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Changing Benefit Elections
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- Changing Benefit Elections
You can only change your benefit elections during Open Enrollment, unless there is a qualifying change in your family status.
Read this information to learn about making changes to your healthcare coverage elections due to a recent:
- - Marriage
- - Domestic Partnership
- - Birth or Adoption of a Child
- - Divorce, Legal Separation or Dissolution of Domestic Partnership
- - Loss of Other Healthcare Coverage
- - Obtaining Other Healthcare Coverage
- - Death of a Dependent
- - Death of a Member
Take special note of the 30 day time period during which you can make healthcare coverage changes after one of these qualifying changes in your family status. When you submit an enrollment application due to a status change be sure to include any required eligibility documentation. Also be aware that members who fail to notify HSS when an enrolled dependent becomes ineligible are responsible for paying the total cost of premiums and services provided, back to the original date of the dependent's ineligibility. Be sure to disenroll dependents if they become ineligible due to divorce, dissolution of partnership or any other reason.
Marriage or Domestic Partnership
To enroll a new spouse or domestic partner and eligible children of a spouse or partner in HSS healthcare coverage, you must submit a completed HSS enrollment application, a copy of your marriage certificate or certificate of domestic partnership, and a birth certificate for each child to HSS within 30 days from the date of the marriage or certification of domestic partnership. A Social Security number must be provided for each dependent. Proof of Medicare enrollment is also required for a same sex spouse or domestic partner (of either gender) who is Medicare-eligible due to either age or disability. Coverage for your spouse or domestic partner and his or her eligible children will be effective the first day of the coverage period following the submission of the required application and documentation. If you do not complete the enrollment process within 30 days from the date of your marriage or certification of domestic partnership, you must wait until the next Open Enrollment to add your new family members.
Same Sex Spouse/Domestic Partner Tax Alert: In keeping with IRS requirements, when you elect healthcare coverage for your domestic partner or same sex spouse (and any dependent(s) of that partner or spouse), you will be taxed by the federal government on the value of the City and County of San Francisco’s contribution toward the cost of healthcare coverage for these dependents. This is referred to as imputed income and may increase your net pay. The State of California does not tax these benefits. In some situations, per IRS rules, you may qualify to avoid imputed income.
Birth or Adoption
Coverage for your newborn child is effective on the child’s date of birth, provided you meet the application deadline and documentation requirements. Coverage for your newly adopted child is effective on the date the child is placed with you, provided you meet the application deadline and documentation requirements. To enroll your newborn or newly adopted child, you must submit a completed HSS enrollment application form and a copy of the birth certificate or adoption documentation within 30 days from the date of birth or placement for adoption. If you do not complete the enrollment process within 30 days from the date of birth or placement for adoption of a new child, you will have to wait until the next Open Enrollment. A Social Security number must be provided within 6 months of the date of birth or adoption, or your child’s coverage may be terminated. For information about obtaining a Social Security number see, www.ssa.gov/pubs/10023.html
Loss of Other Healthcare Coverage
Employees and eligible dependents who lose other coverage may be enrolled by submitting a completed HSS enrollment application form and proof of the loss of coverage within 30 days from the date other coverage terminates. Documentation of lost coverage must indicate the date other coverage ends and the names of the individuals losing coverage. If HSS receives a completed HSS enrollment application and eligibility documentation within 30 days of the loss of coverage, HSS coverage will be effective on the first day of the next coverage period. There may be a break in coverage between the date other coverage terminates and the date HSS coverage begins. If you do not complete the HSS enrollment process within 30 days from the date other coverage terminates for either yourself or an eligible family member, you must wait until the next Open Enrollment.
Divorce, Separation and Dissolution of Partnership
Termination of HSS health coverage for your ex-spouse or domestic partner due to divorce, legal separation or dissolution of domestic partnership is required by law. To drop the dependent, you must submit a completed HSS application form and a copy of your divorce decree, legal separation documents or dissolution of domestic partnership documents within 30 days from the date of divorce, legal separation or dissolution of domestic partnership. Coverage for your ex-spouse or domestic partner will terminate on the last day of the coverage period in which the divorce, legal separation or dissolution of domestic partnership occurred, provided you meet the deadline and documentation requirements stated above. If you do not complete the coverage termination process within 30 days from the date of your divorce, legal separation or dissolution, coverage for your ex-spouse or domestic partner will terminate on the last day of the coverage period in which you submit a completed HSS enrollment application and required documentation. You will then be responsible for paying all required premium contributions for that dependent up to the coverage termination date. Failure to notify HSS of a divorce or dissolution of partnership may result in financial penalties equal to the total cost of benefits and services provided for any ineligible ex-spouse, ex-partner and stepchildren.
Obtaining Other Coverage
You may waive HSS coverage for yourself and/or any enrolled dependent who enrolls in other healthcare coverage. (If you waive coverage for yourself, coverage for your enrolled dependents must also be waived.) Submit a completed HSS enrollment application form and proof of other healthcare coverage enrollment within 30 days from the date of enrollment in the other health plan. Proof of coverage must indicate the effective date of coverage and the names of enrolled individuals. Your HSS healthcare coverage will terminate on the last day of the coverage period in which HSS receives a completed HSS enrollment application, provided you meet the 30-day deadline and documentation requirements. There may be an overlap of healthcare coverage between the date other coverage begins and the date your HSS coverage terminates. You are responsible for paying all required contributions up to the termination date of your HSS healthcare coverage. If you do not complete the coverage termination process within 30 days from the date of enrollment in another healthcare plan, you must wait until the next annual Open Enrollment.
Moving Out of Your Plan’s Service Area
If you move your primary residence to a location outside your health plan’s service areas, you will no longer will be able to obtain services through that plan. You will need to enroll in a different HSS plan that offers service based on your new address. You must complete an HSS application to elect a new plan within 30 days of your move. Coverage under the new plan will be effective the first day of the coverage period following the date HSS receives your completed enrollment application. If you do not enroll in a new plan within 30 days of your move, you must wait until next Open Enrollment.
Death of a Dependent
If an enrolled dependent dies, you should notify HSS as soon as possible and submit a copy of the death certificate within 30 days from the date of death. Coverage for your deceased dependent will terminate the day after the dependent’s death.
Death of a Member
In the event of a member’s death, the surviving dependent or survivor’s designee should contact HSS to obtain information about eligibility for survivor health benefits. To be eligible for health benefits, the surviving spouse or domestic partner of an employee must have been married to the member, or registered as the member’s domestic partner, for at least one year prior to the death of the member. Other restrictions apply. After being notified of a member’s death, HSS will send instructions to the spouse or partner, including a list of documentation required for enrolling in surviving dependent health coverage. To avoid a break in coverage for survivors who were enrolled in HSS benefits at the time of the member’s death, the following must be submitted to HSS within 30 days of the member’s death date of death:
- Completed surviving dependent enrollment form
- Copy of member’s death certificate
- Copy of certificate of marriage or partnership
- Copy of survivor’s Medicare card (if survivor is Medicare-eligible)
