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Separation of Employment

Please review and complete the listed forms upon decision to separate employment with ACPS.

Below are the benefit plans that are affected by your termination of employment with ACPS. For more information, contact:

ACPS Benefits Office
1340 Braddock Place, 5th Floor
Alexandria, VA 22311


Address Changes

  • To ensure you receive communications related to your employment conclusion, including your final pay advice and W-2 wage and tax statement, please report address changes to ACPS Human Resources prior to your departure using Employee Self Service.
  • After you leave employment you should report address changes to the Human Resources office until you receive your W-2 wage and tax statement, and to your retirement plans, which hold the contribution funds accumulated during your ACPS employment. Address changes can be submitted to Human Resources using the Information Change Form (PDF). For more information on your retirement plans, see the Quick Plan Reference at the bottom of this page or email

When Your Health Insurance Benefits Will End

If you paid the employee premium contribution on your medical, dental, and vision coverage through the end of your employment, your health insurance coverage will continue according to the following schedules:

  • Through September 30 if you are a 10-month employee and terminate at the end of the school year.
  • Through August 31 if you are an 11-month employee and terminate employment at the end of the school year.
  • If you are a 12-month employee or if you end your employment prior to the end of the school year, through the last day of the month following the month you leave ACPS.

After your health insurance coverage expires, you may be eligible to elect COBRA continuation coverage.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

You and your eligible spouse and children covered under an ACPS health plan on the date your employment ends may be entitled to continue your coverage through a provision known as COBRA. If eligible, you will receive a COBRA notice and election forms in the mail shortly after termination. The maximum period you may continue COBRA is 18 months. To continue health care coverage through COBRA, you must complete and return the election form within 60 days of your benefit termination date (or COBRA notice date, whichever is later). You must pay the required premiums within 45 days from the date you submit your COBRA election form, and coverage is not effective until the premium is paid. You are responsible for the full COBRA premium.

Your Flexible Spending Accounts (FSAs)

Your FSA benefits generally end when you terminate employment with ACPS. Eligible expenses must be submitted for reimbursement by September 30 of the year in which you terminate employment with ACPS. Any money remaining in your flexible spending account(s) after September 30 is forfeited and cannot be returned to you.

Virginia Retirement System (VRS) and Supplemental Retirement Plan Members Retirement Contributions

If you are terminating employment without retiring, you may contact VRS and the Principal Financial Group regarding your accumulated contributions and the options for handling your contribution funds (including rollover, withdrawal, or retaining accumulated contributions). For details regarding the Virginia Retirement System, contact VRS online or at 1-888-827-3847. You may contact the Principal Financial Group online or at 1-800-547-7754 if you have any questions regarding your Supplemental Retirement Plan.

VRS Life Insurance

If you are a VRS member not eligible for retirement, you may convert your VRS group and/or optional life insurance coverage to an individual plan. Contact the Virginia Retirement System to obtain the Conversion of Group Life Insurance Enrollment (VRS 35E) form (also available on the VRS website). You must submit this form and the first premium payment within 31 days of your ACPS employment termination date to: Minnesota Life, Richmond Branch Office, P.O. Box 1193, Richmond, VA 23218-1193.

Annual Leave

Upon employment termination from a contracted 12-month position, employees will be paid for accumulated annual leave at the rate of pay in effect at the time of termination, to a maximum of 45 days. The annual leave payout will be processed as a separate payment following the last regular pay.

Unused Sick Leave

At the time of your termination, if you have at least three years of service with ACPS, you have the option of receiving a leave payout or having your sick leave transferred to your new employer. The leave payout rate varies depending on your termination status (retirement or resignation). Read more details regarding leave payout (PDF). Contact the Payroll Office at or 703-619-8042 if you have questions regarding leave payments.

If your unused sick leave is not transferred to another Virginia school division within 36 months from your date of termination, it will be forfeited. Note the amount of sick leave that may be transferred is limited by state regulations to a maximum of 90 days. You must complete the Sick Leave Termination Options form (PDF).

Employees eligible for the Sick Leave Payout may choose to transfer the funds to an existing 403(b) or 457(b) savings account with ACPS. The employee must complete and submit the necessary paperwork to the third party administrator company prior to their final work day.

Retirement Savings Accounts: 403(B) and 457(B)

Contributions to your Tax-Deferred Account-403(b) and/or Deferred Compensation-457(b) end when you leave employment with ACPS. All 403(b) distribution requests can be initiated by contacting TSA Consulting Group (TSACG), ACPS' third-party administrator, who is responsible for approving distribution and withdrawal transactions (including cash, withdrawals, rollovers, loans, and hardship withdrawals) at 1-866-796-3786. You may request distributions by completing the necessary forms obtained from your investment provider, attaching them to a Transaction Routing Request form, and submitting all completed documents to TSACG for evaluation and approval. See the Transaction Routing Request Form on the TSACG website.




Medical Group #16811


United Healthcare
Medical Group #714309


Dental Group #1TEQ


Vision Group #9790916


Virginia Retirement System (VRS)
Retirement, Life Insurance


Principal Financial Group
Retirement Group #435557


Flexible Spending Accounts
Group #4002-7613-2585


TSA Consulting Group, Inc. 
403(b) and 457 Plan Administrator