Page 3 - Guide
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Eligibility and Enrollment 2017 Beneits Enrollment
As an EPS employee, you are eligible for medical beneits if you work at least 30 Reminder
hours per week. To be eligible for dental, vision, life, and disability beneits, employees If your spouse is
must work at least 40 hours per week. Beneits are effective on the irst day following offered medical/prescription
30 days of employment. drug benefits through his/her
employer, he/she will not be
eligible for benefits through
You may enroll your eligible dependents for coverage once you are eligible. Your EPS, and must elect coverage
eligible dependents include: through their employer’s plan.
You are required to complete
X Your legal spouse who does not have access to coverage through his/her an Affidavit of Spousal
Coordination of Benefits to
employer verify whether your spouse
X Your children up to age 26, including a natural child, stepchild, legally adopted is eligible to be covered
under this plan for 2016. This
child, or child for whom legal guardianship has been awarded to you or your affidavit will be provided by
spouse HR after benefits enrollment.
If you do not enroll for insurance when you irst become eligible for beneits with
EPS, you will need to wait for the next beneits enrollment. You may only change
coverage within 31 days of a qualiied life event.
Qualified Life Events
Generally, you may change your beneit elections only during the annual enrollment
period. However, you may change your beneit elections during the year if you
experience a qualiied life event, including:
X Marriage X Change in employment status of
X Divorce or legal separation employee, spouse, or dependent child
X Birth of your child X Qualiication by the plan
X Death of your spouse or dependent administrator of a child support order
for medical coverage
child
X Adoption of or placement for X Enrolled in Medicare or Medicaid
adoption of your child X Loss of coverage under any group
health coverage
You must notify Human Resources within 31 days of the qualiied 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 31 days of the qualiied event, you
will have to wait until the next annual enrollment period to make changes (unless you
experience another qualiied life event).
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As an EPS employee, you are eligible for medical beneits if you work at least 30 Reminder
hours per week. To be eligible for dental, vision, life, and disability beneits, employees If your spouse is
must work at least 40 hours per week. Beneits are effective on the irst day following offered medical/prescription
30 days of employment. drug benefits through his/her
employer, he/she will not be
eligible for benefits through
You may enroll your eligible dependents for coverage once you are eligible. Your EPS, and must elect coverage
eligible dependents include: through their employer’s plan.
You are required to complete
X Your legal spouse who does not have access to coverage through his/her an Affidavit of Spousal
Coordination of Benefits to
employer verify whether your spouse
X Your children up to age 26, including a natural child, stepchild, legally adopted is eligible to be covered
under this plan for 2016. This
child, or child for whom legal guardianship has been awarded to you or your affidavit will be provided by
spouse HR after benefits enrollment.
If you do not enroll for insurance when you irst become eligible for beneits with
EPS, you will need to wait for the next beneits enrollment. You may only change
coverage within 31 days of a qualiied life event.
Qualified Life Events
Generally, you may change your beneit elections only during the annual enrollment
period. However, you may change your beneit elections during the year if you
experience a qualiied life event, including:
X Marriage X Change in employment status of
X Divorce or legal separation employee, spouse, or dependent child
X Birth of your child X Qualiication by the plan
X Death of your spouse or dependent administrator of a child support order
for medical coverage
child
X Adoption of or placement for X Enrolled in Medicare or Medicaid
adoption of your child X Loss of coverage under any group
health coverage
You must notify Human Resources within 31 days of the qualiied 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 31 days of the qualiied event, you
will have to wait until the next annual enrollment period to make changes (unless you
experience another qualiied life event).
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