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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 Council members. 
• 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
• Natural children and stepchildren
• Legally adopted children, or children for who you/your spouse are a court-appointed guardian

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 evidence a disabled dependent.

 

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 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 (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 coverage begins:

 

• Marriage certificate, if enrolling a spouse.
• Birth certificates, adoption documents or other court documentation verifying legal guardianship, if enrolling any dependent children. 
• 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.

 

Dropping Dependents

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 Change form)
• 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 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, 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 COBRA FAQ page.

 

For a summary of detailed coverage, please refer to the following links:

City of 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 Insured's.

 

 

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