Qualifying Event/Special Enrollment

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 benefit coverages. 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(PDF, 288KB) including the plan selections and social security numbers (if available). If you are a retiree, complete the retiree benefit enrollment form(PDF, 234KB).
2. Proof of birth (birth certificate/adoption papers) are needed with the Insured's name noted as a 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.  If you are a retiree, complete the retiree benefit enrollment form.
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 a spouse 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 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 either the employee or retiree 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 Employee 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 either the employee or retiree benefit enrollment 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 Office 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.

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 Events

Employment Status Change Events