Tacodeli - 2025 Benefit Guide (English)

Benefits for 2025

Tacodeli

Legal Notices

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan

because of the following qualifying events:

Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or her gross misconduct;

• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following

qualifying events:

The parent-employee dies;

• The parent- employee’s hours of employment are reduced;

• The parent- employee’s employment ends for any reason other than his or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been

notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying

events:

• The end of employment or reduction of hours of employment;

Death of the employee;

• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing

eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days [ or enter longer period

permitted under the terms of the Plan ] after the qualifying event occurs. You must provide this notice to: [ Enter name of

appropriate party ].

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.

2025 Employee Benefit Guide

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