Benefit changes may only be made if you experience a valid qualifying event, such as adopting 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.
RULES: “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.
Supporting Documents Required to Enroll/Cancel Coverage
Documentation of the qualifying event and dependent verification documentation must be submitted directly to the Benefits Office within 31 calendar days (including weekends and holidays) of the qualifying event date. (NOTE: All documents faxed or emailed are considered by the time stamp when they were sent whether office is closed or open.)
EXAMPLE OF QUALIFYING EVENT
REQUIRED SUPPORTING DOCUMENTATION
Birth of a Child
Verification of birth facts issued by hospital
Placement for adoption paperwork -or- Legal documentation of the adoption
Original signed divorce decree
Dependent’s enrollment in another employer’s benefits through job change or open enrollment
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.
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
**Switching plans during the plan year could cause your deductible and out-of-pocket limits to reset.
Benefits become effective the date of the event for: birth and adoption.
Marriage, divorce, and death become effective the first of the month following the event date.
To submit a change, complete the Insurance Change Form and submit with documentation to the Benefits Office via email firstname.lastname@example.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**