Mid-Year Benefit Changes In Status (CIS)

Forms must be requested and submitted with proper documentation within 30 days from the date of the event listed below. You must contact the FBMC Service Center at 1.855.MDC.PS4U (1.855.632.7748), Monday - Friday, 7 a.m. - 8 p.m. ET, for a CIS election form. Appropriate documentation supporting the Change in Status event is required when returning the form.


Marital Status

A change in marital status includes: marriage, domestic partner same sex marriage, death, divorce or annulment (legal separation is not recognized in the State of Florida).


Change in Number of Eligible Dependents

A change in number of dependents includes the following: birth, death, adoption and placement for adoption and change in marital status. Existing eligible dependents can also be added whenever a dependent gains eligibility as a result of a valid CIS event.


Change in Status of Employment Affecting Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee that affects the individual's eligibility under an

employer's plan, such as commencement or termination of employment.


Gain or Loss of Dependents' Eligibility Status

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under an employer's plan due to:

attainment of age; student status; marital status; employment status.


Change in Residence

A change in the place of residence of the employee, spouse or dependent that affects eligibility to be covered under an employer's plan, such as moving out of the network service area (except for Medical Expense FSAs).


Open Enrollment Under Other Employer’s Plan

You may make an election change when your spouse or dependent makes an Open Enrollment change in coverage under their employer’s plan if*:

  • their employer’s plan year is different from your employer’s plan year
  • they participate in their employer’s plan, and
  • their employer’s plan permits mid-plan year election changes under this event.

*Does not apply to a Medical Expense FSA.


* NOTE: If the dependent becomes an M-DCPS employee, the employee covering the dependent needs to cancel the dependent by completing a Change In Status form.



If a judgement, decree or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a grandchild who is your dependent), you may change your election* to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) cover the dependent child and provide coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

*Does not apply to Dependent Care FSA.



Gain or loss of Medicare/Medicaid eligibility and enrollment may trigger a permitted election change. Documentation indicating effective date of event and affected dependents must be presented with CIS form.



If your employer's group health plan(s) are subject to HIPAA's special enrollment provision, the IRS regulations regarding HIPAA's special

enrollment rights provide that an IRC Sec. 125 cafeteria plan may permit you to change a salary reduction election to pay for the extra cost for group health coverage, on a pre-tax basis, effective retroactive to the date of the CIS event, if you enroll your new dependent within 30 days of one of the following CIS events: birth, adoption or placement for adoption. Note that a Medical Expense FSA is not subject to HIPAA's special enrollment provisions if it is funded solely by employee contributions.


Other Election Changes

Domestic Partner of the opposite or same sex and not married and their children: The Internal Revenue Service (IRS) Section 125 “Change in Status” rules and guidelines do not apply. An employee may terminate coverage for their Domestic Partner and/or their child(ren) at any time of the year, but may not reinstate their coverage until the following open enrollment period as long as all of the eligibility criteria has been met once again. You may add a dependent if eligibility requirements are met during the plan year or due to loss of alternative group coverage.


Domestic Partner of the same sex and legally married: Employees covering a same sex domestic partner and legally married can have both the Domestic Partner's relationship to spouse and the post tax deductions changed to pre tax. The change will occur the first of the month after submitting the marriage certificate.


Change in Status (CIS) Cut-Off Effective Dates

Documentation supporting the qualifying CIS event and dependent eligibility documentation must be submitted with the CIS form before (FORM DUE DATE) to have an (EFFECTIVE DATE) effective date. Any form received after (FORM DUE DATE) will be processed for the next available effective date. Please be aware that the form and proper documentation must be submitted within 30 days of the Change in Status event for the changes above to take effect.

Change in Status (CIS) Cut-Off Effective Dates:

Form Due Date















Future cut-off effective dates will be provided as soon as the payroll processing schedule for Fiscal Year 2015-2016 has been made available.

Effective Date















Enrollment Helpline:


7 a.m. to 8 p.m. ET /

Seven days a week

Enrollment Website:


Benefits Inquiry:

FBMC Service Center

Mon - Fri, 7 a.m. to 8 p.m. ET

1-855-5MDC-PS4U (1-855-632-7748)

Office of Risk and Benefits Management

1501 N.E. 2nd Avenue, Suite 335

Miami, Florida 33101

Mon - Fri, 8 a.m. to 4:30 p.m. ET