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Enrollment for Qualifying Individuals Begins Oct. 1

The district has wanted to find a way to expand access to health insurance benefits to meet the diverse needs of our employees and their households. While there were a few legal and logistical obstacles to overcome since the administration first included funds for this expansion in its preliminary budget in February 2013, a clear path forward emerged to allow all regular and full-time employees to add new qualifying individuals to their existing coverage. 
 
The district will hold an open enrollment period October 1-31 for qualifying individuals, and such coverage will begin December 1. To review the criteria and learn how to apply, as well as to review information on the improved compensation, please view the FAQ below. 

 

Expanded Insurance Coverage

1. Am I eligible to elect qualifying individual coverage under the Group Benefit Plan?

Effective October 1, 2013, an AISD employee who is enrolled in the Group Benefit Plan may elect to cover a “qualifying individual” under certain component programs of the Group Benefit Plan, provided the AISD employee has not otherwise elected coverage under any component program of the Group Benefit Plan for a “spouse” (as defined under Texas law) and the AISD employee submits to the plan administrator a Certification of Qualifying Individual Coverage, along with appropriate documentation, that confirms the individual satisfies the criteria for qualifying individual coverage. 

Note: For purposes of the Group Benefit Plan, the term “spouse” means a person of the opposite sex who is married to an AISD employee under Texas law.

2. Under which component programs may I elect qualifying individual coverage? 

An AISD employee may elect to cover a qualifying individual under the following component programs, provided the requirements for coverage are satisfied: health plan, dental plan, vision plan, voluntary cancer insurance plan, voluntary life and AD&D plan and voluntary dependent life plan.

3. What are the criteria for qualifying individual coverage and what documentation must be provided?

A “qualifying individual” is an individual with respect to whom ALL of the following criteria are satisfied:

  1. The individual has resided in the same household with the AISD employee for at least the past 12 months and intends to remain so indefinitely, which can be documented by submitting one (1) document that is described in either category specified below:  

        a. Category 1: A copy of the individual’s driver’s license, voter registration card or other government-issued identity card reflecting the same residential address as the AISD employee; or
        b. Category 2: A copy of a utility, telephone or cable bill designating the individual as a payor on the account and reflecting the same residential address as the AISD employee.
  1. The individual is not a renter, boarder, tenant or employee of the AISD employee.
  1. The individual is not related to the AISD employee as a grandparent, parent, aunt, uncle, cousin, sibling, niece, nephew or child (whether connected by birth, adoption, foster relationship, or statutory or common law marriage).  
  1. The individual is at least 18 years of age. 

The individual is directly dependent upon, or interdependent with, the AISD employee, which must be documented by submitting documentation described in two (2) of the four categories specified below:

       a. Category 1
: A joint loan obligation, mortgage, or lease, or joint ownership of a vehicle;
       b. Category 2: A life insurance policy, retirement benefits account, or will of the AISD employee or individual designating the other as beneficiary thereto, or the will of the AISD employee or the individual which    designates the other as executor;
       c. Category 3: A power of attorney granted to the individual for purposes of health care or financial management of the AISD employee, or a power of attorney granted to the AISD employee for purposes of health care or financial management of the individual; or
       d. Category 4: Proof of a joint bank or credit account, or proof that the AISD employee or individual has signatory authority over the other’s bank or credit account. 

 

4. Is qualifying individual coverage available for my mother-in-law?  What about my step-child?

No.  A person with whom you share a relationship identified in #3 above will not be eligible for qualifying individual coverage, whether the relationship is by blood or marriage.  This means that in-laws and step relatives are excluded from participating in qualifying individual coverage. 

5. May I elect to cover the children of a qualifying individual?

Each child (whether connected by birth, adoption or foster relationship, and whether married or unmarried) of a qualifying individual is also eligible for coverage under the component programs of the Group Benefit Plan specified above until he or she has attained age 26, provided the AISD employee is enrolled in the selected coverage.  No coverage will be provided to the spouse of a qualifying individual’s child, or to a step-child or grandchild of a qualifying individual. 

6. What is the Certification of Qualifying Individual Criteria?

The Certification of Qualifying Individual Criteria is a written statement attesting to the authenticity and truthfulness of the documents submitted and representations made by the AISD employee to the Group Benefit Plan to determine whether an individual satisfies the criteria for coverage of a qualifying individual. 

7. What are the consequences for an employee who provides false information?
An AISD employee who submits false or misleading documentation or makes false or misleading representations to the Group Benefit Plan may be subject to disciplinary action, up to and including termination of employment.  In addition, the submission of false or misleading information or submissions constitutes fraud on the Group Benefit Plan and may result in civil or criminal penalties (where applicable) and the loss of coverage under the Group Benefit Plan (which may include retroactive cancellation of coverage) to the extent permitted under applicable law. 

8. Will I have to submit additional documentation or certifications after I have elected qualifying individual coverage?

The plan administrator of the Group Benefit Plan is authorized to conduct audits of enrollment in the Group Benefit Plan from time to time.  In connection with such audits, the plan administrator may request that you submit documentation and/or make representations to the Group Benefit Plan in support of the individual’s continuing qualification for coverage under the Group Benefit Plan.  In the event that all of the criteria for coverage of a qualifying individual (or for coverage of his or her children) are no longer satisfied, or that the AISD employee fails or refuses to submit the requested documentation and/or make the requested representations, coverage for the qualifying individual and, if applicable, his or her covered children, may be terminated in accordance with the terms of the Group Benefit Plan.

9. Since the 2013 Annual Open Enrollment Period has closed, will there be a special opportunity to elect qualifying individual coverage for the remainder of the 2013-2014 extended plan year?

Yes.  AISD will provide a special opportunity for AISD employees to elect qualifying individual coverage for the remainder of the 2013-2014 extended plan year.  The period to make this election will commence on October 1, 2013 and will end on October 31, 2013. Your election for coverage will be effective as of December 1, 2013.  Once made, the election for qualifying individual coverage (and coverage for a child of a qualifying individual, if elected) will generally be irrevocable for the remainder of such period (i.e. until December 31, 2014).

10. How do I apply for qualifying individual coverage?

To apply for qualifying individual coverage, you must submit the required documentation described above and a fully executed Certification of Qualifying Individual Criteria to the Benefits Department no later than October 31, 2013.   

11. How will employees who are hired after October 31 enroll?

Generally, there are three times when you may elect to add qualifying individual coverage under the Group Benefit Plan:

  • Within 31 days of hire or satisfying the eligibility requirements for participation in the component program;
  • Within 31 days of a qualifying change in status or other event upon which a mid-year change in election is permitted under the terms of  the Cafeteria Plan (e.g. upon satisfaction of the criteria for qualifying individual coverage, upon ceasing to satisfy the criteria for qualifying individual coverage, upon a child’s attainment of age 26, upon a significant improvement in the benefit coverage made available under a component plan); and
  • During the Annual Open Enrollment Period. 

NOTE:  Due to a change in the plan year effective January 1, 2015, elections made during the 2013 Annual Open Enrollment Period relate to coverage for the period commencing on September 1, 2013 and ending on December 31, 2014 (the “2013-2014 extended plan year”).  Commencing on January 1, 2015, each plan year for the Group Benefit Plan will commence on January 1st and end on December 31st, and your elections for coverage under the Group Benefit Plan will be made with respect to each calendar year.

For additional information on your benefits, contact the AISD Benefits Team at 414-1739 or visit www.austinisd.org/benefits.