Sample Guide

Eligibility

Employees working 30 + hours/week are eligible for benefits the first of the month following 60 days. If you enroll in the benefits you may also cover your eligible dependents, these include:

➢ Your legal spouse, unless you are legally separated or divorced;

➢ Your married or unmarried natural children, step- children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:

Under 26 years of age

When can you enroll?

You can sign up for benefits at any of the following times:

• After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family-status change.

If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.

Examples of qualified family-status changes are as follows:

• Change in your work status that affects your benefits • Change in residence or work site that affects your eligibility for coverage

Your marriage

Your divorce or legal separation

Birth or adoption of an eligible child

• Death of your spouse or covered child

• Change in your child’s eligibility for benefits

• Change in your spouse’s work status that affects his or her benefits

• Receiving Qualified Medical Child Support Order (QMCSO)

If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change.

When does coverage end?

Coverage will stop on the last day of the month in which your employment with the company ends.

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