Page 19 - 2020 Benefit

Then, click "Add,"

Dependents and Beneficiaries

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Please verify yu.- family merfflefs and benef)cianes on file
To add a family membef or beneficiary, sin1)ly click the Add Dependent or Add Beneficiary· button
You may also add them later once you haw learned more about a partlC'Ular bene(1t plan and ervoffed

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Name Relationship Dependent Bentfaciary Socials«:wityNl.ffl>tl' BrthDate Geode<
LIAM ADAMS Son or Oa~ter ✓ ✓ 7878 12/03/2002 Male ✓•v
JILLIAN ADAMS Son or Daughter ✓ ✓ 8989 08,07/1996 Female ✓•v
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You will then be prompted to enter personal information for the dependent and/or
beneficiary.

X
Add Dependent
A~A• • R~ oonahip
0 Beneficiary Son or Daughter ....
® Dependent And Beneficiary
"""'·
F •tf- e •
Sophie Am

Social s.cwtry Numb« •
0 SSN Not Available
Adams 100 00 0001

8 ti Oeu.- •
10/28/ 2018 I~ I Female

0 Ful~ Time Student D Tobacco User 0 Disabled

Address
0 Same Address as Employee

123 S Main ST. OKLAHOMA CITY