Page 6 - 2019 CommScope

Important!
If you have a qualifying life event, access the U.S.
employee beneits website or call the CommScope
Beneits Service Center at 833.554.4110 and make
changes to your beneit elections.

Qualifying Life Events

The only time you may make a change to your coverage during the year is if you have a qualifying event in your
family or employment status. Enrollees may change from one coverage type to another upon the occurrence of a
qualifying life event listed below. The election must be made within 31 days of the qualifying life event (or 60 days
in the event of Children’s Health Insurance Program).

Below is an outline of Qualifying Life Events and the documentation needed to make a change to your beneit
plan(s).

Qualifying Life Event Documentation Required
A change in marital status:

„ Marriage „ Marriage certiicate
„ Divorce „ Divorce decree
„ Death of spouse „ Death certiicate
A change in the number of your dependents:
„ Birth or adoption „ Birth certiicate/adoption agreement
„ Death of a dependent „ Death certiicate
„ Dependent(s) obtain their own coverage „ Proof of other coverage and efective date
„ Termination or commencement of employment by employee, „ Documentation from the employer conirming prior
spouse, or dependent coverage and efective date
„ Any signiicant change in your family’s healthcare plan coverage „ Documentation from spouse’s employer conirming
through your spouse’s healthcare plan change in coverage and efective date of change
„ Change in a dependent’s eligibility status (i.e., a dependent child „ Proof of the event (i.e., physician statement)
over the age of 26 becomes mentally or physically impaired), as
long as they were covered by a CommScope health plan since
their 26th birthday.

6 ANNUAL ENROLLMENT GUIDE BENEFITS 2019