Page 3 - Future Steps
P. 3
Eligibility Decline Coverage
If you decline coverage
Benefit Basics under this plan for yourself
All full-time and part-time 30 employees are eligible to participate in the VER or your dependents
(including your spouse)
beneit program. Coverage is effective the irst of the month following 30 because of other health
days of employment. coverage, you may in the
future be able to enroll
Dependent Eligibility yourself or your dependents
in this plan provided you
Eligible* dependents include the following. request enrollment within
30 days after your other
Your legal spouse Dependent children to age 26 coverage ends.
Your same or opposite sex including natural or adopted
domestic partner (employees children, stepchildren, children
will be taxed on the value of for whom you are the legal
coverage for non-tax qualiied guardian, and children under
dependents) qualiied medical support order
Disabled children over age 26
* Proof of dependent status may be required
Mid-Year Benefit Changes
Enrollment changes are restricted to annual enrollment unless you experience
an IRS approved change in family status, which include the following.
The addition of a dependent A change in you or your spouse’s
through birth, adoption, or employment status or loss of
marriage employment
The loss of a dependent through A change in your spouse’s
divorce or death, or if your child employer-provided coverage
reaches the maximum age limit A change of location
for coverage
Remember, you may only make enrollment changes during the year if
you have a change in family status. To make a qualiied change, you must
submit the change to your Beneits Team within 30 days of the date of the
family status change. Failure to act within 30 days will result in the loss of
opportunity to make changes until the next annual enrollment period.
Documentation is required for mid-year beneit changes (e.g., birth certiicate,
marriage license, divorce paperwork, adoption certiicate, etc.). 3
If you decline coverage
Benefit Basics under this plan for yourself
All full-time and part-time 30 employees are eligible to participate in the VER or your dependents
(including your spouse)
beneit program. Coverage is effective the irst of the month following 30 because of other health
days of employment. coverage, you may in the
future be able to enroll
Dependent Eligibility yourself or your dependents
in this plan provided you
Eligible* dependents include the following. request enrollment within
30 days after your other
Your legal spouse Dependent children to age 26 coverage ends.
Your same or opposite sex including natural or adopted
domestic partner (employees children, stepchildren, children
will be taxed on the value of for whom you are the legal
coverage for non-tax qualiied guardian, and children under
dependents) qualiied medical support order
Disabled children over age 26
* Proof of dependent status may be required
Mid-Year Benefit Changes
Enrollment changes are restricted to annual enrollment unless you experience
an IRS approved change in family status, which include the following.
The addition of a dependent A change in you or your spouse’s
through birth, adoption, or employment status or loss of
marriage employment
The loss of a dependent through A change in your spouse’s
divorce or death, or if your child employer-provided coverage
reaches the maximum age limit A change of location
for coverage
Remember, you may only make enrollment changes during the year if
you have a change in family status. To make a qualiied change, you must
submit the change to your Beneits Team within 30 days of the date of the
family status change. Failure to act within 30 days will result in the loss of
opportunity to make changes until the next annual enrollment period.
Documentation is required for mid-year beneit changes (e.g., birth certiicate,
marriage license, divorce paperwork, adoption certiicate, etc.). 3
