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Active Employee Benefits

Form 1095-C

Under the Pension Protection Act, the City of Fort Worth is now required to send employees a 1095-C form, which identifies who was covered by the city's health insurance plan for the plan year.

Employees should keep the 1095-C form with a copy of their completed tax returns after filing to avoid potential penalties in the event of an IRS audit.

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All regular full time employees and those employees who work 30–39 hours per week are eligible for all City of Fort Worth Benefits. Part time employees who work 20–29 hours per week are eligible for dental, basic life insurance, supplemental life insurance, Flexible Spending Accounts, 457 plan, and Allstate voluntary benefits. Seasonal, part time employees who work fewer than 20 hours and temporary employees are not eligible for benefits.

Employee’s spouse, common law spouse, domestic partner, natural child of an enrolled employee who is natural child, foster child, stepchild, grandchild, domestic partner’s child, legally adopted child or child under the employee’s legal guardianship or custodianship.

Dependent Certification

In order to add your dependents you need to supply Human Resources with the required forms of proof of relationship status. Unless otherwise indicated all documentation should be originals.

Below are the documents required for each dependent type:


  • Marriage License; and
  • Last Year Tax Return;
  • If common law: Declaration and Registration of Informal Marriage available at the county clerk’s office

Dependent Children

  • Birth Certificates listing employee, spouse or domestic partner as parent
  • If applicable:
    • Adoption agreement
    • Legal guardianship documents
    • Divorce decree documents showing the dependent
    • Qualified Medical Court Support Order

Disabled Dependent Children age 26 or over.

A completed Dependent Eligibility Questionnaire verifying an ongoing total disability. Written documentation from a physician verifying an ongoing disability may be required.

Coverage Effective Dates

Medical, Dental, FSA, HSA: One month after date of hire Basic Life, Supplemental Life and Long Term Disability: First of the month after date of hire Pension Plan, Deferred Compensation - 457 Plan: Immediately upon hire

Qualifying Events

Qualifying events are situations that may arise during the plan year that allow you to make changes to your plan(s). Qualifying events are determined by the Internal Revenue Service and must follow what the IRS calls the ‘consistency rule.’ What this means is that the change to the plan is a logical response to the qualifying event. For example, the loss of your spouse’s job would not allow you to drop the spouse from the health insurance because that is not a change consistent with the qualifying event.

For a qualifying event, come to the Benefits Office with the necessary documentation and fill out paperwork to make that change. Unless otherwise indicated all documentation should be original documents.

Qualifying Event Deadline to Enroll Change Date Documentation Required

Common law marriage

30 days from event date

Date of Event

Marriage license; Affidavit of Domestic Partnership ;

Declaration and Registration of Informal Marriage available at the County Clerk’s Office



Placement for Adoption

60 days from event date

Date of Event

Birth certificate/birth facts document from the hospital;

Adoption agreement Custody /Guardianship Documents;

Portion of the divorce decree showing the dependent (if applicable)

Commencement of employment by spouse or change in hours affecting health insurance eligibility

(Gain of coverage)

30 days from event date

Date of Event

Offer letter indicating start date and date benefits begin;

Copy of completed enrollment form indicating when coverage begins and that change is due to new hire;

Letter from new company’s Human Resources Department

Termination of employment by spouse or change in hours affecting health insurance eligibility

(Loss of coverage)

30 days from event date

Date of Event

Certificate of Credible Coverage from health insurance provider;

Letter on company letterhead from the previous company indicating when coverage will end and reason coverage ending.


30 days from event date

Date of Event

Original or Certified copy of the death certificate


30 days from event date

Date of Event

Divorce Decree indicating date of dissolution of marriage.



Benefits office
Phone: 817-392-7782
Fax: 817-392-2624

Phone: 844-634-1231

Care Today Near Site Clinic
5450 Clearfork Main Street, Suite 430

Delta Dental
DPPO: 1-800-521-2651
DHMO: 1-800-422-4234

Compass Professional Health Services
Phone: 855-769-4377
Hours: 8 a.m.-6 p.m. Monday-Friday

Phone: 1-800-404-6050

Discovery Benefits (Health Savings Accounts)

Phone: 866-451-3399
Fax: 866-451-3245

Pharmacy: Envision
Helpdesk: 800-361-4542

Surgery Plus
Phone: 855-200-9508

Phone: 1-800-858-6843

Phone: 1-800-537-5024


Fort Worth Employees Retirement Fund

457 Plans

Employee Assistance Program
Aetna Resources for Living

Healthy Challenge Wellness Program
Phone: 817-392-2623

Phone: 888-VIVERAE (888-848-3723)

Employee Discounts & Tickets
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