Benefit changes may only be made if you experience a valid qualifying event, such as the birth of a child, the adoption of a child, getting married, spouse job status change, etc. Changes must be made within 31 days of the event.
The Mansfield ISD Benefit Plan is a Section 125 Flexible Benefit Plan (Cafeteria Plan) allowed under the regulation of Section 125 of the Internal Revenue code. “Pre-tax” elections cannot be revoked or changed during the plan year unless there is a qualifying event.
Election changes must be consistent with the event. An employee cannot elect to drop coverage retroactively; a future cancellation date is required. Please keep in mind, switching plans during the plan year could cause your deductible and out-of-pocket limits to reset.
Supporting Documents Required to Enroll/Cancel Coverage
REMINDER - Any changes made during the plan year must be processed by the Benefits Office.
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EXAMPLE OF QUALIFYING EVENT
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REQUIRED SUPPORTING DOCUMENTATION
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Birth of a Child
Adoption
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Birth Certificate
-or-
Verification of birth facts issued by hospital
Placement for adoption paperwork -or- Legal documentation of the adoption
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Death
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Death Certificate
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Marriage
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Marriage Certificate
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Divorce
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Original signed divorce decree
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Dependent’s enrollment in another employer’s benefits through job change or open enrollment
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Proof of the enrollment including effective date of coverage, type of coverage (medical, dental, vision), and the names of dependents enrolled with their effective date of coverage.
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Loss of benefits due to loss of job or loss of eligibility
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Letter from former employer or print screens from insurance carriers listing:
Types of coverage lost, the last date of coverage, and the names of dependents losing coverage
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Effective Dates
For birth and adoption, benefits become effective the date of the event. Marriage, divorce, and death become effective the first of the month following the event date.
To submit a change, complete the TRS Change Form and submit with documentation to the Benefits Office via email benefits@misdmail.org, fax: 817-548-2161, or in person at: 605 E. Broad Street, Mansfield TX 76063.
**No changes will be made outside of the 31 day window allowed**
Mansfield Independent School District
Mansfield Independent School District