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Qualifying Events

A Qualifying Event is a major life event that allows you to make changes to your benefits enrollment outside of open enrollment. Common Qualifying Events include getting married or having a child.  You can find a complete list on the PDF icon Qualifying Event ChartThe Benefits Office must be notified within 30 days of the life event in order to qualify for enrollment changes. 

If you have experienced a qualifying event and would like to make enrollment changes, please complete and submit the Qualifying Event Form within 30 days from the date of the event.  Proof of the qualifying event will be required.  To process your requested changes, supporting documentation (e.g.  birth certificate, hospital notice, marriage certificate) will need to be submitted to Risk Management within 30 days of the Qualifying Event.  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 miss the 30-day deadline, you will need to wait until the next open enrollment period to make changes.

I need to enroll myself or dependents in coverage

I had a baby/adopted a child

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.

I got married

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:
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 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.

Loss of previous health coverage

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 insured, type of coverage lost and date of loss. 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. If adding otherdependents not previously enrolled, supporting documentation (e.g. birth certificate, adoption papers, marriage certificate) will also need to be submitted. For 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.

I need to add dependent(s) due to judgment, decree, or order

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 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.

I need to drop myself or dependents from City coverage

I got divorced/legally separated

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 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.

Gained new coverage through another qualified health plan

Supporting Documentation:
1. Proof of gained coverage - new insurance information which includes the effective date of coverage, type of coverage, and name(s) of 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 7/1/2020; or 2) POA and Local 911 hired on or after 7/1/2021.

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 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.

I need to remove dependent(s) due to judgment, decree, or order

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 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.

Death of Dependent

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 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.

I need to make a prospective change to my DCC FSA due to change in care provider

I need to increase my Dependent/Child Care FSA contributions

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 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.

I need to decrease my Dependent/Child Care FSA contributions

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 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.

I need to cancel my Dependent/Child Care FSA contributions

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

Residence Change

I moved out of network and need to make a change

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 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 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.

I moved in network and need to make a change

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 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.

Unpaid Leave (non-FMLA)

I am returning from an unpaid leave of absence

If your health coverage 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.

I can't find what I am looking for

Benefits Appointment Request

If you cannot find what you are looking for, please schedule an appointment to speak with an Employee Benefits Specialist or send an email to Benefits@sandiego.gov.