Page 4 - 2023 Hickory Crawdads - Benefits Guide_Neat

BENEFIT BASICS & ELIGIBILITY

What is a Family Status Change? Eligible Dependents
A family status change is a life event that may allow an Your dependent must meet one of the following
Employee to add or drop coverage. The change must be definitions:
consistent with the event and documentation must be
provided to Human Resources within 30 days. Spouse: Your legally married husband or wife
Child(ren): children to age 26 (married or unmarried)
Family status changes are:
• Marriage Children include: natural children, stepchildren, legally
• Divorce adopted children, children placed for adoption, and
• Birth children who you are legally appointed as guardian.
• Adoption
• Death Disabled Child: an unmarried child who is mentally or
• Child reaching age 26 physically handicapped (handicap sustained before the
• Child’s loss of eligibility on another pan age of 25) and incapable of engaging in self-sustaining
• Spouse’s gain or loss of other coverage employment due to such incapacity and is listed as a
dependent on your IRS tax return.
NOTE: A family status change allows a plan change.
A child is automatically terminated from medical, dental,
All payroll deductions/refunds due resulting from plan vision and life insurance coverages the last day of the
changes will be taken on the next paycheck. Deductions and month he/she attains age 26.
refunds are based on the effective date of the change.

Eligible Documents Required Due

Dependents for Enrollment Date
Spouse Marriage License 30 Days
*Child/Stepchild Birth Certificate 30 Days 30 Days
Adoption Documents & Birth
*Adopted Child 30 Days
Certificate
Placement Documents & Birth
*Child Placed for Adoption 30 Days
Certificate
Notification from State Attorney
*Qualified Medial Support Order As directed by AG’s notice
General
Child age 26 or over incapable of
self-sustaining employment due to Attending Physician Statement 30 Days
a mental or physical disability
*Dependent must be less than 26 years old

Note: Enrolling someone who is not qualified as a dependent is considered insurance fraud.

2023 Hickory Crawdads Benefit Guide Page 4