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Benefits Appeals
When submitting an appeal form for benefits, exceptions may only be granted for extenuating circumstances constituting “good cause.” “Good cause” means that a person’s failure to act was not due to lack of diligence, but rather circumstances beyond their control that resulted in a loss of opportunity to enroll or make applicable changes to current plan elections.
If your request for an exception does not meet these guidelines, or would create non‐compliance with Dallas Independent School District’s Cafeteria Plan, which qualifies under Section 125 of the IRS Code of 1986, your appeal may be denied.
Incomplete appeal forms will be denied as invalid. Appeal forms must include all required supporting documentation, such as certificates of credible coverage, confirmation statements, divorce decrees, marriage certificates, birth certificates, etc. You will have another opportunity to enroll or make changes during the next annual enrollment period, or if you experience a Qualifying Life Event (QLE) and notify the Benefits Department within 31 days of such event.
Acknowledgment to Pay Retro Premiums:
Please understand that submitting an appeal form for benefits to request an exception to enroll or make a change is not a guarantee of coverage reinstatement, billing credit, or enrollment. If your request is approved, you agree to payroll-deducted retroactive premiums consistent with the effective date of the approved exception, if applicable. Do not submit this form if you are unwilling to pay retroactive premiums associated with an approved exception.