DEVA Questions & Answers

To ensure that only eligible dependents are covered under the San Francisco Health Service System (SFHSS) health plans. Allowing coverage of ineligible dependents puts health plan administrators at financial risk and passes the cost onto eligible members. 

Upon request, all Employees who has dependent(s) enrolled in an SFHSS health plan must provide the required documentation requested. The dependents include spouses, registered domestic partners, and children

Yes. Even if you initially submitted documentation evidencing dependent eligibility, SFHSS Member Rules allow us to request documentation to prove that your dependent continues to be eligible for coverage.

Failure to provide documentation will result in the termination of your dependent(s) health benefits coverage. 

You will need to provide legal documents that show your relationship to your dependent(s).

For the complete list, visit our DEVA List of Acceptable Documents page.

Yes. If you have an ineligible dependent currently enrolled in benefits, you can remove your dependent by going to myapps.sfgov.org/ccsfportal/signin and logging into eBenefits.

From there, you can drop your ineligible dependent. For instructions on how to access eBenefits or how to register for an account (one-time only), go to sfhss.org/deva.

Begin by reviewing the DEVA List of Acceptable Documents.

Next, gather your documentation verifying your dependent's current eligibility. Go to https://myapps.sfgov.org/ccsfportal/signin to log into eBenefits.

Under eBenefits, select Submit a Qualifying Life Event, followed by I Received a DEVA Notice, to begin the process.

Submit your documentation or drop your ineligible dependent online.

You can also fax your documentation to (628) 652-4701 or mail to SFHSS, 1145 Market St., 3rd Floor, San Francisco, CA 94103. You must attach a Cover Sheet with your documentation.

Before submitting your documentation, be sure to redact information such as account numbers, financial information, Social Security Numbers, etc.

Digital copies will be retained and all hardcopies destroyed. The use, retention, and destruction of materials is done in compliance with regulations for handling Personally Identifiable Information (PII) and Protected Health Information (PHI).

For more information about our privacy policy, visit sfhss.org/sfhss-privacy-policy-and-forms.

If you cannot obtain copies of the required documentation, call SFHSS at (628) 652-4700 to discuss how to provide alternative documentation to verify the eligibility of your dependent. 

If you do not remove an ineligible dependent, coverage will be terminated for the dependent and you may be required to repay health care claims paid on behalf of your dependent including any reimbursements paid to you for ineligible dependents. SFHSS reserves the right to avail itself to other appropriate remedies.

Yes. You will receive a letter from SFHSS within approximately 30 days following the receipt of your documentation informing you of the status of your case.

The termination of health benefits due to eligibility is not a COBRA qualifying event.

There are a number of individual plans available for people who are not eligible for group coverage.

You can also visit Covered California, a government agency, that offers subsidized health plans under the Affordable Care Act (ACA). For more information, visit coveredca.com.

San Francisco Health Service System Member Rules, Section E, covers Dependent Eligibility. Section U covers Member Appeals and Grievances.

Appeals must be submitted within 60 days of the event giving rise to the grievance.

Appeals can be mailed to SFHSS, Attn. Member Appeals, 1145 Market St., Suite 300, San Francisco, CA 94103.

Member Rules can be found at sfhss.org/san-francisco-health-service-system-member-rules.

If you have any questions, contact SFHSS at (628) 652-4700.

Our telephone hours are Monday, Tuesday, Wednesday, and Friday from 9 a.m. to Noon and 1 p.m. to 5 p.m. and Thursday from 10 a.m. to Noon and 1 p.m. to 5 p.m.

The Dependent Eligibility Verification Audit will not include the whole population of the San Francisco Health Service System membership. Only a subset of the membership can be audited every year as there are over 120,000 total members.

The Dependent Eligibility Verification Audit runs from a specific period indicated in your DEVA letter notifications. If the documents you submit are incorrect, incomplete, or illegible, you will receive a letter from SFHSS providing you with additional instructions and a due date for compliance. Once you comply, you will receive a disposition letter informing you that you have complied. If you fail to provide the required documents, you will receive a termination letter for your dependent’s coverage.

Yes. If you have an ineligible dependent currently enrolled in benefits, through eBenefits or by mailing or dropping off a written request. This will satisfy your audit compliance obligation.

No. During the audit you will not be penalized for failing to remove an ineligible dependent. If you do not comply with the audit to show that a dependent is still eligible, your dependent’s coverage will be terminated by the San Francisco Health Service System.

To update your contact information log into the San Francisco Employee Portal and select ‘My Information’ in the left hand-side navigation bar. You can also contact your HR department to update your contact information. It is your responsibility to keep your contact information current with the San Francisco Health Service System.

If you are not able to obtain documents during the audit period, you will still be required to provide documentation that you are attempting to get the required documents once that is received an analyst will reach out to you to confirm your new compliance deadline.

• Taxes: If you choose to get an IRS extension for your tax period, please provide the request documentation and that it was acknowledged by the IRS.
• Birth Certificate: If you are in the process of getting a copy of your child’s birth certificate but know you will not get it in time before the end of the audit, please provide the request form that was filed with your county clerk’s office or other issuing body, for the document.
• For any other document that may be used for compliance, if the member stated that they are in the process of getting it, they should—provide in writing what the document is, when they expect to get it, and what/who is the issuing entity.

Reminder: For any documents in a foreign language, it is the member’s responsibility to provide a certified translation of the document along with the original.

All submitted documents are being worked as they come in. One of two things can happen after you submit your documents, once the document is reviewed:

1. If it meets the requirements (see the DEVA List of Acceptable Documents—for all the requirements of what you’ll need to submit) you will receive a disposition letter around thanking you for your compliance and no other action is required by you, OR
2. If your document(s) does not meet the requirements listed in the DEVA List of Acceptable Documents, you will receive a Notice of Insufficient Documentation letting you know that your documents did not meet the requirements and by when you have to submit the correct documents.
   1. If after this letter you do not submit the required documents, you will receive a termination letter for your dependent’s coverage.

Fax: Review your confirmation sheet from the fax machine that you used, if it is set to generate a confirmation sheet you will be able to see the completed status of the fax transmission.

eBENEFITS: When submitting documents through eBENEFITS, you will get a successful message that your documents were submitted successfully.

Mail/Drop Box: If you mailed or dropped off your documents you can call the call center to confirm receipt. Please allow 10 days for processing. Also documents may not be available for view by phone agents immediately, please allow 3-business days from the time your documents are submitted.

If you find that you submitted incorrect documents during the audit period, please resubmit your documents.

Any incorrect or illegible documents submitted will be reviewed and a letter of Insufficient Documentation will be mailed out to address the insufficiency. You will only have 10-days from the date of the letter to resubmit your documents.

Yes, each dependent must have their own specific verification. A list of acceptable verifications for each type of dependent was sent to you with the first letter you received informing you about the audit.

If you don’t have access to this document, you can print out an extra one at sfhss.org/deva.

Yes. Any incorrect or illegible documents submitted will be reviewed and a letter of Insufficient Documentation will be mailed out to address the insufficiency. You will only have 10-days from the date of the letter to resubmit your documents.

Extensions will only be provided under exigent (or special) circumstances and will be reviewed on a case-by-case basis. If you are seeking an extension due to an approved IRS extension to file your federal income tax, you will be required to provide proof of the extension request from the IRS. If you are seeking an extension due to delays in receiving a child’s birth certificate from the county’s vital records office, you will be required to provide verification that a request for the vital records has been made to the county.

Dependents who are determined ineligible due to the member’s failure to comply with the audit, are not eligible for continuation of coverage through COBRA. If termination of coverage coincides with an otherwise qualifying life event, continuation of coverage may be available.

There are a number of individual plans available for people who are not eligible for group coverage. You can also visit Covered California, a government agency that offers subsidized health plans under the Affordable Care Act (ACA). For more information, visit coveredca.com.