Acom Benefit Guide - Class 1 - Officers, Directors

About Deductions

Premiums for medical, dental, vision and HSA Contribution plans are all deducted on a pre-tax basis because they are covered under Section 125 of the Internal Revenue Code. Once you elect benefits you will not be approved to make changes to your election or drop coverage until the next Open Enrollment period, unless you have a qualifying event. Voluntary life and short-term disability insurance premiums are deducted on a post-tax basis and may be changed outside of the Open Enrollment period.

Information Needed for Enrollment

In preparation of your enrollment, please have the following information readily available for you and your dependent(s): • Date(s) of birth • Social Security Number(s): Mandatory • Full name, relationship, and Social Security Number(s) for Life Beneficiary(ies). (Beneficiaries must be at least 18 years old or you will be required to name a guardian for him/her.)

All Eligibility

Qualifying Life Events

As an Acom employee, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package on the 1st of the month following 60 days of employment. You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include:

Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage.

Qualifying events include:

• Marriage • Divorce or legal separation • Birth or adoption of a child • Death of spouse or dependent child • Change in employment status • Loss of other coverage • Entitlement to Medicare or Medicaid • Child turning 26 years old

• Your legal spouse • Your children up to age 26 (as identified in the plan document)

*Once your elections are effective, they will remain in effect through the plan year.

You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.

3 Acom Integrated Solutions 2022 Enrollment Guide

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