To cancel your coverage, please use the cancellation form at the bottom of our Retiree Insurance page.
You're able to drop coverage mid-year if you have gained coverage elsewhere through an employer-sponsored plan, or through Medicare or a Medicaid plan such as AHCCCS. You may drop any type of coverage that you gain (example: medical, dental, etc.). In order to do so, the Benefits Office must receive from you - within 31 days of the date you gain other coverage (60 days if you gain coverage through a Medicaid program) - both:
1. A properly completed Change Form and
2. Proof of your new coverage
- The proof must include your name, the type of coverage being gained (medical, dental, etc.), and the date the coverage begins
- It must be on letterhead - from the insurance company, an employer, Medicare or Medicaid (AHCCCS in AZ)
- If your proof is a letter from an employer, it must include the name, contact information and signature of the person in the HR benefits area who prepared the letter, so that we can confirm, as needed
- If documentation is from an online system, it must clearly show that coverage is through an employer's plan (as opposed to a private plan)
3. If you are eligible for active employee insurance and would like to receive the medical opt out incentive for having non-City medical coverage, in addition to the above documents, we must also receive your completed Medical Opt Out Form.
The change would be effective the first day of the month following the date you gained the other coverage. However, if your coverage begins on the first day of the month, the change would be effective on that day.
Fax your completed paperwork to us at 791-5942. Please be sure to call (or email) after you fax to make sure we received it.
- Visit our Medical page for Summaries of Benefits and Coverage (SBCs). You are also able to obtain hard copies of SBCs free of charge by requesting them from the Benefits Office (520-791-4597).
Your Insurance Benefits Team