Eligibility
Are you eligible for benefits?

You can participate in HISD benefits plans if:

  • You’re a regular part-time or full-time employee as defined by HISD and a contributing member of the Teachers Retirement System (TRS)
  • You're retired from TRS and rehired into a position that is eligible for benefits
  • You qualify as a full-time employee as defined under Section 4980H(c)(4) of the Internal Revenue Code
Benefits appeals process

If you have applied for benefits and been denied, you have the right to appeal your benefits enrollment status.

To appeal your status, call the HISD Benefits Service Center at 877-780-HISD (4473)

Please note that the appeals process does not review medical or pharmacy claim issues. For those issues, you must contact the carrier directly.

Are your dependents eligible?

Some benefits are available to your dependents if they meet the eligibility rules of your plan. 

 

Eligible dependents include:

  • Your legal spouse, as determined by the laws of the State of Texas
  • Your dependent children

 

Eligible dependent children under 26 years of age include:

  • Your biological children
  • Your stepchildren
  • Your legally adopted children
  • Your foster children, including any children placed with you for adoption
  • Your child who qualifies as your dependent under the terms of a qualified medical child support order (QMSCO)

 

Your child (age 26 or over) who otherwise meets the requirements above may be eligible for dependent coverage if the child is either mentally or physically incapacitated to such an extent to be dependent on you on a regular basis, as determined by Aetna, and meets other requirements as determined by Aetna. You and your dependent’s attending physician must complete a Request for Continuation of Coverage for Handicapped Child form and Attending Physician’s Statement to provide satisfactory proof of the disability and dependency. Contact the HISD Benefits Service Center at 877-780-4473 for these forms. You must submit the forms no later than 31 days after the date the child turns 26. To avoid any gap in coverage, you must have the forms submitted and approved before the end of the month the child turns 26. For more information about eligibility for your disabled dependent, contact Aetna customer service at 877-224-6857 before your dependent reaches age 26.

Eligible dependent grandchildren under the age of 25 may be covered if you provide required documentation. 

Dependent verification

You're required to provide documentation to support the eligibility status of each of your dependents. It’s a simple process you only need to complete once, unless you drop a dependent from your coverage and then add him or her back later. You and your dependents may lose benefits or eligibility if you're covering individuals who don't meet the definition of an eligible dependent. For complete details, call the HISD Benefits Service Center at 877-780-HISD (4473). 

 

For a child, one of these documents verifies eligibility:

  • Adoption certificate
  • Adoption placement agreement
  • Birth certificate with parent’s name listed
  • Documentation of legal custody
  • Documentation of legal guardianship
  • Hospital birth record (within 90 days of birth)
  • Qualified medical child support order

For a spouse, one of these documents verifies eligibility:

  • Current federal tax return showing your spouse listed
  • Declaration of informal marriage
  • Marriage license or certificate

If your dependent is a stepchild, you must also provide a copy of a marriage certificate or other appropriate documentation to substantiate the child’s relationship to the employee or spouse. If you send a copy of your tax return, block out any social security numbers or financial information. Only the first page of your return is required. 

If you have questions, please call the HISD Benefits Service Center at 877-780-HISD (4473), or see this list of frequently asked questions.

When benefits begin

If you are a new employee or newly eligible, your benefits coverage begins on your benefits effective date, which is the first of the month, following 30 days after your new employee date of hire, or transfer date for the newly eligible, as long as you select benefits before your benefits effective date or the date you become eligible for benefits.

For example, if you start work or become benefits eligible on February 12, your benefits begin April 1, as long as you select your benefits before April 1.

For benefits selected during the annual enrollment period, coverage begins January 1 of the following year.

For benefits requiring evidence of insurability, coverage begins the beginning of the month following carrier approval of your application.

When benefits end

Benefits coverage ends on the earliest of:

  • The date the plan ends
  • The last day of the month in which you are no longer eligible
  • The date you stop paying for coverage
  • The last day of the month after you notify the district of your selection to stop participation based on annual enrollment or a qualified life event or a family status change (if the family status change is reported within 31 days of the event)
  • The last day of the month in which you stop working for the district
Learn how the Affordable Care Act affects you

Also known as health care reform, the Affordable Care Act (ACA) has brought many changes to health care in the US, providing benefits like free preventive care and coverage for adult children until age 26.

Everyone is required to have health care coverage that meets the ACA’s minimum guidelines for affordability and value. If you don’t, you may have to pay a fee on your federal tax return. All of HISD’s medical plan options meet ACA guidelines, so, if you’re enrolled in one of our plans, you’re not subject to paying the fee.

 

HISD coverage option ratings

ACA rates health plans based on their actuarial value, which is the percentage of expenses paid for by the plan, and distinguishes them by metal levels from bronze to platinum. Here’s how our plans are rated.

  • Consumer Basic – Limited and Choice: Silver
  • Consumer Plus – Limited and Choice: Silver
  • Open Access: Platinum
  • Select Plan: Gold

 

Where you can purchase coverage that meets ACA requirements  

  • HISD, if you’re eligible
  • Another employer or a spouse’s employer
  • A government plan such as Medicare or Medicaid (or CHIP for your covered dependents)
  • An insurance company
  • The federal Health Insurance Marketplace

 

You can make changes to your HISD plan, including dropping coverage completely, during annual enrollment. If you drop your HISD coverage, you can’t regain district coverage until annual enrollment the following year unless you have a qualified life event (such as getting married or giving birth).

Keep in mind: You forfeit HISD’s contribution to your coverage when you choose a non-district option.

 

IRS Form 1095-C

The IRS requires you to verify and report your medical plan eligibility, coverage selection and covered dependents’ tax ID numbers through IRS Form 1095-C. HISD sends this form to full-time employees as well as part-time employees enrolled in a district medical plan. The form allows you to verify that you—and your spouse and dependents, if applicable—were offered and had qualifying coverage for some or all months of the previous year. This is important whether you were enrolled in an HISD medical plan or chose to purchase coverage elsewhere. Though you’re not required to submit Form 1095-C with your tax return, you do need to keep it with your records in case the IRS requests it.

Click here for more information, visit the IRS website or talk to your tax advisor. You can also call HISD Employee Services at 713-556-7383.

 

Have questions?

Visit healthcare.gov for more information about health care reform, or visit here for some ACA FAQ's.

For any benefits question or concern, one call does it all.
Call us at 877-780-HISD (4473)

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