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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 Forms

COBRA Enrollment Form

COBRA Initial Notice

Important Notices & Documents

Plan Document

COBRA Continuation of Coverage

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Fiesta District

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue coverage of medical, dental, vision and health FSA when coverage is lost for certain reasons, such as termination of employment, divorce, or loss of dependent status.

Eligibility

A variety of loss of coverage events makes you and your covered family members (if applicable) eligible for up to 18 months of COBRA coverage, including:

  • You voluntarily leave the City
  • The City ends your employment for any reason unless you were terminated because of gross misconduct
  • The number of hours you are scheduled to work at the City is reduced below that required for eligibility

In some cases, your covered dependents who lose coverage can continue coverage up to 36 months, such as:

  • You get a divorce or become legally separated
  • You die
  • Your dependent child no longer qualifies as a covered dependent due to the attainment of the Plan's age limit (e.g. age out), unless they are permanently and totally *disabled  

*For more information, please see the Disabled Adult Dependent area under the Eligibility section.

COBRA Qualifying Event
Causing Health Care Coverage to End
Duration of COBRA for Qualified Beneficiaries
Employee Spouse Child(ren)
Employee terminated (for other than gross misconduct)
18 months
18 months 18 months
Employee reduction in hours worked (making employee ineligible for the same coverage)
18 months 18 months 18 months
Employee passes away
N/A 36 months
36 months
Employee becomes divorced or legally separated
N/A 36 months 36 months
Dependent Child ceases to have Dependent status
N/A N/A 36 months

If you and/or a covered family member experience a COBRA qualifying event and have a  loss of health coverage with the City of Mesa, the City will send a COBRA Continuation Coverage Election Notice to your address on file.  Please be sure your mailing address information is up-to-date.  Active employees can update their contact information in ESS.  Retirees and Dependents can update their contact information by completing and submitting a Retiree/Dependent Address Change Form.


How much does COBRA cost?

2019 COBRA Monthly Premium Rates

Medical/Rx Basic Medical Plan
Choice Medical Plan
Copay Medical Plan
Single $497.76 $622.20 $684.42
Family $1,107.72 $1,384.14 $1,670.76
Dental
Preventative Choice Plan
Dental Choice Plan
Dental Choice Plus Plan
Single
$87.21
$96.90
$112.20
Family
$144.84
$173.40
$255.00
Vision Basic Vision Plan
Vision Plus Plan
 
Single $5.65
$9.66
 
Family $15.61
$26.62
 


Steps to elect COBRA coverage:

  1. Review the COBRA Continuation Coverage Election package.
  2. Submit the completed and signed COBRA Enrollment Form to the Employee Benefits Administration Office no later than 60 days after City of Mesa coverage ends or within 60 days of the date of the COBRA Election package notification (whichever is later):

In Person:  
Via Mail:  
Email:
  
Employee Benefits Administration, 20 E Main St, Suite 600, Mesa, AZ 85201
Employee Benefits, PO Box 1466, Mesa, AZ 85211-1466
benefits.info@mesaaz.gov


Group Term Life and AD&D Portability and Conversion Privileges 

If you lose eligibility for Life and AD&D insurance coverage with the City of Mesa, you may be eligible to continue your existing Basic and Supplemental Life and AD&D Insurance coverage at individual rates under the Portability and/or Conversion provisions of the respective insurance policies. 

Application for Portability

Portability allows you and your covered dependents to continue your existing Basic and Supplemental term-life and AD&D insurance under a separate group policy.  Unlike conversion, portable coverage does not have a cash value and the rates you pay will increase as you age.  You will not need to answer any medical questions or have a physical exam to port existing coverage unless you choose the Preferred Life Rates option, which may result in lower premium rates, or you choose to increase the amount of your coverage.  If you choose the Preferred Life Rates option or increase your coverage amount, you must complete a Statement of Health Form.

To Port your Basic and Supplemental Term-Life and AD&D Insurance:

  1. Complete and submit the Life Insurance Portability Form to the Employee Benefits Administration office within 31 calendar days from your last day worked
  2. Employee Benefits will complete "Record Keeper" verification section and forward the application to the insurance carrier for processing
  3. Evaluate your premiums using thePortability Rate sheets.  The insurance company will bill you directly for these premiums

Application for Conversion

Conversion allows you and your covered dependents to convert some or all of your existing term life and AD&D policies to individual whole life or accident policies.  You can convert Basic and Supplemental Life and AD&D when you lose this coverage for any reason (e.g. termination or retirement from employment, move to a non-benefit eligible position, spouse or dependent no longer eligible for coverage (divorce, age-out).

To convert your Basic and/or Supplemental Life and AD&D Insurance:

  1. Submit the Notice of Group Life Insurance Conversion Privilege to the Employee Benefits Administration office within 31 calendar days from your last day worked
  2. The Employee Benefits Administration office will complete and return the Notice to you, which provides the necessary information required for a Conversion Application
  3. Call 877-275-6387 for a local MassMutual financial professional to contact you directly, usually within 48 hours of your request, to complete a Conversion Application and determine your rate.

 

 

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