Page 4 - Open Enrollment Guide Sample
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Eligibility
Benefit Basics
Important
Changing Your Medical, Eligibility for Benefits
Dental, or Vision All full-time team members are eligible for medical, dental, vision,
Coverage During the Year and supplemental life beneits on the irst of the month following 60
Any amount you pay for beneits will consecutive days of employment. All team members hired prior to
be deducted from your pay before October 3, 2013 with an average of over 30 hours/week over the last
federal, state and local taxes. 12 months will be offered beneits regardless of employment status
Lower taxes mean you keep more of (seasonal, part-time, etc.).
what you earn. Because of this, IRS
regulations do not allow you to change If you are an eligible team member, you must take our coverage and you
your pre-tax beneits during the year
unless you have a qualiied family cannot take coverage as a dependent of another eligible team member.
status change or experience a loss of
creditable coverage (otherwise known Dependent Eligibility
as a life event). Eligible dependents for medical, dental, and vision coverage include your
Life events include:
spouse, children up to age 26, and your disabled children of any age, as
Qualiied family status changes long as disabled before 26. If a husband and wife are both covered as
such as marriage or divorce, birth employees under the Plan, their children can be covered as dependents of
or adoption of child, death of a the husband OR of the wife, but not both.
spouse or a child, start or end of
your spouse’s employment, etc.
Spouse Eligibility
A loss of creditable coverage
may occur if you or an eligible If your spouse has coverage available through another employer
dependent had healthcare they must enroll and elect that coverage as primary. [Client] will
coverage under another not cover a spouse as primary if they are eligible for employer
healthcare plan and lost it sponsored coverage elsewhere.
because you were no longer
eligible, your employer stopped
making contributions, or your Decline Coverage
COBRA beneits ended. If you decline coverage under this plan for yourself or your dependents
You must notify the Beneits (including your spouse) because of other health coverage, you may in the
Department within 30 days of the future be able to enroll yourself or your dependents in this plan provided
life event if you would like to make
a change in your medical, dental, or you request enrollment within 30 days after your other coverage ends.
vision coverage.
[Client]
Eligibility
Benefit Basics
Important
Changing Your Medical, Eligibility for Benefits
Dental, or Vision All full-time team members are eligible for medical, dental, vision,
Coverage During the Year and supplemental life beneits on the irst of the month following 60
Any amount you pay for beneits will consecutive days of employment. All team members hired prior to
be deducted from your pay before October 3, 2013 with an average of over 30 hours/week over the last
federal, state and local taxes. 12 months will be offered beneits regardless of employment status
Lower taxes mean you keep more of (seasonal, part-time, etc.).
what you earn. Because of this, IRS
regulations do not allow you to change If you are an eligible team member, you must take our coverage and you
your pre-tax beneits during the year
unless you have a qualiied family cannot take coverage as a dependent of another eligible team member.
status change or experience a loss of
creditable coverage (otherwise known Dependent Eligibility
as a life event). Eligible dependents for medical, dental, and vision coverage include your
Life events include:
spouse, children up to age 26, and your disabled children of any age, as
Qualiied family status changes long as disabled before 26. If a husband and wife are both covered as
such as marriage or divorce, birth employees under the Plan, their children can be covered as dependents of
or adoption of child, death of a the husband OR of the wife, but not both.
spouse or a child, start or end of
your spouse’s employment, etc.
Spouse Eligibility
A loss of creditable coverage
may occur if you or an eligible If your spouse has coverage available through another employer
dependent had healthcare they must enroll and elect that coverage as primary. [Client] will
coverage under another not cover a spouse as primary if they are eligible for employer
healthcare plan and lost it sponsored coverage elsewhere.
because you were no longer
eligible, your employer stopped
making contributions, or your Decline Coverage
COBRA beneits ended. If you decline coverage under this plan for yourself or your dependents
You must notify the Beneits (including your spouse) because of other health coverage, you may in the
Department within 30 days of the future be able to enroll yourself or your dependents in this plan provided
life event if you would like to make
a change in your medical, dental, or you request enrollment within 30 days after your other coverage ends.
vision coverage.
[Client]
