Health Service System Rules govern enrollment eligibility for employee and retiree members and their families.
HSS administers health benefits for eligible San Francisco City & County Employees (including the San Francisco Superior Court), Retirees, SFUSD employees, SFCCD employees.
The following City employees are eligible to participate in the Health Service System as defined in San Francisco Administrative Code Section 16.700:
Employee eligibility for HSS healthcare coverage is determined by the San Francisco Unified School District. Please confirm your eligibility with the SFUSD Benefits Office. The following SFUSD employees may be eligible for healthcare coverage administered by the Health Service System. Note: Temporary Exempt or “As Needed” SFUSD employees are not eligible for HSS administered healthcare coverage.
Employee eligibility for HSS healthcare coverage is determined by the Governing Board of the San Francisco Community College District. Review the SFCCD Benefits Guide or contact the SFCCD Benefits Office for more information.
Newly eligible retirees must enroll in an available medical and/or dental plan within 30 days of their retirement effective date. You must provide the Health Service System with a completed Retiree Enrollment Application and all required documentation within this initial 30 day enrollment period. Health Service System Rules requires that to be eligible for retiree healthcare coverage the retiree must have been a member of the Health Service System at some time during their active employment. Other restrictions may apply.
HSS member employees and retirees may enroll eligible dependents on their health coverage. Dependent eligibility and enrollment deadlines are outlined below.
A member’s legal spouse or domestic partner may be eligible for HSS healthcare coverage. Proof of marriage or registered domestic partnership is required, as well as the dependent’s Social Security number. Proof of Medicare enrollment must also be provided for a same-sex spouse or domestic partner (of either gender) who is age 65 or older, or who is Medicare-eligible due to a disability. Enrollment in HSS benefits must be completed within 30 days of the date of marriage or partnership. In that case, coverage begins on the first day of the coverage period after a completed application and eligibility documentation is filed with HSS. Legal spouses and domestic partners can also be added to a member’s coverage during annual Open Enrollment.
A member’s natural child, stepchild, adopted child (including child placed for adoption), and the natural or adopted child of a member’s enrolled domestic partner are eligible for coverage up to 26 years of age. Coverage terminates at the end of the coverage period in which the child turns 26. Eligibility documentation is required upon initial enrollment.
Children under 19 years old who are placed under the legal guardianship of an enrolled member, a member’s spouse, or domestic partner are eligible. If a member is required by a court’s judgement, decree or order to provide health coverage for a child, that child is eligible up to age 19. Coverage termi-nates at the end of the coverage period in which the child turns 19. The member must provide HSS with proof of guardiansh
Children who are disabled may be covered beyond the age limits stated previously, provided all of the following criteria are met. (A newly hired employee who enrolls an adult disabled child age 26 or older must meet all requirements below except 1 and 2.)
Members and dependents who do not have a Social Security number on file at HSS risk having benefits terminated. Social Security numbers for newborns must be provided within 6 months of the date of birth. Visit www.ssa.gov/pubs/10023.html for more information. If your dependent does not qualify for a Social Security number, please contact HSS at (415) 554-1750.
Members must notify HSS within 30 days and cancel coverage for a dependent who becomes ineligible. If a member fails to notify HSS, the member may be held responsible for the costs of ineligible dependent health premiums and any medical service provided.