Page 5 - 2016 Open Enrollment
P. 5
Pericient, Inc.
You are eligible for medical, dental, vision,
Beneits Eligibility life, and disability beneit programs if you
are a full-time employee working 30 hours
per week. Beneits will begin on the irst
Making Benefit Or Life Status Changes of the month following your date of hire.
You will only be able to make coverage or enrollment changes during Your eligible dependents include*:
open enrollment, unless you have an IRS-approved change in family
status, which includes the following. Your legal spouse, same and opposite
sex
The addition of a dependent through birth, adoption, or Your domestic partner, same and
marriage opposite sex
The loss of a dependent through divorce or death, or if your Your children include:
child reaches the maximum age limit for coverage
Dependent children to age 26
A change in you or your spouse’s employment status from full-
time to part-time, or vice versa Natural or adopted children,
stepchildren, children for whom you
A spouse’s loss of employment are the legal guardian, children under
A change in your spouse’s employer-provided coverage (i.e., open qualiied medical support order.
enrollment) Disabled children over age 26
A change of location * You may be required to provide
proof of dependent status.
Remember, you may only make enrollment changes during the year
if you have a change in family status. To make a qualiied change,
you must submit the change to your Beneits Team within 30 Spouse Eligibility
days of the date of the family status change. During open enrollment you will verify
whether your spouse is employed and
Documentation is required for life changes (e.g., birth certiicate, offered healthcare coverage through his
marriage license, divorce paperwork, adoption certiicate, etc.). or her own employer. If your spouse is
offered their own company coverage and
you choose to enroll them into Pericient’s
medical plan, an additional $50 per pay
period will be charged on top of your
medical plan contribution. This provision
does not apply to dental or vision
coverage.
5
You are eligible for medical, dental, vision,
Beneits Eligibility life, and disability beneit programs if you
are a full-time employee working 30 hours
per week. Beneits will begin on the irst
Making Benefit Or Life Status Changes of the month following your date of hire.
You will only be able to make coverage or enrollment changes during Your eligible dependents include*:
open enrollment, unless you have an IRS-approved change in family
status, which includes the following. Your legal spouse, same and opposite
sex
The addition of a dependent through birth, adoption, or Your domestic partner, same and
marriage opposite sex
The loss of a dependent through divorce or death, or if your Your children include:
child reaches the maximum age limit for coverage
Dependent children to age 26
A change in you or your spouse’s employment status from full-
time to part-time, or vice versa Natural or adopted children,
stepchildren, children for whom you
A spouse’s loss of employment are the legal guardian, children under
A change in your spouse’s employer-provided coverage (i.e., open qualiied medical support order.
enrollment) Disabled children over age 26
A change of location * You may be required to provide
proof of dependent status.
Remember, you may only make enrollment changes during the year
if you have a change in family status. To make a qualiied change,
you must submit the change to your Beneits Team within 30 Spouse Eligibility
days of the date of the family status change. During open enrollment you will verify
whether your spouse is employed and
Documentation is required for life changes (e.g., birth certiicate, offered healthcare coverage through his
marriage license, divorce paperwork, adoption certiicate, etc.). or her own employer. If your spouse is
offered their own company coverage and
you choose to enroll them into Pericient’s
medical plan, an additional $50 per pay
period will be charged on top of your
medical plan contribution. This provision
does not apply to dental or vision
coverage.
5
