Qualifying Life Event
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Please see the information below under the Adding or Dropping Coverage section that explains the qualifying event process and the documents you will need to provide so we can submit the request to add or drop coverage through the district due to a Qualifying Life Event. Please provide this information immediately as this information is extremely time-sensitive per IRS and TRS guidelines. Please note: You only have 31 days from the date of the event to make this change.
There are two (2) forms that must be completed, signed and dated along with proof of the Qualifying Life Event (QLE) to be processed:
Hays CISD change form
Please ensure that you send all information, including required proof of the QLE directly to the Director of Benefits Diana Diaz at InsuranceBenefits@hayscisd.net so the request is processed accordingly and timely.
Plan rates can be found here: 24-25 Medical plan rates
Plan highlights can be found here: 24-25 TRS ActiveCare Plans & Highlights
Making Qualifying Life Event Changes
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When you experience a qualifying life event, you have the opportunity to add or change coverage for yourself or additional eligible family members. The following qualifying life events will allow you to add or make changes for you, your spouse, and/or child(ren) to coverage within the first 31 days of the event. Examples of a qualifying enrollment event include, gaining a new dependent through marriage, divorce, birth, adoption or placement for adoption, or if an individual with other health insurance coverage or supplemental benefit (dental, vision, etc.) involuntarily loses that coverage.
If you do not request the appropriate changes or provide the required documentation/forms during the applicable special enrollment period, the changes cannot be made until the next plan enrollment period. If the forms are submitted after the enrollment period the request to add coverage will be denied–even if there would be no change in premium.
Open Enrollment: Requesting a change during a spouse or parent's open enrollment period: A spouse or parent voluntarily dropping coverage for themselves and/or covered dependent(s) during their open enrollment period is not considered a qualifying event. Involuntary loss of coverage as a result of the spouse’s or parent’s employer’s open enrollment period such as coverage is no longer being offered for the spouse or dependent child is considered a qualifying event. Employee must submit proof of the involuntary loss which can be from the open enrollment benefit material page that clearly states it is an involuntary loss or a letter from the spouse’s or parent’s employer.
Payroll Adjustments: The cost of coverage may change based on the selected coverage category. You can not elect to drop coverage retroactively; a future cancellation date is required. Premiums are deducted for the current month (August payroll pays for August premiums and so on). There may be a possibility of multiple premiums owed based on the event date and when documents are returned to our office. It may take up to two pay cycles to see an adjustment on your pay check.
The following reasons for dropping coverage do not qualify as special enrollment events:
- An increase in premium cost;
- A reduction in the employer's contribution to the premium;
- Any other voluntary termination of coverage, including voluntary dropping coverage at the spouse's open enrollment period, including failure to pay your premium;
- Any additional surcharge or benefit reduction for spouse coverage;
- Any reduction of benefits such as an increase in deductible or change in the coordination of benefits;
- A doctor or health care provider no longer participates in the plan's network;
- Enrollment of loss of coverage through the health care exchange under the Affordable Care Act mandate is generally not considered a special enrollment event for TRS-ActiveCare plans. Please contact the Employee Services department to see if losing your individual plan is a qualifying life event.
Adding Coverage: (Birth of a child, Marriage, Divorce, Loss of Other Coverage, etc.) please provide:
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1. TRS Medical Enrollment Application and Change Form (provided above).2. Qualifying Life Event Change Form (provided above).3. Proof of loss that identifies the employee and/or dependent(s) name(s), coverage type lost, and coverage end date:
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The spouse’s or parent’s change in job status which includes loss of job; dependent coverage no longer offered through spouse’s orparent’s employer sponsored plan, or;
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A covered dependent child turning age 26
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Loss of Medicaid or CHIP letter, or;
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Final Divorce Decree; or Legal Separation court order addressing health insurance and/or supplemental benefits.
- Gaining a dependent, birth certificate for newborn child; adoption documentation; marriage certificate filed with the court; etc.
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Please click on this link to see what type of proof is acceptable for your situation: QLE Information
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Dropping Coverage: (Gaining Other Coverage, including Medicare, CHIP, etc.), please provide:
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1. TRS Medical Enrollment Application and Change Form (provided above).2. Qualifying Life Event Change Form (provided above).3. Proof of coverage that identifies the employee and/or dependent(s) name(s), coverage type added, and coverage begin date.
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Proof of the spouse’s or parent’s employer’s open enrollment period. This can be from benefit book page that clearly states it is an open enrollment period or a letter from the spouse’s or parent’s employer, or;
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Proof of the spouse’s or parent’s new hire enrollment period. If the hire date and enrollment date are not within 31 days of each other include documentation from the employer or employer correspondence there was a waiting period on when benefits begins
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Proof of enrollment in Medicare, Medicaid, or CHIP
Please click on this link to see what type of proof is acceptable for your situation: QLE Information -
