Mid-Year Plan Changes

Qualifying Events:

1. Marriage
2. Adoption
3. Birth
4. Divorce
5. Court Order
6. Change in Employment

If you have experienced a qualifying event, you must:
Contact Employee Benefits, Assistance and Risk Management (EBARM) within 30 days of such change to request the appropriate forms to stop or modify your benefit election(s) at 813-794-2376, or Extension 4-2376 from any district work location.

Complete and return the change in status request forms to EBARM – Attn: Melanie Zonfrillo with written documentation of qualifying change in status event.

Sunbelt Worksite Marketing, Inc., the contract administrator, will determine if your change in status meets IRS regulations. If your change results from a qualifying change in status event, the change(s) to your benefit(s) will be made effective on the first day of the month following receipt of all properly completed paperwork and documentation, unless otherwise provided by law.

Change in Status Documentation Requirements

1. Marriage - Copy of Marriage Certificate
2. Divorce - A certified copy of the “Final Judgment”
3. Birth - Copy of birth certificate or social security card application “Notification Letter”
4. Adoption - Copy of adoption decree, placement for adoption papers or forms provided by the court
5. Death - Copy of Death Certificate
6. Legal Custody of Child - Documentation that the child is your legal dependent
7. Eligible for Medicare, Medicaid, or State Children Health Insurance Plan (SCHIP, i.e. Florida KidCare) - Copy of card or letter stating the effective date of coverage and names of individual eligible for coverage
8. Dependent Flexible Spending Account - Letter from provider stating the effective date of change and the rate of increase or decrease
9. Unpaid Leave - Letter from employer stating dates of unpaid leave
10. Significant Change in Coverage
• Loss of Coverage - A letter from employer stating the date coverage terminates
• New Eligibility - A letter from spouse’s employer stating date of newly eligible coverage
11. Change in Employment (Spouse)
• New Hire – A letter from employer stating the date of hire and date eligible for medical coverage
• Termination –Documentation stating the effective termination date of medical coverage
12. Ineligible Dependent
• Employment – A letter from dependent’s employer stating date of hire and date eligible for medical coverage
• Student – If dependent has graduated or dropped out of college, a letter from the college stating such
• Marriage – Copy of marriage certificate

Frequently Asked Questions

What is a Change In Status (CIS)?
IRS permitted mid-year plan election changes fall into three groups: Change in Status (CIS), Cost or Coverage Changes, and Other (Federal and State) Laws or Court Orders.  This brochure looks only at the Change in Status (CIS) events allowed under your employer’s plans and established IRS guidelines.

Can I change my benefits during the year?
In general, during the plan year, under limited circumstances as provided by the District School Board of Pasco County’s plans and IRS regulations, a CIS event may permit you to change a pre-tax benefit election or vary a salary reduction amount if you, your spouse, or dependent gains or loses eligibility for coverage under an employer’s plan.

What type of changes can I make?
The IRS requires that mid-year plan election changes must be on “account of,” and corresponds with, “a change in status that affects your own, your spouse’s, or your dependent’s eligibility.  The IRS requires mid-year plan election changes be on account of, and consistent with, a permitted event. Mid- year plan election changes are not automatic. Even if you experience a permitted CIS election change event under IRS regulations, your employer’s component plans’ insurance contracts may not allow (or may limit) mid-year plan election changes.

How do I know if I have experienced a change in status?
The 2-Step Rule: You can only change your benefit election(s) during the plan year if:

1. a qualifying change in status event has occurred; and,
2. the requested election change(s) corresponds with the event.

When will my requested change(s) become effective?
Upon approval, your requested change(s) will be effective on the first day of the month following receipt of all properly completed paperwork and documentation, unless otherwise provided by law.

What are qualifying events?

1. Change in your legal marital status – including marriage, death of a spouse, or divorce.
2. Change in number of tax dependents – including marriage, birth, death, adoption, or placement for adoption.
3. Change in employment status that affects your own, your spouse or dependent’s eligibility – including termination or commencement of employment, commencement or return from unpaid leave of absence.
4. The gain or loss of a dependent eligibility status – such as attainment of specified age; student status; marital status; or any similar circumstances which satisfy or cease to satisfy eligibility status.
5. Change of residence of employee, spouse, or dependent that affects their eligibility for coverage.

When can I complete paperwork to add my newborn?
You can pre-enroll your unborn child by completing and returning the necessary paperwork to the Employee Benefits office. After your child is born, you must provide documentation of birth within 60 days.  If you provide documentation within 30 days of the birth, you will not be charged premiums for the first month of coverage.  If you fail to enroll your newborn within 30 days, but enroll within 60 days of birth, you will be required to pay premiums from the date of birth.  If you do not give notice to enroll and do not provide documentation within 60 days of your newborn’s birth, you will have to wait until the next open enrollment to enroll your newborn in the Board’s health care plan.

Can I add other dependents when I add my newborn?
Yes, you can add existing dependents whenever a dependent gains eligibility because of a qualifying change in status event.

If one of my dependents becomes eligible for Medicaid/Medicare, can I cancel coverage for all of my dependents at this time?
No, you may cancel coverage for that dependent only.

If my dependent becomes eligible for Florida KidCare or I purchase an individual policy from an outside provider. Can I drop my dependent coverage mid year?
Yes, you may drop coverage for the covered dependent.

If my dependent loses eligibility for coverage under Medicaid or Florida KidCare, can I enroll them in health coverage?
Yes. If you or your dependent(s) lose eligibility for coverage under Medicaid or Florida KidCare or become eligible for premium assistance, you must notify EBARM within 60 days.

Can I increase or decrease contributions to my Dependent Care Flexible Spending Account mid-year?
You may increase or decrease contributions to your Dependent Care Flexible Spending Account if you switch providers and it results in an increase or decrease in cost or if your current provider increases or decreases their rate.

Can I change my benefits at any time after I have experienced a Change in Status?
No, you must notify EBARM within 30 days of a qualifying change in status event.

What happens if I fail to notify EBARM of my change in status event within 30 days?

1. It is the responsibility of the employee to notify EBARM of a change in status that affects the employee’s, their spouse’s, or their dependent’s eligibility.
2. Failure to notify EBARM within 30 days will result in your benefit election(s) continuing until the next plan year. You can make such changes during open enrollment to be effective January 1, or the next calendar year.
3. It is the School Board’s policy not to refund overpayment of premiums.

What if my requested changes are denied?
If your requested changes are denied, you will have 30 days from the date of the denial to file an appeal with Sunbelt Worksite Marketing, Inc.

Mail the appeal request to:  Sunbelt Worksite Marketing, Inc., Attn: APPEALS, P.O. Box 1287, Auburndale, FL 33823.

For additional information email .(JavaScript must be enabled to view this email address) or call extension 4-2376.

Helpful Links:
CareHere Health and Wellness Center  |  2012 Group Benefit Providers  |  2011 Group Benefit Providers  |  BlueCross BlueShield of Florida |  Behavioral Health & Substance Abuse: Horizon Health  | Pharmacy: Envision Rx Options  |  Delta Dental  |  Minnesota Life  |  Davis Vision  |  Flexible Spending Account: TASC  |  Authorized 403(b) Investment Companies  |  TSA Administrator: TSA Consulting Group  | Florida Retirement System   |  Student Accident Insurance  |  Employees in Transition: Community Resources

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A Message from Mary Tillman

The staff in EBARM wants all employees to be healthy, in mind and body, so they can be ready everyday to do their best for our children. Remember as you access health services that the District is self-insured for all medical, pharmacy and mental health services. Therefore, spend wisely, whenever you can use generics, see a primary care doctor instead of a specialist.

Also, take care of yourself, lose weight if you need to, stop smoking, take your medications as prescribed, and get some exercise. This is all good for your mind, body and wallet.