To make changes to benefits outside of an open-enrollment period, employees must have experienced an Applicable Qualifying Event, as defined by the Internal Revenue Service (IRS). Changes based on financial reasons alone are not allowed under the current IRS regulations.

The request for a change of benefits must be made within 31 days of the Applicable Qualifying Event. Within the context of changing benefits, "Applicable" refers to a change that is directly related to the individual experiencing the qualifying event. I understand that I have 31 days to notify HR if a dependent becomes ineligible and if I fail to do so, then I am responsible for any cost incurred by the City for claims and employer premiums after the dependent became ineligible.

For dependent(s) added to coverage, you are required to submit a Public Benefit Dependent Affidavit with supporting documentation. Documentation must be submitted within 90 days from the benefit coverage effective date.

Failure to submit supporting documentation will result in dependent(s) being removed from your coverage.

"Qualifying Events" include:

• A birth or an adoption  

  Accepted Documents

   Birth Certificate
   Adoption Final Court Documents  
• Marriage, divorce or legal separation
   

  Accepted Documents

   Marriage Certificate
   Divorce Decree 
  Documentation Needed - To enroll your spouse in the City of Surprise’s group benefit plans you must provide a marriage certificate to verify spousal benefit eligibility. Verification helps ensure that the City of Surprise only covers those who qualify for coverage. Please submit a copy of your marriage certificate, along with all other documentation needed to Human Resources.
• A death  

  Accepted Document

   Death Certificate  
• Child loses eligibility because of age
• Employee’s spouse gains or loses coverage  

  Accepted Document

   Loss of Coverage
  (must have effective end date of coverage)   through employment
• Significant change in the financial terms of health benefits provided through a spouse’s employer or another carrier
• Change in employment status (from full-time to part-time or part-time to full-time)

Except for coverage of a newborn, all other changes in coverage begin the first day of the month following the qualifying event. Coverage for the newborn is effective on the child’s date of birth. The premiums for newborn coverage cannot be pro-rated and must be paid for the entire birth month.

For dependent(s) added to coverage, you are required to submit a Public Benefit Dependent Affidavit with supporting documentation. Documentation must be submitted within 90 days from the benefit coverage effective date.

Failure to submit supporting documentation will result in dependent(s) being removed from your coverage.

For additional information, please contact the City of Surprise HR Department.