Employee/Retiree Loses Other Qualifying Coverage

You're able to add coverage mid-year if you have lost coverage elsewhere through an employer-sponsored plan or through a Medicaid plan such as AHCCCS.  (Being dropped from coverage during a spouse's open enrollment is also considered a loss of coverage through an employer-sponsored plan.) 

You may add any type of coverage that you lose through a qualifying plan (example: medical, dental, etc.) for the individuals for whom you have proof of the loss of coverage. 


ACTION ITEMS - DOCUMENTATION:

Fax your completed paperwork to the Benefits Office at 791-5942.

Call (or email) after you fax to make sure that we received it.

Within 31 days after the date you lost other coverage (60 days if the coverage you lost was through Medicaid or a State Children’s Health Insurance – CHIP – Program), the Benefits Office must receive:

1. A properly completed Change Form and

2. Proof of loss of other coverage

  • The proof must include:
    • Names of individuals who have lost coverage
    • Type of coverage lost (medical, dental, etc.)
    • Date coverage ended
  • It must be on letterhead (either from the insurance company, employer or government agency)
    • If it is 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 it's a printout from an online system, it must clearly demonstrate that the plan is an employer-sponsored plan (as opposed to a private plan)

3. If you're a retiree and you want to add dental and/or vision, we must also receive proof of continuous dental/vision insurance coverage elsewhere for the 36 months immediately preceding the date you will be joining the City's plan(s). Visit the Insurance Handbook for details about the continuous coverage rules for retiree dental/vision.


DEPENDENTS ARE SUBJECT TO AUDIT

The City contracts with an outside audit firm to conduct eligibility verification audits. Generally, audits occur after the spring open enrollment, but they may occur at any time. If an individual isn't properly verified through the audit process, the individual will be removed from insurance, and you may be responsible for any claims paid. Please watch your home mail carefully to ensure that you don't miss deadlines.


WHEN WILL COVERAGE GO INTO EFFECT?

Provided proper documentation is received by the deadline, additions with the City of Tucson would be effective the first day of the month following the date you lost the other coverage; however, if your loss of coverage was on the first day of the month, coverage with the City would go into effect that same day.

Employees: Additions/increases to life insurance are available only during the annual open enrollment and aren't available as a result of mid-year life events.


ADDITIONAL INFORMATION

Rates

Insurance Handbook

Coverage Information

  • 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).

 

Thank you.

Your Insurance Benefits Team