Are you eligible for benefits?

You can participate in Katy 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, 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 Outlook at 866-222-KISD (5473) 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 866-222-KISD (5473). Please note that appeals process does not review medical or pharmacy claim issues. For those issues, you must contact the carrier directly.

Are your dependents eligible?

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

  • Legal spouse (unless legally separated)
  • Child under age 26 for medical, dental and 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)
  • 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.
  • Child who qualifies as your dependent 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.



How the term child is defined

The term child can mean a number of things, including:

  • Your natural or legally adopted child, stepchild, foster child or any other child for whom you are a legal guardian

  • Any grandchild whom you claimed as a dependent on your federal income tax return for the year you first covered him or her, and have continuously covered since

  • Grandchildren under age 26, unless they otherwise meet the eligibility definition

When benefits begin
  • If you are newly hired or newly eligible and select benefits before the deadline, coverage begins the first of the month following your hire date (or the date you become eligible for benefits). If you are hired on the first day of the month, your benefits are effective that day.

  • 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.

  • 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 Outlook.
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 Katy ISD’s medical plan options meet ACA guidelines for value, and the Consumer Basic Limited employee-only plan qualifies as affordable, so, if you’re enrolled in one of our plans, you’re not subject to paying the fee.


Katy 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.

  • Consumer Basic – Limited and Choice: Silver

  • Consumer Plus – Limited and Choice: Gold


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 Outlook 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.

For any benefits question or concern, including 24/7 Nurse Line access, one call does it all.
Call us at 866-222-KISD (5473)