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Rules of the game
Who is eligible?
You are eligible for coverage under the benefits plans if you meet the following guidelines:
- You’re a full-time employee or part-time employee regularly scheduled to work at least 30 hours a week.
- You’re a retiree now covered by a city medical plan.
- You’re a survivor of a deceased city employee or retiree, up to age limits and application of other plan rules.
- You’re a deferred-retired employee who will become eligible to receive a pension within five years after termination, and you continuously pay the monthly retiree contribution for health coverage.
- You're a retiree who opted out of your city healthcare plan after Jan. 1, 2010.
If both you and your spouse work for the city, you may be covered as an employee or as a dependent – but not both. Dependents may be enrolled under only one parent or guardian.
Eligible dependents
Eligible dependents are defined as the following:
- Legal spouse
- Unmarried natural or adopted children to age 25, if they qualify as dependents for federal income-tax purposes
- Children to age 25, over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income-tax purposes
- Grandchildren and stepchildren to age 25 if they qualify as your dependents for federal income-tax purposes and live with you
- Disabled dependents over age 25 who are incapable of self-sustaining employment because of mental retardation or physical handicap. The dependent must be primarily dependent on you for more than 50 percent of financial support and approved for coverage after age 25
- Unmarried dependent children who lose Medicaid coverage may be enrolled under the employee’s medical plan within 31 days after Medicaid coverage is lost. They may be covered to age 25 if they qualify as your dependents for federal income-tax purposes
- Dependents for whom a court order has been received requiring the employee or retiree to provide health care coverage, provided HR benefits receives the court order within 31 days after issuance. After a divorce, an ex-spouse is not eligible. A divorce decree may not be amended to require an employee or retiree to cover an ex-spouse under a city medical plan.
Changes to your benefits are limited to open-enrollment periods, unless you have a qualified change in family status. The change in benefits must be consistent with the status change.
Qualified family-status changes
Qualified family-status changes include the following:
- Marriage or divorce
- Birth or adoption of a child
- Death of a dependent
- A dependent child reaches age 25, marries before age 25, or goes into the military
- A spouse’s loss of coverage
- A spouse becomes employed and enrolls in that employer’s benefits program
- You or your spouse change from full-time to part-time employment or vice-versa, or you experience a significant change in your spouse’s benefits or premium payments
- A dependent loses Medicaid medical coverage
If you have a family-status change, you must submit a status-change form and documentation within 31 days of the change.
| Insider's tip |
When your dependents become ineligible for coverage, they will be dropped from the medical and dental plans. You must submit a status-change form within 31 days to stop paying for their coverage.
You will receive a refund of the premiums you paid only from the date of your notification.
If you don’t drop them, but continue to pay the premiums, they are still ineligible for coverage. You will not get a full refund beyond 60 days from the date HR benefits receives your notice, and you may be responsible for any claims incorrectly paid on their behalf.
You can get a benefits-change form from your department human resources liaison or the HR benefits division at 611 Walker, 4th floor. |
Required documentation
To add dependents for coverage, you must submit the required documents. The following is a list of documents you must provide with your medical/dental election or change form by the open-enrollment deadline.
- Spouse: copy of a certified marriage certificate
- Common-law spouse: declaration and registration of an Informal Marriage Certificate
- Children under age 25, if not added at time of birth or if you are requesting reinstatement of their coverage: birth certificate or legal document that establishes your paternity and a completed Certification of Financial Dependency form
- Children to age 25, over whom you have legal guardianship or legal foster care: copy of the legal documents granting custody, guardianship or foster care
- Grandchild(ren) to age 25, who are your covered dependent for federal income-tax purposes: Certification of Financial Dependency form and a birth certificate
- Disabled dependents over age 25 if they were covered before age 25 and are primarily dependent on you for more than 50 percent of their financial support: medical documentation of the disability or mental handicap
There is no waiting period for dependents added during open enrollment.
Your completed forms must be given to your department human resources liaison by April 18, 2010. Any changes you make will be effective May 1, 2010. |
More rules of the game
How to enroll or make changes
Employees: If you want to enroll or make changes to your current coverage, ask your department human resources liaison for an enrollment or change form.
You can also submit your forms to HR benefits, 611 Walker, 4th floor.
If you don’t enroll now
If you do not enroll for benefits during open enrollment, you may apply during the year for coverage in the HMO plan by completing a medical/dental election form. Your coverage will be effective on the first or the 16th of the month following the 90-day waiting period from the date you submit your enrollment form. You may not enroll in the PPO or dental plan until open enrollment in 2011, unless you have a qualifying family-status change through loss of other group coverage.
Life insurance
You may apply for voluntary group life insurance at any time. If you apply for first-time coverage or increase your coverage during this enrollment period, you must complete a personal-health statement. You will begin paying premiums after the insurance company approves your application.
Insider's tips
Deferred-retired employees
If you are eligible to receive a pension within five years after you terminate employment, you are a deferred-retired employee and may keep your medical and dental coverage for you and your covered dependents. You may keep life insurance for yourself. You will pay the same premiums retirees pay.
Long-term disability
If you were hired after September 1985 and are a municipal employee or classified firefighter, you are covered under the Compensable Sick Leave Plan. After one year of employment, you are usually covered under the Long-Term Disability Plan. If you become disabled, you must apply for your disability benefit within 12 months after the disability caused you to stop working, or within 60 days after termination for a disability that occured before termination of employment. You may qualify to receive the benefit until age 65.
Life insurance
Review your life-insurance beneficiary. If you have had a life event such as marriage, divorce, birth, adoption,or death, you may want to change your beneficiary.
If your spouse and you work for the city, you both have employee basic life insurance of one times your annual base salary. You cannot be your spouse’s dependent. Only one of you may cover dependent children.
You may buy life insurance up to four times your base salary. Your spouse’s maximum coverage is $50,000. A child’s maximum coverage is $10,000.
Medical/dental coverage
If you die while an employee, your covered surviving spouse and covered children may keep medical and/or dental coverage until your spouse remarries or becomes covered under another group medical or dental plan. Single dependent children may be covered until age 25. Your spouse will pay employee-rate premiums.
If a work-related accident, injury or exposure causes your death, your covered surviving spouse may keep medical/dental coverage until he or she becomes eligible for Medicare or become covered under another group plan.
COBRA
If you are covered under the benefits plans when you terminate employment, you may keep your medical and dental coverage for 18 months through the Consolidated Omnibus Budget Reconciliation Act. You will pay the total premium plus a 2 percent administrative fee. If you become disabled during that period, you may keep COBRA benefits for 29 months, when you should qualify for Medicare.
No paycheck? How to keep your benefits
If you are an active employee but you do not receive a paycheck from the city and you want to retain your benefits, you must pay your premiums directly to the benefits division at 611 Walker, 4th floor. Premiums are not deducted from the check you receive from the workers’ compensation carrier.
What’s in your benefits file?
You may review your benefits file at 611 Walker, 4th floor, weekdays, 8 a.m.- 5 p.m. Because your records are confidential and protected, a written request, a written release with your notarized signature, or your physical presence is required. Present your ID card. Information will not be released over the phone.
Change of address
When you change your mailing address, you also need to update your address with your HR liaison or payroll representative, and when your address is updated in the city’s system, the new address transfers to the benefits carriers. To receive important information about your medical and dental plans, your address must be current at all times.
Opt-out Opt-in feature
Retirees can opt out of their city health benefits plans and re-enroll in the future. To opt out, you must submit a Retiree Medical/Dental Opt-out form to HR benefits. Your opt-out election will be effective the first of the following month. Remember, your opt-out applies to your dependents. You can opt back into a city plan during any open enrollment, after a family-status change that causes you to lose coverage elsewhere, or after a 90-day waiting period. To re-enroll, you will need to submit a Retiree Medical/Dental Opt-in form to HR benefits and provide relationship documents for dependents.
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