Page 6 - Guide
P. 6
Dependent Verification
We have a responsibility to ensure employees and dependents enrolled in our plan
are indeed eligible for coverage. You must supply the required documentation
verifying each of your eligible dependents meet our eligibility criteria or your
dependent will not be added. Please refer to the list below to determine what
documents you will need to provide for your dependent. This dependent audit
will be completed by One SourceVirtual and documents will be sent to your home
within 30 days of your beneit start date. You must supply the required documents
prior to the deadline. Failure to submit paperwork timely will result in your
dependents being terminated from the beneit plan(s). Please reach out to your HR
partner with questions regarding this process.
Required documentation is listed below. Please scan all required documents and
email them to HussmannBeneits@OneSourceVirtual.com. If you have a special
circumstance, please feel free to reach out to your HR partner or call One Source
Virtual directly at 855.944.4877.
X Legal spouse
Z Government issued marriage certiicate
X Biological child
Z Government issued birth certiicate (including parent’s name)
X Step child
Z Government issued birth certiicate (including parent’s name)
Z Government issued marriage certiicate (if married in the last 12 months)
X Adopted child
Z Adoption placement agreement including child’s birthdate or petition for
adoption including child’s birthdate or adoption certiicate including child’s
birthdate
Working Spouse Surcharge
This surcharge is intended to help manage the overall costs of health beneits while
maintaining the value of our programs. Hussmann will pay the majority of coverage
costs for a working spouse who is enrolled in our medical plan, but you will pay
a $1,300 annual surcharge if your spouse is eligible for subsidized group medical
coverage through his or her employer and chooses to enroll in medical coverage
through Hussmann. This surcharge will come out of each paycheck. To calculate the
amount which will be deducted from your paycheck, divide the annual amount by
26 if you are paid bi-weekly or 52 for bi-monthly. After enrollment, you will receive
a Workday task to complete a spousal afidavit if you elect to cover your
Hussmann
spouse on Hussmann’s medical plan.
Corporation
6
We have a responsibility to ensure employees and dependents enrolled in our plan
are indeed eligible for coverage. You must supply the required documentation
verifying each of your eligible dependents meet our eligibility criteria or your
dependent will not be added. Please refer to the list below to determine what
documents you will need to provide for your dependent. This dependent audit
will be completed by One SourceVirtual and documents will be sent to your home
within 30 days of your beneit start date. You must supply the required documents
prior to the deadline. Failure to submit paperwork timely will result in your
dependents being terminated from the beneit plan(s). Please reach out to your HR
partner with questions regarding this process.
Required documentation is listed below. Please scan all required documents and
email them to HussmannBeneits@OneSourceVirtual.com. If you have a special
circumstance, please feel free to reach out to your HR partner or call One Source
Virtual directly at 855.944.4877.
X Legal spouse
Z Government issued marriage certiicate
X Biological child
Z Government issued birth certiicate (including parent’s name)
X Step child
Z Government issued birth certiicate (including parent’s name)
Z Government issued marriage certiicate (if married in the last 12 months)
X Adopted child
Z Adoption placement agreement including child’s birthdate or petition for
adoption including child’s birthdate or adoption certiicate including child’s
birthdate
Working Spouse Surcharge
This surcharge is intended to help manage the overall costs of health beneits while
maintaining the value of our programs. Hussmann will pay the majority of coverage
costs for a working spouse who is enrolled in our medical plan, but you will pay
a $1,300 annual surcharge if your spouse is eligible for subsidized group medical
coverage through his or her employer and chooses to enroll in medical coverage
through Hussmann. This surcharge will come out of each paycheck. To calculate the
amount which will be deducted from your paycheck, divide the annual amount by
26 if you are paid bi-weekly or 52 for bi-monthly. After enrollment, you will receive
a Workday task to complete a spousal afidavit if you elect to cover your
Hussmann
spouse on Hussmann’s medical plan.
Corporation
6
