Qualifying Life Events

Guidelines

To change benefit elections mid-year due to a qualifying life event, you must complete your benefits election change, including the submission of all required documentation, no later than 30 calendar days after the qualifying event occurs.

If your election change process is not completed within 30 days of the date of your qualifying event, you must wait until the next Open Enrollment period in October to make the change (individuals with End-Stage Renal Disease may be prohibited from changing medical plans).

COVID-19 Relief 

SFHSS members can now make a one-time mid-year benefits election change for Plan Year 2020 due to new IRS guidelines that were approved by the Health Service Board on May 28, 2020.

Please note that you cannot make any changes to your vision plans due to COVID-19 Relief. There is no 30-day deadline for changes made due to COVID-19 Relief.

See the How to Make Benefits Changes below for more details on how to enroll.

Marriage or Domestic Partnership

To enroll a new spouse or domestic partner and eligible children of a spouse or partner in SFHSS healthcare coverage, you can make your health benefit election changes online using Life Events or submit a completed Enrollment Application Form along with a copy of the certified marriage certificate or certificate of domestic partnership and a birth certificate for each child to SFHSS within 30 days of the legal date of the marriage or partnership. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

A Social Security number must be provided for each family member being enrolled. Proof of Medicare enrollment is also required for a domestic partner who is Medicare-eligible due to 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. Per IRS rules, the employer premium contribution for domestic partner health coverage is taxable imputed income (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

To enroll your newborn or newly adopted child, you can make your health benefit election changes online using Life Events or submit a completed 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. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Coverage for an enrolled newborn child will be effective on the child’s date of birth. Coverage for an enrolled adopted child will be effective on the date the child is placed. A Social Security number must be provided within six months of the date of birth or adoption, or your child’s coverage may be terminated. For information about obtaining a Social Security number, visit ssa.gov

Legal Guardianship or Court Order

Coverage for a dependent per a court order will be effective the date of court order if all documentation is submitted by the 30-day deadline.

You can make your health benefit election changes online using Life Events or submit a completed Enrollment Application Form. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Divorce, Separation, Annulment and Dissolution of Partnership

By law, you must disenroll ineligible dependents within 30 days from the date of a divorce, legal separation, annulment or dissolution of partnership. You can make your health benefit election changes online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Coverage for an ex-spouse, domestic partner and stepchildren will terminate on the last day of the coverage period in which the divorce, legal separation, annulment or dissolution of domestic partnership occurred, provided you complete disenrollment within 30 days.

Failure to notify SFHSS can result in significant financial penalties equal to the total cost of benefits and services provided for any ineligible dependents.

Loss of Other Health Coverage

SFHSS members and eligible dependents who lose other coverage may enroll by submitting a completed application and proof of loss of coverage within 30 days of the date other coverage terminates. Coverage can be lost due to termination of employment, change from full-time to part-time work, dropping other employer coverage during the Open Enrollment period, ineligibility for Medicare or Medicaid, unpaid leave of absence or return from military service.

Documentation of lost coverage must state the date other coverage ends and the names of individuals losing coverage. If required documentation is submitted, SFHSS 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 SFHSS coverage begins. 

You can make your health benefit elections online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Obtaining Other Coverage

You may waive SFHSS coverage for yourself or a dependent who enrolls in other health coverage (if you waive coverage for yourself, coverage for all your enrolled dependents must also be waived). Submit a completed SFHSS application and proof of enrollment within 30 days of 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. After all required documentation is submitted, SFHSS coverage will terminate on the last day of the coverage period. There may be an overlap of coverage between the date other coverage begins and the date SFHSS coverage terminates. You must pay premium contributions up to the termination date of SFHSS coverage.

You can make your health benefit election changes online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Moving Out of Your Plan’s Service Area

If you move your primary residence to a location outside your health plan’s service area, you cannot obtain services through that plan. Don’t risk termination of coverage. You must enroll in a different SFHSS plan that offers service based on your new address within 30 days of your move. Coverage under the new plan will be effective the first day of the coverage period following the date SFHSS receives your enrollment application and any required documentation. 

You can make your health benefit election changes online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Death of a Dependent

If an enrolled dependent dies, notify SFHSS as soon as possible and submit a copy of the death certificate within 30 days of the date of death. Coverage terminates the day after the dependent’s death. 

You can make updates online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Death of a Member

In the event of a member’s death, the surviving dependent or survivor’s designee should contact SFHSS 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. The surviving spouse or domestic partner of an employee member hired after January 9, 2009, may not be eligible for SFHSS benefits. Other restrictions apply.

After being notified of a member’s death, SFHSS 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 SFHSS benefits at the time of the member’s death, the following must be submitted to SFHSS within 30 days of the member’s 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)

A surviving spouse or partner who is not enrolled on the deceased member’s health plan at the time of the member’s death may be eligible for coverage, but must wait until the next Open Enrollment period in October to enroll. Surviving dependent children of a member must meet eligibility requirements for dependent children and be enrolled at the time of the member’s death and are only eligible for benefits under a surviving spouse or surviving domestic partner.

You can make updates online using Life Events or submit a completed Enrollment Application Form along with a copy of the legal documentation of your family status change. See How to Make Benefit Changes Due to a Qualifying Life Event below for more details.

Changing Contributions to a Flexible Spending Account (FSA)

Per IRS regulations, some qualifying events may allow you to initiate or modify Flexible Spending Account (FSA) contributions. For questions about qualifying events and authorized FSA contribution changes contact SFHSS at (628) 652-4700. For a list of qualifying events and corresponding authorized FSA contribution changes, visit our Flexible Spending Accounts page.

Responsibility for Premium Contributions

Change in coverage due to a qualifying event may change premium contributions. Review your paycheck or pension check to make sure premium deductions are correct. If the premium deduction is incorrect, contact SFHSS. You must pay any premiums that are owed. Unpaid premium contributions can result in termination of coverage.

How to Make Benefit Changes

If you are a City and County of San Francisco or Superior Court of San Francisco employee and would like to make a benefits change outside of Open Enrollment for a Qualifying Life Event or a one-time change due to COVID-19 Relief, you can make your changes online using eBenefits.

Go to How to Enroll for details.

If you are already familiar with how to use our online eBenefits portal, visit the San Francisco Employee Portal and click on Life Events under Benefits

If you do not have access to eBenefits or are a San Francisco Unified School District employee, City College of San Francisco employee, or a retiree, you can make your Qualifying Life Event or COVID-19 Relief health benefits elections by downloading and returning a completed Enrollment Application Form. 

Find your Enrollment Application Form by clicking the appropriate link below.

City and County of San Francisco
MEA
Superior Court of San Francisco
SFUSD
City College
Retirees with Medicare
Retirees without Medicare

Fax your completed form along with photocopies (no originals) of your supporting documentation to (628) 652-4701 or mail to SFHSS, 1145 Market Street, 3rd Floor, San Francisco, CA 94103.

Questions?
Our telephone hours are Monday, Tuesday, Wednesday and Friday from 9am to 12pm and from 1pm to 5pm and Thursday from 10am to 12pm and 1pm to 5pm. Our number is (628) 652-4700 or toll-free: (800) 541-2266.

Posted On

Aug 12, 2020