Page 4 - 2015 OE Sample Guidebook
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YOUR COMPREHENSIVE BENEFITS PROGRAM
[Client] provides a complete package of beneits to assist you and your family both physically and inancially.
Some beneits you pay for and other beneit costs are shared between you and [Client]. The contributions you
make for Medical, Dental, and Vision Coverage, Supplemental Beneits, and the Flexible Spending Accounts are
made on a pre-tax basis and are not subject to federal, most state, and local income taxes, as well as Social Security
withholding, thereby saving you taxes.
Beneit Who Pays Tax Treatment
Medical/Prescription Coverage [Client] and You Pre-Tax
Dental Coverage [Client] and You Pre-Tax
Vision Coverage [Client] and You Pre-Tax
Basic Term Life and Accidental Death Insurance [Client] Not Applicable
Disability [Client] Not Applicable
Optional Term Life Insurance You Post-Tax
Voluntary Accidental Death and Dismemberment Insurance You Post-Tax
Healthcare Flexible Spending Account You Pre-Tax
Dependent Care Flexible Spending Account You Pre-Tax
Supplemental Beneits (AFLAC) You Pre-Tax
Eligibility
Qualified Family Status Change
You are eligible for the beneits You may only make changes to your choices during the calendar year if you have a
described in this booklet if you qualifying family status change. Qualiied Family Status Changes include:
are an active, full-time employee Marriage Your spouse’s employer’s medical
scheduled to work 30 hours or plan, in which you are currently
more per pay week. Your eligible Birth, placement for adoption or enrolled, ceases its contributions
dependents include: adoption of a child to the plan’s cost or has an open
Divorce, legal separation or enrollment (does not apply to FSA)
Your legal eligible spouse annulment
(refer to the Spousal Employer A court issues a Qualiied Medical
Child Support Order (QMCSO)
Coverage Certiication Your spouse’s termination of requiring the plan to provide
employment
information to determine medical coverage for your
eligibility) Signiicant change in the cost dependent child
of your current coverage or the
Your dependent children up to options being offered A dependent becomes eligible or
age 26 ineligible for coverage, which could
Death of a dependent put you in a different coverage
Children of any age who are category
dependent on you for support If you experience a Qualiied Family Status Change, you must notify Human
because of a physical or mental Resources within 31 days of the change. Depending on the type of change, you
disability may qualify may need to provide proof of the change. It is your responsibility to notify Human
Resources when a dependent is no longer eligible for beneit coverage.
4
[Client] provides a complete package of beneits to assist you and your family both physically and inancially.
Some beneits you pay for and other beneit costs are shared between you and [Client]. The contributions you
make for Medical, Dental, and Vision Coverage, Supplemental Beneits, and the Flexible Spending Accounts are
made on a pre-tax basis and are not subject to federal, most state, and local income taxes, as well as Social Security
withholding, thereby saving you taxes.
Beneit Who Pays Tax Treatment
Medical/Prescription Coverage [Client] and You Pre-Tax
Dental Coverage [Client] and You Pre-Tax
Vision Coverage [Client] and You Pre-Tax
Basic Term Life and Accidental Death Insurance [Client] Not Applicable
Disability [Client] Not Applicable
Optional Term Life Insurance You Post-Tax
Voluntary Accidental Death and Dismemberment Insurance You Post-Tax
Healthcare Flexible Spending Account You Pre-Tax
Dependent Care Flexible Spending Account You Pre-Tax
Supplemental Beneits (AFLAC) You Pre-Tax
Eligibility
Qualified Family Status Change
You are eligible for the beneits You may only make changes to your choices during the calendar year if you have a
described in this booklet if you qualifying family status change. Qualiied Family Status Changes include:
are an active, full-time employee Marriage Your spouse’s employer’s medical
scheduled to work 30 hours or plan, in which you are currently
more per pay week. Your eligible Birth, placement for adoption or enrolled, ceases its contributions
dependents include: adoption of a child to the plan’s cost or has an open
Divorce, legal separation or enrollment (does not apply to FSA)
Your legal eligible spouse annulment
(refer to the Spousal Employer A court issues a Qualiied Medical
Child Support Order (QMCSO)
Coverage Certiication Your spouse’s termination of requiring the plan to provide
employment
information to determine medical coverage for your
eligibility) Signiicant change in the cost dependent child
of your current coverage or the
Your dependent children up to options being offered A dependent becomes eligible or
age 26 ineligible for coverage, which could
Death of a dependent put you in a different coverage
Children of any age who are category
dependent on you for support If you experience a Qualiied Family Status Change, you must notify Human
because of a physical or mental Resources within 31 days of the change. Depending on the type of change, you
disability may qualify may need to provide proof of the change. It is your responsibility to notify Human
Resources when a dependent is no longer eligible for beneit coverage.
4
