be during an Open Enrollment period.


Moving Out-of-State (OOS) - Changing Coverage to OOS Medical Plan

If an enrolled member (or their enrolled dependent) moves outside the state of Arizona for at least 4 months of the calendar year, the entire family unit has the option to transfer to the OOS Medical Plans.  The OOS Medical Plans provides members with access to Blue Cross/Blue Shield PPO networks in both Arizona and other states for all covered services, not just emergency services.  OOS Medical Plans are administered directly by BCBSAZ.  Otherwise coverage levels and costs mirror the In-State Medical Plans.

  1. An online Out-of-State Enrollment form must be completed and submitted.
  • Change to OOS Medical Plan will be effective first of the following month in which notified of the move outside of the state of Arizona
  • New ID cards for both Medical and Prescription Drug benefits will be generated; ID cards and Explanation of Benefits (EOB) will be sent to the cardholders (primary member, i.e. employee or retiree) address.  It is the responsibility of the cardholder to mail the ID card's and EOB's to applicable dependents.


Qualifying Event Chart

Mid-year changes are only those permitted in accordance with Section 125 of the Internal Revenue Code. This chart is only a summary of some of the permitted plan changes and is not all inclusive.  This chart should NOT be referenced for Health FSA or Dependent Care FSA Accounts.

Family Change Event
If you experience the following event
 You may make the following change(s)
 You may NOT make these types of changes
Marriage
  • Enroll yourself, if applicable
  • Enroll your new Spouse and other eligible dependents
  • Drop health coverage (to enroll in your Spouse’s plan)
  • Change health plans, when options are available
  • May not drop health coverage and not enroll in Spouse’s plan
Divorce
  • Remove your Spouse from your health coverage
  • Enroll yourself (and your children) if you or they were previously enrolled in your Spouse’s plan
  • May not change health plans
  • May not drop health coverage for yourself or any other covered individuals
Gain a child due to birth or adoption
  • Enroll yourself, if applicable
  • Enroll the eligible child and eligible spouse
  • Change health plans, when options are available
  • May not drop health coverage for yourself or any other covered individuals
Child requires coverage due to a QMSO
  • Add child named on QMCSO to your health coverage (enroll yourself, if applicable and not already enrolled)
  • Change health plans, when options are available, to accommodate the child named on the QMCSO
  • May not make any other changes, except as required by the QMCSO
Loss of child eligibility-e.g., child reached maximum age for coverage
  • Must remove the child from your health coverage
  • Child will be offered COBRA (unless child of a Committed Partner).
  • May not change health plans
  • May not drop health coverage for yourself or any other covered individuals
Death of a dependent (Spouse or child)
  • Remove the dependent from your health coverage
  • Change health plans, when options are available
  • May no drop health coverage for yourself or any other covered individuals
Covered person receives or loses Medicare or Medicaid entitlement 
  • Drop coverage for the person who became entitled to Medicare or Medicaid
  • Add the person who lost Medicare/Medicaid entitlement.
  • May not drop health coverage for yourself or any other covered individuals
Employment Status Change Event
Spouse becomes eligible for health benefits in another group health plan
  • Remove your Spouse from your health coverage, with proof of other plan coverage
  • Remove your children from your health coverage, with proof of other plan coverage
  • Drop coverage for yourself only with proof that Spouse added you to the Spouse’s new group health plan
  • May not change health plans
  • May not add any other eligible dependents to your health coverage
Spouse loses employment or otherwise becomes ineligible for health benefits in another plan 
  • Enroll your Spouse and, if applicable, eligible children in your health plan
  • Enroll yourself in a health plan if previously not enrolled because you were covered under your Spouse’s plan
  • Change health plans, when options are available
  • May not drop health coverage for yourself or any other covered dependents
You lose employment or otherwise become ineligible for health benefits 
  • Enroll in your Spouse’s plan, if available
  • Elect COBRA coverage for the Qualified Beneficiaries (you and your covered dependents) 
 

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