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 at least 40 or
more hours per week.
- Part-time employees working at least 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 Councilmembers. are considered as in-network.
- 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.
Dependent Eligibility
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;
- Unmarried natural children;
- Unmarried legally adopted children, or
children for who you/your spouse are a
court-appointed guardian;
- Unmarried stepchildren who reside with you.
Dependent children are eligible until the end of
the month following their 19th birthday. However, if
children are under age 23 and attending school on a
full-time basis, or are participating in a religious
excursion, they may continue to be covered as long
as they continue to meet this requirement. At age
23, dependent children are no longer eligible for
coverage as your dependent unless they are disabled
and unable to maintain self-sustaining employment
because of their disability.
Enrolling Dependents
If you have a new dependent as a result of
marriage, birth, adoption, or placement for
adoption, you may be able to enroll yourself and
your eligible dependents. However, you must request
enrollment within 31 days after 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 after the
date your or your dependent's other coverage ends
(of 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
coverage begins:
- Marriage certificate, if enrolling a spouse.
- Birth certificates, adoption documents or
other court documentation verifying legal
guardianship, if enrolling one or more dependent
children.
- Verification of student status or religious
excursion, if enrolling one or more dependent
children ages 19 through 22 years of age.
- Natural parent's divorce decree, if
enrolling one or more stepchildren who lives
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.
Dropping Dependents
Aside from the Open Enrollment period, you may
only drop dependents due to a qualified change in
family status which include:
- Divorce (Copy of divorce decree required
with Benefit/Enrollment Change form);
- Legal separation (Copy of legal separation
documentation required with Benefit/Enrollment
Change form);
- Loss of dependent;
- Dependent no longer a full-time student;
- Dependent acquires other insurance through
their employer (Copy of other insurance card or
documentation required with Benefit
Enrollment/Change form).
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, you will need to
complete the Supplemental Life Insurance
Enrollment/Change form to discontinue paying
premiums for an ineligible dependent. If you
continue to pay premiums on an ineligible dependent,
the premiums will not be refunded to you.
Student Status Verification
Insureds who have unmarried dependents 19 to 23
years of age will need to submit verification of
full-time student status to Employee Benefits.
Remind your dependents to give you a copy of their
school registration or other documentation showing
12.00 or more credit hours.
This documentation is required each semester and
must be received for the Benefits Office to verify
benefit coverage.
When submitting a copy of the school
registration, the following is required:
- Dependent's name;
- Name of accredited institute of learning;
- Number of credit hours (at least 12.00 hours
to be considered full-time);
- "Spring 2007" or "Fall 2007" (depending on
time of year) listed for semester;
- Employee's name and employee ID number on
the documentation.
You can either mail or fax us the documentation
at:
Mail: City of Mesa Employee Benefits
PO Box 1466
Mesa, AZ 85211-1466
Fax: 480-644-4548
If you know your dependent will not meet the
eligibility requirements for continuation of
coverage as a dependent, 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 your dependent who is losing
coverage.
For a summary of detailed coverage, please refer to the following links:
Members who reside out of state must use HealthSmart providers for in-network
coverage. See HealthSmart Network for Out of State Insureds.
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