Insurance FAQ

Eligibility

Am I eligible for insurance (employee)?

Employee eligibility


You are eligible for insurance if you are hired to work, on average, 30 or more hours per week (130 or more hours per month) on a permanent basis, or if you are an elected official. 

  • If you are a variable hour, temporary or seasonal employee, you generally won’t be eligible for insurance.

Am I eligible for insurance (retiree)?

Retiree Eligibility


To be eligible for retiree insurance, you must

  • Have worked in benefits-eligible position since prior to January 1, 2016 and through your date of retirement *
  • Meet pension eligibility requirements for normal retirement
    • Deferred retirees: You are ineligible for retiree insurance
    • Disability or early retirees: Contact the Benefits team to determine your eligibility

In general, retiree medical is available to retirees under age 65

  • If you qualify for Medicare before age 65 due to disability, contact your benefits team to discuss additional requirements
  • Retirees' dependents who qualify for Medicare (due to age or disability) are ineligible for medical
    • Contact your benefits team if your dependent qualifies for Medicare before turning 65

Retiree dental and vision require maintenance of continuous dental / vision coverage.

  • Addition of dental or vision post-retirement is contingent upon ability to prove continuous coverage (applies to retirees plus their spouse & children)

See the Insurance Handbook and Retiree Health Continuation AD for details.

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* If you retire and later return to work as an insurance benefits eligible employee, you forfeit future retiree insurance (medical, dental, vision, life). Employees hired or rehired on or after January 1, 2016 are ineligible for retiree insurance and have limited insurance continuation options through COBRA. See our Retiree Insurance FAQ under Retiring or Separating from Service, below.

Am I eligible for City insurance if I have coverage through another source (Medicare, Tricare, another employer)?

Employees

Employees are eligible for in City insurance, even if they have similar coverage through a non-City source, such as having coverage through a spouse's job, Tricare or Medicare. 

Retirees

While retirees and their dependents  may be enrolled in additional dental, vision and life insurance while being enrolled in the City's insurance, they may not be enrolled in City medical if they have medical insurance through another source, including:

  • Another employer's medical (on your own or through a spouse/partner)
  • Tricare
  •  Medicare1

If you are a retiree or a dependent of a retiree and you have two or more medical plans, you must contact the City's benefits team immediately to disenroll from City medical. 

  • We do audit for other insurance, and you may be required to repay premiums and / or claims costs if you have other medical insurance at the same time that you have City medical.

1 Retirees under 65 who qualify for Medicare due to disability may be allowed to remain enrolled in City medical. See Medicare FAQs for details.

Which dependents are eligible?

Dependent Eligibility


  • Your spouse (unless divorced or legally separated)
  • Your children under age 26
    • Biological
    • Step
    • Adopted (including those placed for adoption)
    • Foster
    • Child named as an “alternate recipient” under a Qualified Medical Child Support Order (QMSCO)
    • Child for whom you have full permanent legal guardianship (generally excludes children over 18; contact your benefits team with questions

Under limited circumstances, you may be able to continue coverage for disabled dependents once they reach age 26; contact your benefits team with questions.

Do I need to prove my dependents are eligible?

Yes. We audit all dependents to make sure they're eligible. 

You'll be asked to supply documents such as:

  • government-issued birth and marriage certificates, and 
  • proof that you and your spouse are still married, such as your tax return from last year, or a household bill or statement that lists your spouse at your address

You'll be contacted for information when you've been selected for an audit, and you'll have a limited time to provide documents, so please make sure you have them available. 

What if I don't verify my dependents' eligibility by the deadline?

When you're chosen for an audit, you'll have a deadline for supplying documents proving your dependents' eligibility. 

Dependents who aren't verified are removed from coverage, and you may be responsible to repay money associated with their coverage.

If they're removed from coverage, your next opportunity to re-enroll them and prove their eligibility will be during the annual open enrollment period, with coverage starting the following July 1.

I'm the survivor of a benefits-eligible retiree. May I continue insurance if I remarry?

Surviving widow(er) of retiree re-marries

If you're enrolled in City benefits (medical, dental and/or vision) as a surviving widow of a deceased retiree and you re-marry, you lose your eligibility and must drop your City of Tucson insurance. 

Periodically, we will audit your eligibility to ensure that you continue to meet requirements. It is important that you respond in a timely manner in order to ensure that your coverage continues if you are eligible.

Enrolling or Making Changes

How do I enroll or request a change?

You can accomplish most enrollment, including your new hire enrollment and most life event requests, via the enrollment system.

Many requests require additional documentation, which you can upload through the enrollment system. 

We invite you to review information that's relevant to your particular request by exploring additional FAQs on this page.

When does my insurance begin? (new hires & newly eligible employees)

For new hires or employees who have recently started working 30+ hours each week on a permanent basis, insurance begins the first day of the month, following 30 days of eligible employment. For example:

  • If you're hired on February 1, your insurance would start April 1
  • If you're hired March 1 or 2, your insurance also would start April 1
  • If you're hired March 3 - 31, your insurance would start May 1

You'll need to elect coverage within your first 30 days of employment, or within 30 days of moving into a benefits-eligible position if you weren't previously eligible for insurance. For example, employees who start working in a benefits-eligible position on February 1 need to enroll by March 2, unless it's leap year, in which case enrollment must be completed by March 1. 

If you don't enroll by your benefits start date, your next opportunity will be during the spring open enrollment period, or earlier if you have a qualifying life event like losing coverage through another employer's plan. See our other FAQs for details.

Medical Opt Out Incentive

If you waive City medical and provide proof of other qualifying coverage, you may be eligible to receive the $36.92 biweekly opt out incentive payment.

  1. Log your request to receive the incentive under Menu > Requests > Opt out incentive
  2. As part of your request, upload your proof of other qualifying medical insurance
    • A new request and new documentation is required each plan year
    • Because Workday houses incentive payment information separately from insurance requests like dropping City coverage, this step is required even if you already uploaded documentation under a request to drop City insurance

Open Enrollment

Open enrollment is your annual opportunity to add, drop, or change your insurance selections and the people you're covering. The City has two open enrollment periods:
  • Spring enrollment includes medical, dental, vision, life, long term disability, and Colonial coverage.
    • Elections generally take effect July 1
    • The plan year is July 1 - June 30
  • Fall enrollment includes the health care and dependent day care flexible spending accounts
    • Elections take effect January 1
    • The plan year is January 1 - December 31

Making changes when it's not open enrollment

You may change some benefits without a qualifying life event by logging your request in the enrollment system such as
  • Dropping life insurance
  • Reducing long term disability
  • Dropping after-tax Colonial benefits
  • Changing your personal HSA contribution

If you're a retiree, you may drop your insurance at any time by logging your request in the enrollment system

To change other benefits outside of open enrollment, you'll need to have a qualifying life event. 
  • See below for the most common types of qualifying events
  • The list below doesn't cover all possible qualifying life events; if you've had a major life change and don't see information that you're seeking, please contact your benefits team: benefitquestions@tucsonaz.gov

Birth or Adoption

Congratulations and best wishes to you and the newest member of your family! 

You have 60 days after your child is born, adopted or placed for adoption to request coverage for your new child:
  1. Add your child's personal information and request medical and dependent life coverage for your child via the enrollment website. (You'll need to wait until the next open enrollment period to add dental and/or vision.) 
  2. Be sure to update your life insurance beneficiaries as part of this process. Remember, the City will provide employer-paid life insurance, but only if you register your child for the coverage.
  3. Be sure to upload a copy of your child's birth certificate as part of the enrollment process. If you don't have it yet, you'll have 60 days from the date your child is born / adopted to upload it.
  4. If we receive your request and the birth certificate within the 60-day deadline, coverage begins as of the date of birth / adoption. This may mean that we'll collect retroactive premiums from you, if we receive your request after the coverage start date.

SSN

Be sure to apply for a Social Security number for your child, if the hospital doesn't submit the application for you. Please call us as soon as you receive the SSN so we can add it to your child's record. 

Dependent Audit

You'll need to prove all new dependents' eligibility through the City's audit process. This usually occurs in the spring but could occur at any time. Visit the other FAQs for details.

Other items to consider

  1. Work with your department's payroll team if you'd like to update your tax withholding
  2. Consider whether you need to update your beneficiaries for your HSA Bank account, Colonial benefits, pension, deferred compensation, union benefits, and any non-work related policies and financial accounts.
  3. Consider creating a simple will, if you don't already have one.

Marriage

You have 31 days after you get married to request coverage for your new spouse and step-children:
  1. Add their information and request their coverage via the enrollment website. Be sure to update your life insurance beneficiaries as part of this process. Remember, the City will provide employer-paid life insurance for them, but only if you register them for the coverage.
  2. You'll need to upload a copy of your marriage certificate as part of the enrollment process.
  3. Coverage will start the first day of the month following your date of marriage. This may mean that we'll collect retroactive premiums from you, if we receive your request after their coverage start date.

Dependent Audit

You'll need to prove all new dependents' eligibility through the City's audit process. This usually occurs in the spring but could occur at any time. Visit the other FAQs for details.

Retirees Requesting Dental and/or Vision

Retiree dental and vision have continuous coverage requirements. For new family members to be approved for dental and/or vision, in addition to requesting the coverage, you will need to prove that they have had continuous similar coverage for the 36 months immediately preceding the date City coverage would take effect.

Other items to consider

  1. If you're changing your name, be sure to supply a copy of your new Social Security card to your department's payroll team. Also check with them if you'd like to update your tax withholding
  2. Consider whether you need to update your beneficiaries for your HSA Bank account, Colonial benefits, pension, deferred compensation, union benefits, and any non-work related policies and financial accounts.
  3. Consider creating a simple will, if you don't already have one.

Divorce

You have 31 days after you get divorced to remove your former spouse and step-children from City insurance:

  1. Log your request via the enrollment website. Be sure to update your life insurance beneficiaries as part of this process. 
  2. You'll need to upload a copy of your divorce decree (first page and signature page only).
  3. Coverage will end the last day of the month during which you divorce. This may mean that we'll refund retroactive premiums to you, if we receive your request after the coverage end date.

Other items to consider

  1. If you're changing your name, be sure to supply a copy of your new Social Security card to your department's payroll team. Also check with them if you'd like to update your tax withholding
  2. Consider whether you need to update your beneficiaries for your HSA Bank account, Colonial benefits, pension, deferred compensation, union benefits, and any non-work related policies and financial accounts.
  3. Consider creating a simple will, if you don't already have one.

Gaining other coverage

You have 31 days after you, your spouse or child gain other group insurance to drop corresponding coverage with the City (60 days if you gain AHCCCS, Medicaid or CHIP).

  1. Log your request to drop individuals who gained coverage from the same type of insurance that was gained
  2. Upload proof of the new coverage showing:
    • Who gained coverage
    • Type of coverage gained (medical, dental, vision)  
    • Date coverage started
City coverage ends the last day of the month during which the new coverage starts. This may mean that we'll refund retroactive premiums to you if we receive your request after the new coverage starts.


Medical Opt Out Incentive

If you waive City medical and provide proof of other qualifying coverage, you may be eligible to receive the $36.92 biweekly opt out incentive payment.

  1. Log your request to receive the incentive under Menu > Requests > Opt out incentive
  2. As part of your request, upload your proof of other qualifying medical insurance. Because Workday houses incentive payment information separately from insurance coverage requests, this step is required even though you already uploaded your documentation under the request to drop coverage.

Other items to consider

  1. You may drop only the same type of coverage that was gained through another group health plan, such as through another employer, Medicaid, Medicare or Tricare. 
  2. You may not drop coverage outside open enrollment if you gain coverage through an individual policy, such as through the Health Insurance Marketplace.
  3. Consider whether you need to update your beneficiaries for your HSA Bank account, Colonial benefits, pension, deferred compensation, union benefits, and any non-work related policies and financial accounts. See the "Changing Your Beneficiary" FAQ for details.
  4. Consider creating a simple will, if you don't already have one.

Note to retirees

If you're a retiree, you may drop coverage at any time by logging your request in the enrollment system. No proof of gaining other coverage is necessary. The change would be effective the first of the month following the date you log your request.

Losing other coverage

You have 31 days after you, your spouse or child lose other coverage to request coverage with the City (60 days if you lose AHCCCS, Medicaid or CHIP).

  1. Log your request to add individuals who lost coverage to the same type of insurance that was lost
  2. Upload proof of the lost coverage showing:
    • Who lost coverage
    • Type of coverage lost (medical, dental, vision)  
    • Date coverage ended
  3. Retirees wishing to add dental or vision also must upload proof that they and any dependents for whom they are requesting coverage had similar coverage through another group plan for the 3 years immediately preceding the date City coverage would go into effect. This requirement applies only to retirees. 
City coverage starts the first day of the month following the date other coverage ends. We'll collect retroactive premiums from you if we receive your request after the old coverage ends.

Dependent Audit

You'll need to prove all new dependents' eligibility through the City's audit process. This usually occurs in the spring but could occur at any time. Visit the other FAQs for details.

Other items to consider

  1. Make sure you understand the rules. For example, you may join coverage only if you lose coverage through another group health plan, such as through another employer, Medicaid, Medicare or Tricare. You may not join coverage outside open enrollment if you lose coverage through an individual policy, such as through the Health Insurance Marketplace.
  2. Retirees pay vision premiums directly to the vision insurance carrier. Only medical and dental are deducted from pension checks.
  3. Consider whether you need to update your beneficiaries for your HSA Bank account, Colonial benefits, pension, deferred compensation, union benefits, and any non-work related policies and financial accounts. See the "Changing Your Beneficiary" FAQ for details.
  4. Consider creating a simple will, if you don't already have one.

Changing your beneficiary

You may need to designate beneficiaries separately for different benefits with the City:

Drop Medical, Dental, Vision - Retirees Only

Retirees may drop medical, dental, and/or vision - or drop dependents from medical, dental, and/or vision - by logging into Workday, clicking on Benefits under the Workday Menu, then Change Benefits, and following the prompts to drop coverage. No documentation is required for this change. Workday will allow you to continue through the process without submitting documentation.

***

Employees, please review the FAQ titled Gain of Other Coverage, above. Outside of open enrollment, employees may drop coverage only within prescribed deadlines, and if they gain similar coverage through another qualifying plan, per IRS rules.

Updating your address, phone or email address

If you have insurance through City of Tucson, please update your address, phone, and/or email address, via Workday.

In addition, retirees, please contact your retirement team to ensure that pension and deferred compensation communications continue to reach you:

Retiring or Separating from Service (Leaving Employment)

I'm leaving the City. When does my insurance end?

Medical, dental, vision, life and employee assistance program coverage end the last day of the month during which you separate from employment. 

Long term disability, Colonial coverage and flexible spending accounts end on your last day worked. You have 90 days from your separation date to submit FSA claims. See our FSA page for details.

Do I need to check out with the Benefits team?

Be sure to update your mailing address in Workday

After separation, you'll still need receive important correspondence from the City; please keep your address current in Workday. Also consider changing your address with the US postal service if you move. 

Retirement Check-out

Congratulations on your upcoming retirement! Please email us once you've established your retirement date with TSRS or PSPRS so we can schedule an appointment with you to review your insurance options.

During our 30-45 minute meeting, we will review your options, and you will make your initial retirement insurance selections.

  • Spouses are welcome but not required at the insurance check-out meeting

Non-Retirement Check-out

If you are leaving for reasons other than retirement, it is not necessary to meet with the Benefits team. If you have questions after reviewing our FAQ, please reach out so we can assist: benefitquestions@tucsonaz.gov.

Leaving Due to Disability

If you are leaving due to a disability, you may be eligible to file a long term disability claim, and you may be eligible to continue life insurance without paying premium. Deadlines exist

  • Visit our Forms page to download the long term disability claim form and/or life insurance waiver of premium form.
  • Visit the long term disability and life insurance paged for information about how to contact our insurance carriers in case you have questions. 

Retiree insurance

Retiree benefits

At the time of retirement, you may continue existing medical, dental and vision and you may drop family members from coverage; you may not add plans, change plans, or add people to coverage. 

For information about changing plans or adding coverage or family members, please refer to the "Making Changes" FAQs.

Employees hired or rehired on or after January 1, 2016 are ineligible for retiree insurance.

Some rules differ once you retire

  • The City does not contribute to HSA accounts post-retirement
    • If you're enrolled in the high deductible medical plan with HSA, you may continue the medical plan when you retire, but you won't receive additional HSA bank account contributions
    • Your medical will be switched to the HRA on the first day of July following your retirement
  • Once you retire, the City's dental and vision plans have continuous coverage requirements, meaning that you may continue coverage for people who are enrolled, but it's difficult to add new people (including yourself)
    • Be sure to add plans and people during open enrollment before you retire so you may continue coverage into retirement
    • See the Insurance Handbook for details
  • Once you retire, you may not be enrolled in City of Tucson medical if you have medical through another employer, Medicare, Tricare, or Medicaid such as AHCCCS. This same rule applies to your dependents. City medical must be dropped promptly for individuals enrolled in another medical plan. 

Medical, Dental, Vision

Upon retirement, insurance-eligible retirees have the option to continue existing medical, dental and/or vision either through the City's retiree health plan or through the federal COBRA provisions. The benefits of electing coverage through the City's retiree health plan include:

  • Longer period of coverage
    • Retiree medical coverage generally continues until you reach age 65 and retiree dental and vision have no age limit (although they do have a continuous coverage requirement - see the Insurance Handbook for details), whereas COBRA coverage generally ends 18 months after you leave employment
  • Premium subsidy
    • The City subsidizes retiree medical rates, whereas you pay 102% of the premium for COBRA coverage
    • Public Safety retirees also receive a state subsidy for retiree dental and/or medical continuation

Life

  • When you retire, your City employee life insurance ends, and the City provides eligible retirees with $7,500 of retiree life insurance
  • Eligible retirees also have the option of continuing employee life insurance by paying the insurance carrier directly
    • Continuing life insurance is expensive, and coverage ends at age 70; we recommend that you shop around to compare prices and coverage

Employee Assistance Program, Long Term Disability, FSAs, Colonial

All other insurance ends when you retire. Visit the other FAQs in this section for details.

COBRA (Non-retiree medical / dental / vision, EAP, Health Care FSA)

Continuing Insurance: Medical, dental, vision, EAP, Health Care FSA

Watch your mail for information from the City's COBRA administrator ASI COBRA.

COBRA is a federal law that allows eligible employees to continue existing medical, dental, vision, and EAP insurance after leaving City employment. In some cases, health care flexible spending accounts also may be continued so you have more time to incur and submit FSA claims.

If you elect to continue coverage with ASI COBRA, you'll pay 102% of premiums for elected coverage. Rates are available on our RATES page.

  • You may want to consider COBRA continuation if
    • You do not meet retiree insurance eligibility requirements 
    • You meet eligibility but choose to continue coverage under COBRA rather than the retiree provisions
    • You have health care FSA money that you haven't spent or claimed

Continuing Colonial, Life, LTD, Dependent Care FSA

Colonial

Life

Long Term Disability & Dependent Care FSA

  • LTD and dependent care FSA benefits cannot be continued after leaving employment

HSA vs HRA Medical Plan

Who's eligible for an HSA?

You must be enrolled in a qualified High Deductible Health Plan like the City's high deductible plan with HSA. Additionally:

  • You must have a valid SSN and a primary residence in the U.S.

  • You cannot be covered by any other type of health plan, including Medicare Part A or B

  • You cannot be covered by TriCare or a general purpose health care flexible spending account (FSA)

  • You cannot have received medical benefits from Veterans Administration for any non-service-connected disabilities at any time during the previous three months

  • You cannot be claimed as a dependent on another person's tax return (unless it's your spouse)

Source: HSA Bank Frequently Asked Questions - Members

Advantages of opening an HSA

  • Free money
    • The City contributes funds to your account totaling $1,500 annually if you're single or $3,000 annually if you're covering dependents (pro-rated for part-year enrollment)
  • Tax savings
    • You may make additional pre-tax contributions, which reduces your taxable income
    • Any after-tax contributions that you make are tax deductible
    • HSA funds earn interest tax free (except in NJ) and aren't taxed when used for IRS-qualified medical expenses
  • Yours to keep
    • Unused funds that will roll over year to year - no "use or lose it" penalty
    • Funds are yours to keep - even after you leave the City - and can be used to pay for COBRA premiums or qualified health care costs, both now and later
  • Investment potential
    • You have potential to build more savings through investing; choose from a variety of HSA self‐directed investment options with no minimum balance required
  • Save for retirement
    • They also can provide additional retirement savings: After age 65, funds can be withdrawn for any purpose without penalty

Who owns the money?

HSA

You own the money once it's deposited into your account. You keep it, even after you leave the plan or City employment. The City will no longer pay the plan maintenance fee, though, once you leave the plan.

HRA

The City owns the money in your account. think of it as a "promise to pay." If you or a covered dependent has an eligible medical claim, claims will be paid automatically from available funds. Once you've spent the full fund, you're responsible for remaining amounts. 

When will the money be in my account?

HSA

Every July 1st that you're enrolled in the medical plan with HSA, you'll receive $500 in late July. Additional funds are deposited into your account 1-2 weeks after each pay day for the remaining 25 pay periods each year: $20 for single coverage or $60.

If you join the plan after July 1 (for example, as a new hire or due to a qualifying life event), the initial $500 is pro-rated.

HRA

You have access to the money at the start of each plan year (July 1): $1,000 for single coverage, or $2,000 if you're covering at least one dependent.

If you join the plan after July 1 (for example, as a new hire or due to a qualifying life event), the funding is pro-rated.

Do the funds roll over from year to year? (Will I lose the money)

HSA

The account is your personal account. Unspent money is yours to use on eligible expenses, even after you leave the plan.

HRA

As long as you're enrolled in the plan, the City-owned fund rolls over year to year. However, if you disenroll or leave City employment, you'll forfeit remaining funds. Also, if you move from covering at least one dependent (spouse or child) to individual coverage, your fund balance will be reduced by $1,000.

Will I lose funds if I stop covering my spouse and/or child(ren)?

HSA

No. The money belongs to you.

HRA

Yes, if it means that you're the only one who will be covered after your family member(s) leave the plan. When you go from having "dependent" coverage to single coverage, your fund balance is reduced by $1,000.

As long as you still have at least one family member enrolled, your fund level won't be reduced.

I'm enrolled in the HSA. What happens when I leave City employment?

Because the HSA bank account is your personal account, you keep the money when you leave employment. However, a few things do change:

  • The City stops contributing to your HSA bank account when you leave employment
    • You may not change plans when you leave employment
    • If you continue your medical as a retiree or through COBRA:
      • You continue on the same high deductible medical plan until the end of that plan year (June 30)
      • You don't receive City contributions - and you may not make personal pre-tax contributions - to your HSA bank account to help pay for out-of-pocket costs for care that you receive
      • However, you may use existing HSA account funds to reimburse yourself for IRS-qualified premiums, plus plan deductibles and coinsurance
    • If you're still enrolled in the medical plan the following July 1 (as a retiree or under COBRA), we automatically convert your medical plan to the HRA, unless you change it to a different plan during open enrollment
  • You become responsible for monthly HSA banking fees
    • As with any personal account, you may leave your money where it is, or you may transfer your funds to another bank that offers HSA accounts 

May I make personal contributions?

HSA

Yes. You can reduce your taxable income by making personal contributions, up to the IRS maximum, which includes both the City's contributions and your personal contributions.

HRA

No.

May I use funds for qualified pharmacy, dental and vision expenses?

HSA

Yes, as long as the IRS considers them qualified health care expenses.

HRA

No. Funds are applied only to qualifying medical claims.

May I invest the funds?

HSA

Yes. You own the funds and may invest them in a wide range of mutual funds, stocks and bonds.

HRA

No. The money in the HRA account belongs to the City, so the City controls it. It is a "promise to pay" if and when you have qualifying claims.

Is additional paperwork required?

HSA

When you join:

Although you usually won't have to provide additional documents when you join the plan, sometimes the bank will run into issues when it tries to verify the data in your profile as part of the federally required Customer Identification Process. This can happen if you've moved or changed your name. In that case, the bank will ask for additional documents. 

Every year:

You'll have to file IRS Form 8889 with your tax return. You'll receive both a 1099-SA tax form that shows total contributions to your account and a 5498-SA that shows withdrawals, including payments to health care providers. You'll want to save receipts showing how you spent the money to be able to demonstrate that funds were used for qualifying expenses if you're ever audited by the IRS.

HRA

Because the City owns the funds and applies them only to qualifying expenses, no additional documents are required from you.

City Insurance & Medicare

Employees & Medicare:


How does Medicare eligibility affect City insurance for employees and their dependents?

MEDICAL

Employees and their dependents may remain covered under City medical, even after they’re Medicare-eligible.

However…

  • Remember that the IRS says you can’t have contributions to an HSA bank account if you’re eligible for Medicare
    • Consider enrolling in one of the other medical plans at open enrollment before you or your covered family members reach Medicare eligibility
  • Be sure you understand IRS, Social Security and Medicare rules to understand how enrollment in the HSA can affect you after you become eligible for Medicare

DENTAL & VISION

  • Dental and vision aren’t affected by Medicare

Retirees & Medicare:

How does Medicare eligibility affect City insurance for retirees and their dependents?

Employee Medical

Medicare eligibility has no impact on employee insurance unless you would like to drop coverage. See the "Making Changes" FAQs for details about dropping coverage.

Retiree Medical

Turning 65

  • Medical generally ends when a retiree or a retiree's dependent reaches Medicare eligibility due to turning age 65
    • Be sure to have other medical insurance in place before turning 65
    • If you are a PSRPS retiree with fewer than 40 Medicare quarters, please also read that FAQ for options

Medicare due to disability (before age 65)

  • Retirees who qualify for Medicare before reaching age 65 may be able to continue existing medical insurance
    • You must notify us if you qualify for Medicare, and you must enroll in Medicare A & B, or you may have gaps in coverage that could result in you paying large bills
    • Contact your Benefits team for additional information
  • Medicare-eligible dependents of retirees (regardless of age) may not remain enrolled in City medical
    • You must notify us if your dependent qualifies for Medicare before age 65
    • Be sure to have other medical insurance in place before the first day of Medicare eligibility to avoid costly gaps in coverage
      • The City audits retirees for other insurance
      • It’s in your best interest to notify us in a timely manner to avoid the possibility of having to pay back City-paid premiums or claims

Dental & Vision

  • Dental and vision aren’t affected by Medicare eligibility

I'm going on Medicare. May I continue medical for my currently covered spouse or child?

You may elect to continue your spouse or child's medical enrollment, as long as your spouse or child doesn't qualify for Medicare or have other group insurance (for example, through another employer).

  • We must receive your election before your (the retiree's) Medicare eligibility begins
    • You'll pay 100% of the premium (City subsidy ends)1
    • Once dependents leave the plan, they may not re-enroll

Payment

  • TSRS retirees: Premium is deducted from your pension check, as long as your check is sufficient to cover the cost
  • PSPRS retirees: The state doesn't allow pension deductions for dependent-only coverage. The City has contracted with a third party administrator, ASI COBRA, to manage enrollment and payment for dependent-only medical coverage. After you return your election form to the City's Benefits team, watch your mail for a welcome letter with payment instructions from ASI COBRA.

ID numbers, deductibles, PCP assignment, prior authorizations

  • Continuing dependents receive new medical ID numbers
  • Plan year deductibles begin again under the new ID; amounts paid toward deductibles under the old ID don't transfer to the new ID
  • HRA funds under your old ID are forfeited, and a new (pro-rated) HRA fund begins under the new ID
  • PCPs, referrals, prior authorizations and step therapy history may not transfer to the new ID number - contact Cigna for assistance
  • Call Cigna (800-244-6224) and your providers to update your new record before you receive care

If you (the retiree) are starting Medicare before age 65 due to disability, the City subsidy will continue for you and dependents, provided you remain continuously enrolled. Contact your Benefits team for details.

If I continue my dependent's City medical, will my PSPRS subsidy help pay for it?

No. The state is unable to administer dependent-only premiums. You must be enrolled in a plan to receive the PSPRS subsidy.

May I remain on the City’s prescription plan after my medical ends?

No. Unless you have fewer than 40 Medicare quarters because you weren't permitted to pay into Medicare while working for the City (PSPRS only), both City medical and prescription drug coverage end when you reach age 65.

I have fewer than 40 Medicare quarters. What are my options? (PSPRS only)

PSPRS retirees who have fewer than 40 quarters because they weren't allowed to pay into Medicare while working for the City may

  • Continue existing medical by paying 100% of the premium 
    • City subsidy ends, but you may still receive the applicable state subsidy

or 

  • Forfeit City medical and receive reimbursement for the retiree's Medicare Part A 
    • Carefully review Sections VII and VIII of the Retiree Health Benefits Continuation Program Administrative Directive for full details
    • Does not apply to dependents' Part A premium
    • Once coverage is canceled, you may not resume it

Before your 65th birthday, the City's Benefits team must receive your continuation election and documentation from the Social Security Administration (SSA) demonstrating that you will be required to pay for Medicare Part A.

  • Begin your research in advance. Contact SSA to understand if you earned required Medicare hours through other work, or if you may be able to attach to Medicare through a spouse or former spouse. 

May I continue City dental and vision?

Yes. Your existing City dental and vision generally will continue automatically, unless you initiate a request to drop them. 

However, if you're a commissioned public safety retiree and you enroll in the state’s dental plan, your City dental will end. The state will pay only for one dental plan – either the state's or the City's. Be certain that you understand which plan you're choosing.

Why is my City medical ending before my 65th birthday?

Generally, you are eligible for Medicare the first day of the month during which you turn age 65. 

  • Example: If your birthday is September 24, you are eligible for Medicare September 1

However, if your birthday falls on the first day of the month, you are eligible for Medicare the first day of the month PRIOR to the month during which you turn age 65.

  • Example: If your birthday is November 1, you are eligible for Medicare October 1 

Visit Medicare.gov for additional information.

When will the medical deduction stop on my paycheck?

Because your pension pays you retroactively (meaning that your pension check pays premium for the month that just ended), you generally will see a deduction the month before your birthday, but not during your birthday month.

Example: 

  • Your birthday is April 20
  • Medicare starts April 1 and City medical ends March 31
  • You will see a deduction on your March pension check (paid March 31), and you won't see a deduction on your April check (paid April 30)

However, if you are a TSRS retiree and you elect to continue medical for your spouse and/or child, the new deduction amount for your dependents will begin the date that your deduction normally would end.

How do I apply for Medicare?

Please contact the Social Security Administration: 

  • (800) 772-1213
  • www.ssa.gov
  • 3808 N. 1st Ave, Tucson, AZ 85719 (call in advance to confirm working hours)

What options would you recommend for exploring Medicare?

Medicare plan offerings vary by state. While we are unable to recommend plans, below are some options for you to explore, based on feedback we have received from other retirees: 

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Contact the Benefits team

Contact one of our Vendors

Cigna - medical, dental, EAP

  • 800-244-6224 (members)
  • 888-806-5042 (pre-enrollment)
  • mycigna.com

Avesis - vision

  • 833-282-2438
  • avesis.com
  • Plan 926COT-L2
  • Group 10790-2150 (employees) & 10790-2152 (retirees)

Hartford - life & LTD

  • 888-301-5615 (claims)
  • 800-331-7234 (applications)

ASI Flex (flexible spending accounts)


Colonial (voluntary insurance)


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