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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
Verification of birth facts issued by hospital
Date of the event
Adoption Placement for adoption paperwork
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.

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