Eligibility
Learn more about the benefit eligibility requirements for yourself and your dependents.
Eligibility
Katy ISD encourages the health and financial well-being of its employees by providing access to quality and affordable healthcare. The coverage effective date will begin on the 1st day of the month following employee date of hire. If you are hired on the first day of the month, your benefits are effective the first of the following month. All benefit elections must be made within 31 calendar days from your date of hire. For benefits selected during the annual enrollment period, coverage begins January 1 of the following year. The insurance plan year is from January 1st - December 31st. Note: Once your enrollment window has closed, you may not make any changes to your elections unless you experience a Qualifying Life Event (QLE). For benefits requiring evidence of insurability, coverage begins the beginning of the month following carrier approval of your application.
You’re a regular employee, either active or on a paid leave approved by the district.
You're an active, contributing member of the Teachers Retirement System (TRS) or, if retired from TRS, you're rehired into a position that makes you eligible for benefits.
According to the Affordable Care Act guidelines, you are also eligible for benefits if you work for Katy ISD 30 hours or more per week. Please contact Benefits Helpline at 866-222-KISD (5473) if you feel you are eligible under these guidelines and have not been given the opportunity to enroll.
Benefits Information for New-Hires QA
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 Benefits Helpline at 866-222-KISD (5473). Please note that appeals process does not review medical or pharmacy claim issues. For those issues, you must contact the carrier directly.
Dependent Eligibility
If you apply for coverage for yourself, you may also elect coverage for any of your eligible dependents.
Dependent Verification is now required for all dependents covered on medical, dental, vision, and spouse life. When you enroll your dependent you will be notified that verification is required in order to cover that dependent on one of our plans. You will receive a letter telling you what is acceptable documentation and where to send those documents. For questions regarding dependent verification, you may contact our benefits administrator at 866-222-KISD (5473).
Eligible Dependents include one or more of the following:
Legal spouse (unless legally separated)
Child under age 26 for medical, dental, vision, life and personal legal coverage
Unmarried dependent child up to age 25 for existing Katy ISD cancer care coverage (no new policies are being written)
A child is defined as your natural child, legally adopted child, stepchild, a grandchild who is a Dependent of the Participant for federal income tax purposes and resides full time with Participant, and any child for whom you are the court-appointed guardian
Unmarried child of any age who is incapable of self-support because of mental disability or physical handicap if declared as such before age 26, provided the child was covered before the limiting age and is solely dependent on the employee for support and maintenance, and that proof of the incapacity and dependency is provided when first enrolled and verified when asked. For more information about eligibility for your disabled dependent, contact Aetna customer service at 877-224-6857 before your dependent reaches age 26.
Important note: You and your dependents may lose benefits or eligibility if you’re covering individuals who don’t meet the definition of an eligible dependent.
When Do 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
Making Changes: Qualifying Life Events
Generally, benefit changes are limited to open enrollment.
If you experience a Qualifying Life Event (for instance: getting married or having a baby), please contact Benefits Helpline; proof of the Qualifying Life Event must be submitted to the Benefits Helpline at 866-222-KISD (5473) within 31 calendar days in order to change current benefit election.
Benefit Elections must be consistent with the event
You can only make changes to the specific plans where dependents will be affected
If you are adding benefits due to a life event, in most cases the benefits become effective the first day of the month following the notification to Benefits Helpline
Benefits and new rates become effective the date of the event for birth, adoptions, marriage, divorce, and death; or the day after benefits end, when the event is loss of coverage
The event date must be consistent with the information in the Supporting Documentation
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.
Where you can purchase coverage that meets ACA requirements
Katy ISD, 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 Katy ISD plan, including dropping coverage completely, during annual enrollment. If you drop your district coverage, you can’t regain Katy ISD coverage until annual enrollment the following year unless you have a qualified life event (such as getting married or giving birth). Dropping out of a Marketplace plan is not considered a life event.
Keep in mind: You forfeit Katy ISD’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. Katy ISD sends this form to full-time employees (as defined by ACA) as well as other 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 a Katy ISD 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 Benefits Helpline at 866-222-KISD (5473).
Have questions?
Visit healthcare.gov for more information about health care reform, or visit here for some ACA FAQ's.
Naming/Changing Beneficiaries
You need to designate a beneficiary even if you don’t elect supplemental life insurance coverage. When you name a beneficiary for your basic life insurance provided by Katy ISD, that beneficiary is automatically selected for your supplemental life insurance, if enrolled. You can update your beneficiaries at any time and for any reason by calling Benefits Helpline at 866-222-KISD (5473). You can also change your beneficiary online.
In addition to updating your beneficiaries with Benefits Helpline, you need to designate beneficiaries for your active member death and retirement benefits with TRS. For instructions, click here.
Qualified Medical Child Support Order
A qualified medical child support order (QMCSO) is a court order requiring you to add medical coverage for your child. Here’s how it works:
The court order goes directly to the Risk Management office for processing.
If you already have medical coverage through the district, your child will be enrolled in the same plan.
If you’re not enrolled, you’ll both be enrolled in the Memorial Hermann ACO plan. Look for a letter or email notification.
The effective date of the change is the first day of the month following receipt of the order.
Risk Management also receives and processes National Medical Support termination notices. When they receive a termination order, they’ll notify you of the option to keep or drop the coverage for your child. Any changes become effective the first day of the month after they receive your election change.
Employment/COBRA
Your spouse gains benefits
Within 31 days of your spouse gaining benefits through their employer, contact Benefits Helpline to change coverage for you, your spouse and/or your dependents. You will need to know the date your spouse’s benefits become effective. Call 866-222-KISD (5473) between 8 a.m. and 5 p.m. weekdays, excluding holidays, or click the Enroll button on the home page Quick Links.
Drop coverage:
Medical
Dental
Vision
Add, drop, increase or decrease coverage:
Supplemental life and AD&D
Spouse life
Child life
Disability
Personal legal plan
Drop coverage for your spouse or dependents:
Cancer care
Change contribution amount:
Health care FSA
Dependent day care FSA
You may need to submit evidence of insurability for some changes. Changes generally take effect on the first day of the month after the new benefits are effective.
Your spouse loses benefits
Within 31 days of your spouse losing benefits through their employer, contact Benefits Helpline to change coverage for you, your spouse and/or your dependents. You will need to know the date your coverage is ending with your spouse’s employer. Call 866-222-KISD (5473) between 8 a.m. and 5 p.m. weekdays, excluding holidays, or click the Enroll button on the home page Quick Links.
Add coverage:
Medical
Dental
Vision
Add, drop, increase or decrease coverage:
Supplemental life and AD&D
Spouse life
Child life
Disability
Personal legal plan
Change contribution amount:
Health care FSA
Dependent day care FSA
You may need to submit dependent verification documents and/or evidence of insurability for some changes. Changes are effective the first day of the month after you notify Benefits Helpline.
Your spouse’s enrollment period is different from Katy ISD’s
If your spouse’s benefits enrollment period happens during a different time of the year than ours, you can change your Katy ISD benefits within 31 days of your spouse’s annual enrollment. Changes are effective the first day of the month after you notify benefits helpline call 866-222-KISD (5473) between 8 a.m. and 5 p.m. weekdays, excluding holidays, or click the Enroll button on the home page Quick Links.
You leave Katy ISD
When you leave the district, the date your benefits coverage ends depends on whether or not you finish your contract with Katy ISD.
If you don't finish your contract, your benefits end on the last day of the month in which your employment ends.
If you finish your contract and leave at the end of the school year, you’re allowed to keep your benefits through August 31. You can decide whether to be paid out early or keep receiving your checks through the summer. Complete the Employee Payoff and Benefit Election form included in your exit package to let us know which option your prefer.
If you leave the district and return within 31 days, your benefits are automatically reinstated with no break in coverage. Premiums for the reinstated coverage are deducted from the first available paycheck.
If you leave Katy ISD but return to work AFTER 31 days and you are still benefits-eligible, you must re-enroll to receive benefits.
You may be able to extend your health care coverage (medical, dental, vision and your health care FSA) for a limited time through COBRA, and some of your benefits may be portable or convertible. For more information about COBRA, Katy ISD Risk Management at 281-396-2266.
Benefits portability and conversion
You can keep some of your benefits through portability or conversion after you’re no longer employed by Katy ISD or when one of your dependents becomes ineligible for benefits—even after COBRA expires.
Portability means you continue being covered under the plans offered by Katy ISD. To port your coverage, you have to apply to the insurance carrier. The carrier provides you with new rates for your policy, which may be higher than what you were paying as a Katy ISD employee. You pay your premiums directly to the carrier, and no evidence of insurability is required, though you still need to meet the group policy’s terms and conditions.
Conversion means you convert your Katy ISD plan to an individual policy. You pay your premiums directly to the carrier. Your new policy may or may not provide the same level of benefits as the group plan you were covered under, and you still need to meet the group policy’s terms and conditions to convert your benefits.
For most plans, the insurance carrier must receive your application and first premium payment within 31 days of the end of your group coverage. Contact your carrier for more information.
A note about Life Insurance
OneAmerica automatically sends information regarding conversion/portability of life insurance coverage once an employee terminates employment with Katy ISD.
COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue your health care coverage (medical, dental, vision and health care FSA) after your employment with Katy ISD ends for any reason other than gross misconduct. Within 31 days of the end of your employment or loss of benefit eligibility, you’ll receive information on COBRA and an election form mailed to your home address. You must sign up for COBRA within 60 days of your last day of employment or the last day your dependent was eligible for benefits, or you and your dependents become ineligible for coverage.
COBRA coverage usually lasts 18 months and can be extended up to 29 months if you’re disabled, or up to 36 months if coverage ends due to the loss of dependent eligibility. You pay the full cost of COBRA coverage, plus an administrative fee. Below are the 2027 COBRA rates per month.
Medical COBRA rates per month | ||||
Option | EE | EE+SP | EE+CH | EE+FM |
Choice POS II | ||||
Memorial Hermann ACO | ||||
HDHP (High Deductible Health Plan) | ||||
Kelsey-Seybold | ||||
Dental COBRA rates per month | ||||
Option | EE | EE+SP | EE+CH | EE+FM |
DHMO Plan | ||||
Mid PPO Plan | ||||
High PPO Plan | ||||
Vision COBRA rates per month | ||||
Option | EE | EE+SP | EE+CH | EE+FM |
Low Plan | ||||
High Plan | ||||
Qualifying Event | Supporting Documentation | Dependent Documentation |
Marriage | Marriage Certificate | Birth Certificates are required if adding spouse's children |
Death (you, spouse or dependent child) | Death Certificate | No additional documentation required |
Divorce or Annulment | Certified copy of Divorce Decree | Birth Certificates are required if adding children not currently enrolled in benefits |
Adoption |
| No additional documentation required |
Birth |
| No additional documentation required |
Dependent Reaches Age 26 |
|
|
Loss or Gain of Coverage | Proof of enrollment or termination of benefit coverage from spouse's employer. Proof must contain effective or termination dates of coverage, type of coverage (medical, dental, vision, etc.) and the names of dependents effected |
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Gain of Medicare/ Medicaid or CHIP | Proof of enrollment of benefit coverage. Proof must contain effective or termination dates of coverage, type of coverage (medical, dental, vision, etc.), and the names of the dependents effected (has 60-day window) |
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Need Support? Contact Us!
1-866-222-KISD (5473)
Monday - Friday, 8am - 5pm CST
For any benefits question or concern, including 24/7 Nurse Line access, one call does it all.