Eligible Dependent Information

Who qualifies as an eligible dependent for the City of Surprise medical, dental and vision plans? 

  • The contract holder’s lawfully or legally married spouse. 
  • The contract holder’s children or children of the contract holder’s spouse (up to the age of 26), including birth children, legally adopted children, stepchildren, children placed for adoption, children under legal guardianship substantiated by a court order and children who are entitled to coverage under a medical support order. 
  • The contract holder’s domestic partner. 
  • Children of the contract holder’s domestic partner (up to the age of 26).

Am I required to submit supporting documentation for my dependents?

Yes, for all dependents you must submit a Public Benefit Dependent Affidavit with supporting documentation. Documentation must be submitted within 90 days from the benefit coverage effective date or you dependent(s) will be dropped from coverage. 

Additionally, the following documentation is required:

  • Spouse: Please submit a copy of your marriage certificate.
  • Domestic Partner: Please submit a Domestic Partnership Affidavit all supporting documentation pre-dated 12 months and a Certification of Domestic Partner Tax Status. 
  • Children: We may require additional documentation to substantiate your relationship with enrolled children on your plan. 

By enrolling a dependent in coverage you understand that you have 31 days to notify HR if a dependent becomes ineligible and process a Qualified Life Event and if an employee  fails to do so, then they will be responsible for any costs incurred by the City for claims and employer premiums after the dependent became ineligible.

Please contact Human Resources Benefits with any questions at Benefits@surpriseaz.gov or 623-222-3532