Coverage Options and Eligibility
The following individuals are eligible to enroll in one of the health
plans offered through the City of Mesa:
- Full-time employees working 40 or more hours per week.
- Part-time employees working 20 hours per week on a regular,
year-round basis in a benefits-eligible position.
- Elected officials of the City of Mesa, including Mayor and
- Retired employees of the City of Mesa who qualify and begin
receiving retirement benefits from ASRS or PSRS on the first day of the
month following retirement.
- Disabled employees who have retired from employment due solely to a
disability and are receiving a long-term disability benefit and who
continue to meet the requirements of disability.
If you elect coverage for yourself, you may also elect the same coverage
for your eligible dependents. Eligible dependents are defined as one or more
of the following:
- Legal spouse
- Natural children and stepchildren
- Legally adopted children, or children for who you/your spouse are a
Dependent children are eligible until the end of the month in which they
turn 26, after which time they're no longer eligible for
coverage as your dependent 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.
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
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 (or after the employer stops
contributing toward the other coverage).
To enroll eligible dependents who have never been enrolled in one of the
City-sponsored health plans, complete the Benefit/Enrollment Change Form and
submit it to Employee Benefits. You also will need to submit copies of the
following applicable documents to the Employee Benefits Office before
- Marriage certificate, if enrolling a spouse.
- Birth certificates, adoption documents or other court documentation
verifying legal guardianship, if enrolling any dependent
- Natural parent's divorce decree, if enrolling any
stepchildren who live with you for determination of primary/secondary
coverage status. If divorce decree does not apply, provide a written,
signed document stating who is responsible for insurance coverage.
- Insurance card/proof of insurance, if you or your dependents are
covered under another health insurance plan.
Aside from the Open Enrollment period, you may only drop dependents due
to a qualified change in family status which include:
- Divorce (Provide Benefits with a copy of divorce decree with Benefit/Enrollment
- Legal separation (Provide Benefits with a copy of legal separation documentation
with Benefit/Enrollment Change form)
- Loss of dependent
- Dependent acquires other insurance through their employer (Copy of
other insurance card or documentation required with Benefit
You must request disenrollment within 31 days after dependent's loss of
coverage for dependent to qualify for COBRA coverage.
If you have Supplemental Life Insurance on the dependent that is losing
coverage, please complete the Supplemental Life Insurance
Enrollment/Change form to discontinue paying premiums for an ineligible
dependent. Premiums paid for an ineligible dependent will not be refunded to you.
If you know a dependent will not meet the eligibility requirements for
continuation of coverage, please complete a Benefit
Enrollment/Change form to drop their coverage, and submit it to Employee
Benefits as soon as possible. The Benefits Office will then determine if
your dependent is eligible for continuation of coverage through COBRA. Any
COBRA information will be addressed directly to the dependent losing
coverage. For more details about COBRA visit the Dept of Labor's
For a reference of detailed coverage, please refer to the following links:
Mesa Plan Document
Members who reside out of state must use BCBS Blue National providers for
in-network coverage. See BCBS Blue National Network for Out of State
Main Street, Ste 600
Mesa, AZ 85201
Open Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax
Option 3: Claim Status
E-mail (password resets cannot be done via email)
Federally Mandated Notices