Qualifying Events/Special Enrollments

 

Newborns

1. Complete the benefit enrollment form including the plan selections.

2.  Proof of birth is needed with the Insured's name noted as parent on paperwork.

3.  A copy of the social security card and birth certificate is needed as soon as the Insured receives.

4.  Baby will be added to the plan(s) as of the date of birth.

5.  The Insured has 31 days from the date of birth to add the newborn to their benefit plans.

6. If the 31 days has passed, the baby cannot be added until the next open enrollment effective the  following first of next year.

7. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.

 

Other Family Member Additions

1. Complete the benefit enrollment form including the plan selections.

2. A copy of the marriage certificate, birth certificate, guardianship papers, court documents, child support decree, or loss of benefit coverage is required to add the new member.

3. The change will take effect the first of the month following the change. (i.e. loss of coverage 6/15/13, coverage will start with the City of Mesa 7/1/13).

4. Insured has 31 days from the qualifying event to add the new member to their benefit plan.

5. If the 31 days has passed, the member cannot be added until the next open enrollment effective the  following first of next year.

6. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.

 

Family Member Removals

1. Complete the benefit enrollment form including the plan selections.

2. A copy of the divorce decree, proof of other insurance, medical order of support, or spouse open enrollment notice is required to remove the dependent from your plan(s).  Verification sent to the Benefits office must have the names and  dates fall within the 31 day timeframe.

3. The change will take effect the first of the month following the change. (i.e. date of divorce 6/15/13, coverage will terminate with the City of Mesa 7/1/13).

4. Insured has 31 days from the qualifying event to remove the  member from their benefit plan.

5. If the 31 days has passed, the dependent cannot be terminated until the next open enrollment effective the following first of next year.

6. Send all paperwork to the Benefits office or email paperwork to benefits.info@mesaaz.gov.

 

Changing Dependents to Out of State Plan - Active Employees & In-State Retirees

1. A completed out-of-state dependent form is needed for each out-of-state dependent.

2. Proof of the out-of-state address is needed for verification purposes.

3. Make sure the form is completed and signed and returned to the Benefits Office.

4. If the dependent is currently enrolled in the out-of-state plan and only their new out-of-state address needs to be updated, please complete the Retiree or Dependent Address Change Form or email benefits.info@mesaaz.gov with the Insured's ID, name of the dependent(s), the old address, the new address, and a current contact phone number.

 

Changing Address for Out of State Dependents - Retirees Living Out-of-State ONLY

If the dependent is currently enrolled in the out-of-state plan and only their new out-of-state address needs to be updated, please complete the Retiree or Dependent Address Change Form or email benefits.info@mesaaz.gov with the Insured's ID, name of the dependent(s), the old address, the new address, and a current contact phone number.

 
 

Employee Benefits
20 E Main Street, Suite 600
Mesa, AZ 85201
Open Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax

Option 2: Medical/Dental Verify

Other Questions

Password Resets

Option 3: Claim Status

Option 4: Retiree Questions

Option 5: Flex Spending


E-mail (password resets cannot be done via email)

Forms

Federally Mandated Notices