Requesting Changes

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 which lets employees pay for certain qualified medical expenses – such as health insurance premiums – on a pre-tax basis.

Making Changes to Your Insurance Coverage

Insurance coverage cannot be revoked or changed during the plan year unless the employee experiences a special enrollment event. Only qualifying events with proper supporting documentation are allowed outside of the designated open enrollment period.

Qualifying events and supporting documentation include:

qualifying event	required supporting documentation	benefit effective date
Birth of a child	Birth certificate -or- Verification of birth facts issued by hospital	Date of the event
Adoption	Placement for adoption paperwork -or- Legal documentation of the adoption	Date of the event
Death	Death Certificate	First of month following the event date
Marriage	Marriage Certificate	First of month following the event date
Divorce	Original signed divorce decree	First of month following the event date
Dependent's enrollment in another employer's benefits through job change or open enrollment	Proof of the enrollment including effective date of coverage (medical, dental, vision), and the names of dependents enrolled with their effective date of coverage
Loss of benefits due to loss of job or loss of eligibility	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

Submission Guidelines

Any changes to insurance must be submitted to the Benefits Office within 30 days after the qualifying event by filling out the TRS Change Form and providing proof of loss or new coverage showing the effective date.

Submissions can be made via email at benefits@misdmail.org, by fax at 817-548-2161 or in person at 605 E. Broad Street, Mansfield, TX 76063.

NOTE: 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.

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Through the Employee Benefits Portal, staff members can update their contact information, view/change beneficiaries and view health & supplemental coverage plans.