You must submit your Qualifying Event form within 30 days of event, even if you do not have the supporting documentation. Documentation can be submitted as received.

Supporting Documentation:
Birth certificate; hospital notice; verification letter; adoption papers

Special Instructions:
To process your requested changes, supporting documentation (e.g. birth certificate, hospital notice, verification letter, adoption papers) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox. Once your form is approved, you will be able to make your benefit enrollment elections in SAP. If adding additional dependents to coverage, supporting documentation (e.g. birth certificate, adoption papers, marriage certificate) will also need to be submitted. Coverage will be effective the 1st of the month following the date of the qualifying event.

You must submit your Qualifying Event form within 30 days of the event, even if you do not have the supporting documentation.  Documentation can be submitted as received.

Supporting Documentation:
Marriage certificate

Special Instructions:
To process your requested changes, supporting documentation (e.g. marriage certificate) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox. Once your form is approved, you will be able to make your benefit enrollment elections in SAP. If adding additional dependents to coverage, supporting documentation (e.g. birth certificate, adoption papers) will also need to be submitted. Coverage will be effective the 1st of the month following the submission of the completed qualifying event form.

If you, your spouse, qualified dependent(s) and/or tax-dependent domestic partner has lost health coverage through another qualified health plan, you may add coverage only for the benefit that was lost.

Supporting Documentation:
Loss of Coverage Letter or COBRA notification letter – must include the loss of coverage effective date, types of coverage lost, and the names of applicable individuals who lost coverage.

Special Instructions:
To process your requested changes, supporting documentation (e.g. loss of coverage letter) will need to be submitted to Risk Management within 30 days of the Qualifying Event. The letter must contain the names of the insured, the type of coverage lost and the date of loss. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox. If adding other dependents not previously enrolled, supporting documentation (e.g. birth certificate, adoption papers, marriage certificate) will also need to be submitted. For a tax-dependent domestic partner, you must provide an Affidavit of Domestic Partnership or domestic partnership registration, and Certification of Federal Tax Dependent status. Coverage will be effective 1st of the month following submission of the completed Qualifying Event form.

Supporting Documentation:
Divorce Decree; Judgment or Order

Special Instructions:
To process your requested changes, supporting documentation (e.g. divorce decree, judgment, order) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

Supporting Documentation:
Divorce Decree or Legal Separation Document

Special Instructions:
To process your requested changes, supporting documentation (e.g. divorce decree or legal separation document) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

Supporting Documentation:
1. Proof of gained coverage - new insurance information which includes the effective date of coverage, type of coverage, and name(s) of the applicable individual(s) who are enrolled in the coverage.

And, if applicable:

2. Waiver of Medical Insurance Form - If you are waiving coverage for yourself, you may also be required to submit a Waiver of Medical Insurance Form if you fall into one of the following groups: 1) MEA, Local 145, Local 127, DCAA, and Unrepresented/Unclassified hired on or after July 1, 2020; or 2) POA and Local 911 hired on or after July 1, 2021.

Special Instructions:

To process your requested changes, supporting documentation (e.g. proof of gained coverage and, if applicable, Waiver of Medical Insurance form) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

Supporting Documentation:
Judgment; Decree or Order

Special Instructions:
To process your requested changes, supporting documentation (e.g. decree, judgment, order) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form.  If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

Supporting Documentation:
Death Certificate

Special Instructions:
To process your requested changes, supporting documentation (e.g. death certificate) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

The new effective Date will be the start of the next month.

Supporting Documentation:
Proof of Provider Change

Special Instructions:
To process your requested changes, supporting documentation (e.g. proof of provider change) will need to be submitted to Risk Management within 30 days of the Qualifying Event. The proof of provider change must also include the name of the dependent being cared for and the care provider's name. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

The new effective Date will be the start of the next month.

Supporting Documentation:
Proof of Provider Change

Special Instructions:
To process your requested changes, supporting documentation (e.g. proof of provider change) will need to be submitted to Risk Management within 30 days of the Qualifying Event. The proof of provider change must also include the name of the dependent being cared for and the care provider's name. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

You only have 30 days after the stop date to submit claims. However, only costs incurred up to the stop date are acceptable claims.

Supporting Documentation:
Proof of Provider Change

Special Instructions:
To process your requested changes, supporting documentation (e.g. proof of provider change) will need to be submitted to Risk Management within 30 days of the Qualifying Event. The proof of provider change must also include the name of the dependent being cared for and the care provider's name. If you have supporting documentation available now, you may attach it to this form below. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox. This is a prospective change; funds already contributed are not refunded, per IRS regulations. You will need to submit claims to use any existing balance to HealthEquity/WageWorks.

If you are currently enrolled in a City medical, dental, and/or vision plan and have moved outside of the coverage area, you may change coverage to an in-network plan, or drop coverage entirely for yourself and your dependents.

Supporting Documentation:
Utility Bill, Bank Statement, Driver’s License, Lease/Rental Agreement or Mortgage Documents showing the new address.

Special Instructions:
To process your requested changes, supporting documentation (e.g. proof of residence change) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.

If you are not currently enrolled in a City medical, dental, and/or vision plan because you lived outside of the coverage area and you have just moved to a residence that is within the coverage area (in-network), you will then become eligible to enroll yourself and dependents.

Supporting Documentation:
Utility Bill, Bank Statement, Driver’s License, Lease/Rental Agreement, or Mortgage Documents showing the new address.

Special Instructions:
To process your requested changes, supporting documentation (e.g. proof of residence change) will need to be submitted to Risk Management within 30 days of the Qualifying Event. If you have supporting documentation available now, you may attach it to the Qualifying Event form. If you do not have supporting documentation at this time, you may submit the form without attachments and Risk Management will work with you as you obtain your documentation. Communication regarding your qualifying event will be processed through your SAP Portal Inbox. Coverage will be effective 1st of the month following the submission of the completed Qualifying Event form.

If your health coverage is terminated due to an unpaid leave of absence and you return to work in the same plan year, your elections in effect before your leave of absence will be reinstated. You are not eligible to make an election change unless you missed open enrollment.

Special Instructions:
Depending on the nature and extent of your leave, you may have special enrollment options. Complete the Qualifying Event Form and Risk Management will follow up with you. Communication regarding your qualifying event will be processed through your SAP Portal Inbox.