Health Service System - City & County of San Francisco

Life is always changing. Make sure your benefits are up-to-date. Read this information to learn about making changes to your healthcare coverage elections due to a recent:

• - Marriage
• - Domestic Partnership
• - Birth or Adoption of a Child
• - Divorce, Legal Separation or Dissolution of Domestic Partnership
• - Loss of Other Healthcare Coverage
• - Obtaining Other Healthcare Coverage
• - Death of a Dependent

Take special note of the 30 day time period during which you can make healthcare coverage changes after one of these qualifying changes in your family status. When you submit an enrollment application due to a status change be sure to include any required eligibility documentation.

Marriage or Domestic Partnership
To enroll your new spouse or domestic partner and their eligible child(ren) in your HSS healthcare coverage you must submit a completed HSS Enrollment Application and a copy of your marriage license or certificate of domestic partnership and birth certificates for their child(ren) to the Health Service System within 30 days from the date of your marriage or certification of domestic partnership. Coverage for your spouse or domestic partner and their eligible children will be effective on the date of marriage or certification of domestic partnership, provided you meet the enrollment deadline and documentation requirements stated above. If you do not complete the enrollment process within 30 days from the date of your marriage or certification of domestic partnership, you must wait until the next annual open enrollment period to add your new family members.

Domestic Partner Tax Alert: When you elect healthcare coverage for your domestic partner (and any dependent(s) of your domestic partner), you will be taxed on the value of the City and County of San Francisco's contribution toward the cost of healthcare coverage for these dependents, per IRS requirements. This is referred to as imputed income and may affect your net pay.

Birth or Adoption
To enroll your newborn/newly adopted child in your HSS healthcare coverage you must submit a completed HSS Enrollment Application and a copy of the birth certificate or adoption documentation within 30 days from the date of birth or placement for adoption. Coverage for your newborn child will be effective on the child's date of birth provided you meet the deadline and documentation requirements stated above. Coverage for your newly adopted child will be effective on the date the child is placed with you for adoption provided you meet the deadline and documentation requirements stated above. If you do not complete the enrollment process within 30 days from the date of birth or placement for adoption of a new child, you must wait until the next annual open enrollment period to do so.

Divorce, Separation and Dissolution of Partnership
To terminate healthcare coverage for your ex-spouse/domestic partner due to divorce, legal separation or dissolution of domestic partnership, you must submit a completed HSS Enrollment Application and a copy of your divorce decree, legal separation documents or dissolution of domestic partnership documents within 30 days from the date of divorce, legal separation or dissolution of domestic partnership. Coverage for your ex-spouse/domestic partner will terminate on the last day of the coverage period in which the divorce, legal separation or dissolution of domestic partnership occurred provided you meet the deadline and documentation requirements stated above. If you do not complete the coverage termination process within 30 days from the date of your divorce, legal separation or dissolution, coverage for your ex-spouse/domestic partner will terminate on the last day of the coverage period in which you submit a completed HSS Application and required documentation and you will be responsible for paying all required contributions up to the coverage termination date.

Loss of Other Healthcare Coverage
You can enroll an eligible dependent that loses other healthcare coverage by submitting a completed HSS Enrollment Application and proof of the loss of coverage within 30 days from the date the other coverage terminates. Coverage for your dependent will be effective on the first day of the coverage period following the date HSS receives a completed HSS Enrollment Application provided you meet the deadline and documentation requirements stated above. Please note that there may be a break in healthcare coverage between the date that other coverage terminates and the date that HSS coverage begins. If you do not complete the enrollment process within 30 days from the date that the other coverage terminates, you must wait until the next annual open enrollment period to add your eligible dependent.

Obtaining Other Coverage
TYou may terminate healthcare coverage for yourself and/or your enrolled dependents if you or they become eligible for other healthcare coverage by submitting a completed HSS Enrollment Application and proof of other healthcare coverage enrollment within 30 days from the date of your enrollment in another healthcare plan. Your HSS healthcare coverage will terminate on the last day of the coverage period in which HSS receives a completed HSS Enrollment Application provided you meet the deadline and documentation requirements stated above. Please note that there may be an overlap of healthcare coverage between the date your other coverage begins and the date your HSS coverage terminates. You are responsible for paying all required contributions up to the termination date of your HSS healthcare coverage. If you do not complete the coverage termination process within 30 days from the date of your enrollment in another healthcare plan, you must wait until the next annual open enrollment period to do so.

Death of a Dependent
If an enrolled dependent dies, you should notify HSS as soon as possible and submit a copy of the death certificate within 30 days from the date of death. Coverage for your deceased dependent will terminate at midnight on the date of the dependent's death.

Death of a Member
In the event of a member's death, surviving dependent(s) or another designee should contact HSS within 30 days from the date of the member's death to obtain information about any available survivor benefits.