WHO IS ELIGIBLE? Benefits are available to all full-time Members working a minimum of 30 hours per week and their dependents. For those enrolling during Open Enrollment, your benefits will become effective on 4/1/2023. For new hires, your benefits will become effective on first of the month after date of hire.
z Choose to enroll in or decline a plan by checking the appropriate option. If necessary, choose which dependents to add. When finished, tap “ Enroll ”. Continue for each benefit plan. z When finished, review your enrollment, and tap “ Finalize ”. Then, tap “ Sign and Submit ” in the pop-up window.
Eligible dependents include:
If you need assistance with username andpassword reset, please email HRsupport@siteimpact.com .
Your legal spouse or domestic partner
MAKING CHANGES You may only make changes to your elections during open enrollment each year or during the year if you experience a qualifying event. Qualifying events include, but are not limited to: z Birth, legal adoption, or placement for adoption. z Marital status. z Dependent child reaches age 26. z Spouse gains or loses employment or eligibility with current employer. z Death of a covered dependent. z Spouse or dependent becomes eligible or ineligible for Medicare/Medicaid or SCHIP. z Change in residence that changes eligibility for coverage. z Court-ordered change. Changes to your coverage due to a qualifying life event must be made within 30 days of that life event. Proof of the qualifying life event is required (marriage certificate, divorce decree, birth certificate, or loss of coverage letter).
Your children from birth to age 26
(Including your natural/legally adopted/stepchildren, and/ or your unmarried dependent children of any age who are mentally or physically disabled and who are dependent on you for support)
HOW TO ENROLL
To sign up for benefits, visit www.paycom.com Employee Self Service portal and mobile app before the end of your enrollment period. Please follow these steps to enroll: z From Notifications Center, tap the current year’s benefits enrollment. Review the instructions and tap “ Start Enrollment ” z Review your information. Tap “ Edit ” to change anything or “ Next ” to continue. z Complete the Pre-Enrollment Questions and tap “ Save and Next ”. (You can also edit existing dependent and beneficiary information on this screen, as well as add a dependent or beneficiary)
Note: Any change you make to your coverage must be consistent with the change in status.
ENROLLMENT DEADLINES
Type of Member/Dependent
Enrollment opportunity
Coverage effective date
Current member
Annually during the enrollment period
Start of plan year
New hire
Must enroll within 30 days of hire
4/1/2023
Changes must be made within 30 days of life event
Qualified life event
Date of life event
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