Eligibility
Are you eligible?

You can participate in Aldine ISD benefits plans if:

  • 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 will be within 90 days, 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 Aldine ISD 30 hours or more per week. Please contact Benefits Outlook at 866-284-AISD (2473) if you feel you are eligible under these guidelines and have not been given the opportunity to enroll.  

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 Outlook at 866-284-AISD (2473). 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, unless you’re legally separated 

  • Your child(ren) under the age of 26

  • Your child(ren) who qualify as your dependents under the terms of a qualified medical child support order (QMCSO)

  • Your child(ren) of any age dependent on you for support due to a continuing physical or mental disability that began before age 26, provided the child(ren) were covered before age 26 and meet one of the following criteria:

    • You claim the child(ren) as dependents on your federal income tax return

    • The child(ren) qualify for Medicaid support

    • You have court-approved power of attorney for the child(ren) and can provide verification of the incapacity and eligibility on request

    • Your child(ren) who qualify as your dependents under the terms of a qualified medical child support order (QMCSO)

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.

For more information about eligibility and disabled status, contact Aetna customer service at 877-224-6857.

When benefits begin
  • If you're a new enrollee and choose benefits before the deadline in your benefits email, your coverage begins the first of the month following your date of hire, or when you become eligible, if that's after your hire date. If your hire date is the first of the month, that's your benefits effective date.

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

  • For benefits requiring evidence of insurability, coverage is effective the first of the month after notification of approval.

 

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 last day of the month after you notify the district of your selection to stop participation based on benefits enrollment 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 Aldine ISD’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.

 

Aldine ISD 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.

  • Memorial Hermann ACO: Silver

  • Open Access Select: Bronze

  • KelseyCare HMO: Gold

 

Where can you purchase coverage that meets ACA requirements?  

  • Aldine 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 Aldine ISD plan, including dropping coverage completely, during annual enrollment. If you drop your district coverage, you can’t regain Aldine ISD 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 Aldine 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. Aldine ISD 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 Aldine 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 Outlook at 866-284-AISD (2473).

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, including 24/7 Nurse Line access, one call does it all.
Call us at 866-284-AISD (2473)