Changes During the Year
Under certain circumstances, you may be allowed to make changes to your benefit elections during the plan year (Jan 1 – Dec. 31), such as adding or dropping dependents, depending on whether or not you experience an “eligible” qualifying event as determined by the Internal Revenue Service (IRS) Code, Section 125. Change in status will be made effective on a prospective basis only. Making a change on a prospective basis means that the District will process all approved mid-year changes on the first day of the month after you have completed a benefits change form and have submitted all required supporting documentation.
Within 60 days of a qualifying event, you must submit a Change in Status Enrollment along with supporting documentation to the Employee Benefits Department. Upon approval of your election change request, your existing elections may be stopped or modified (as appropriate). However, if your election change request is denied, you will have 30 days from the date you receive the denial to file an appeal with DCPS Employee Benefits.
Mid-year Appeals Process
You will need to submit a written request for review within 30 days of the initial enrollment
Your appeal must include:
- Name of employer
- Contact information, including an email address and a phone number so you may be easily contacted in a timely manner
- Why you believe your request for a variance should be considered
- Any additional documents, information or comments you think may have bearing on your appeal
Submit your appeal to:
Duval County Public Schools
Attn: Employee Benefits Dept 2nd Floor APPEALS
1701 Prudential Drive
Jacksonville, FL 32207
Visit www.myFBMC.com for information on rules governing periods of coverage and IRS Special Consistency Rules.
What are the IRS Special Consistency Rules Governing Changes in Status?
- Loss of Dependent Eligibility – If a change in your marital or employment status involves a decrease or cessation of your spouse’s or dependent’s eligibility requirements for coverage due to your divorce, annulment from your spouse, your spouse’s or dependent’s death or a dependent ceasing to satisfy eligibility requirements, you may decrease or cancel coverage only for the individual involved. You cannot decrease or cancel any other individual’s coverage under these circumstances. In most cases a change in plans is not allowed (e.g., Contributory to Non-Contributory).
- Gain of Coverage Eligibility Under Another Employer’s Plan – If you, your spouse or your dependent gains eligibility for coverage under another employer’s plan as a result of a change in marital or employment status, you may cease or decrease that individual’s coverage if that individual gains coverage or has coverage increased under the other employer’s plan.
- Dependent Care Expenses – You may change or terminate your Dependent Care FSA election when a Change in Status (CIS) event affects (i) eligibility for coverage under an employer’s plan, or (ii) eligibility of dependent care expenses for the tax exclusion available under IRC §129.
- Group-Term Life Insurance – For any valid CIS event, you may elect either to increase or decrease these types of coverage, as long as the request is consistent with the qualifying event.
Is Enrolling In or Terminating Out of an Individual Plan Offered Through the Healthcare Exchange a Valid Change in Status Event?
Enrolling in or terminating out of individual plans offered through the Healthcare Exchange is a valid change in status event.
Note: Failure to enroll in the Healthcare Exchange after canceling DCPS health insurance does not qualify for reinstatement of Health Insurance Benefits with DCPS.
Special Enrollment Period
An employee may re-enroll in the DCPS health plan only during an annual open enrollment period as determined by the School Board of Duval County, FL or during a “special enrollment period” (Change in Status). A “special enrollment period” is a period of time during which you may be able to elect to enroll yourself and/or dependents after one of the following events occur*:
- Loss of other medical insurance coverage – You may be able to enroll yourself and/or your dependent(s) provided that you request enrollment within 60 days after such other coverage ends. In the case of COBRA continuation coverage, you may be eligible for a special enrollment period if the COBRA coverage is exhausted. A special enrollment period is not available if coverage under your prior plan or COBRA coverage was terminated for failure to timely pay the required premiums.
- Acquiring a new dependent – If you acquire a new dependent as a result of marriage, birth, adoption or placement for adoption you may be able to enroll yourself and/or your dependents provided that you request enrollment within 60 days after the date of marriage, birth, adoption or placement for adoption*.
*Note: In order to enroll a dependent, the employee must also be enrolled.