Page 7 - Benefits Guide 2022 EPO

Who is Eligible?

As an employee of Mission you are eligible for benefits on the first day of the month following your date of
hire. You are considered a full-time employee if you work 30 hours or more per week. If you work 24-29
hours per week, you are considered a part-time employee.

Eligible Dependents
You may cover your eligible dependents under any of the benefit options offered under our plans. Your eligible
dependents may include:
• Your legal spouse
• Your children up to age 26, regardless of full-time student or marital status
• Your unmarried children over age 26, who are incapable of self-support due to physical or mental disability, if
they became disabled while an otherwise eligible dependent
• A child whose age is less than the limiting age and for whom the employee has received a Qualified Medical
Child Support Order (QMCSO) or National Medical Support Notice (NMSN) to provide coverage

Spousal Documentation
In order to add your legal spouse to the Health Plan, you must provide one of the required documents listed below:
• Copy of the Official State Marriage Certificate
• Official Certificate of Informal Marriage (if available) or Affidavit of Common Law Marriage
• If you have elected medical coverage from Mission for your legal spouse and they are eligiblefor coverage through
his/her employer, you will be required to complete a Spousal Surcharge Affidavit.

Qualified Change in Status
You can only change your coverage during the year when you experience a qualified change in status, such as:
• Marriage or divorce;
• You or your spouse give birth or adopt a child;
• A covered dependent no longer meets the plan’s definition of eligibility;
• You become disabled;
• Death of a dependent spouse or child;
• You end your employment with the Company;
• Change in employment status
• You or a covered dependent lose coverage through another plan; or
• A significant change in the health coverage for you or your dependents attributed to employment.
Any changes you make to your coverage must be made within thirty (30) days of the event. Supporting
documentation of the qualifying change is required and must be turned into the People Operations Department at
mpcbenefits@missionpharmacal.com. Please contact the People Operations Department for details.

7