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Qualifying Life Event Change Request

Benefit changes may only be made outside of Open Enrollment if you experience a QUALIFYING LIFE EVENT, such as:

  • Birth of a child
  • A change in your spouse's employment status
  • Gain or Loss of other health coverage
  • Eligibility for Medicare or Medicaid
  • Adoption of a child
  • Marriage
  • Divorce

How do I request the change to my benefits?

Your request must be submitted to the MISD Benefits Office for review and processing. To request a change, please complete the Benefits Change Request and submit it along with supporting documentation to the Benefits Office within 31 days of the qualifying life event.

Please submit your documents by

  • Email: benefits@misdmail.org; Please include "QLE Request" in the subject line
  • In Person: 605 E. Broad Street, Mansfield, TX 76063

See below for a list of qualifying life events and the acceptable documentation required to support your benefit change request:

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

ENROLLMENT IN ANOTHER GROUP HEALTH COVERAGE

Please provide proof of enrollment in the new group health insurance plan. Acceptable documentation includes:

  • A copy of the new insurance ID card - or
  • A benefits enrollment confirmation from the employer’s portal  -or
  • A screenshot or PDF of the employee's benefit elections - or
  • A coverage confirmation letter from the employer

The documentation must clearly show:

  • The effective date of coverage
  • The type of coverage
  • The names of all individuals covered under the plan

 

 

First of month following the event date

LOSS OF HEALTH COVERAGE
  • A letter from former employer- or-
  • COBRA Notice -or-
  • Insurance termination letter

The documentation must clearly show:

  • The effective date coverage ended
  • The type of coverage that was lost (health insurance)
  • The employee's name and the names of any eligible dependents requesting enrollment

First of month following the event date

MARRIAGE

Marriage Certificate

First of month following the event date

MEDICARE

Copy of the Medicare Part B card – or –Letter from the SSN Administration

First of month following the event date

MEDICAID

Letter from Texas Health and Human Services

First of month following the event date

 

 

 

ADOPTION

Placement for adoption paperwork -or- Legal documentation of the adoption

Date of the event

DIVORCE

Copy of signed divorce decree (relevant pages only)

 

 

 

 

** No benefit election changes will be processed outside of the 31 day window following the qualifying life event date. **

Before changing medical plans, please be aware that your deductible and out-of-pocket maximum may start over under the new plan.

It may take 7 to 10 business days for the enrollment to be updated in the carrier's system. ID cards are typically mailed within one week after the carrier's records are updated.

The Mansfield ISD Benefits Plan is a Section 125 (Cafeteria) Plan. Pre-tax benefit elections cannot be changed during the plan year unless you experience a qualifying life event and provide the required documentation within the applicable timeframe (31 days).  Any requested change to your benefits must be directly related to the qualifying life event being reported.

For all other benefits-related matters, log in to the Employee Benefits Portal.
Available year-round, the portal allows you to:

  • View your current health and supplemental benefit elections
  • Review coverage details
  • View and update beneficiary designations
  • Update your contact information
  • Access benefit plan information and resources