Page 4 - Down East Wood Ducks 2022 Benefits Guide

BENEFIT BASICS & ELIGIBILITY

What is a Family Status Change? Eligible Dependents
A family status change is a life event that may allow an Your dependent must meet one of the following
employee to add or drop coverage. The change must be definitions:
consistent with the event and documentation must be
provided to Human Resources within 30 days. Spouse: Your legally married husband or wife
Child(ren): children to age 26 (married or unmarried)
Family status changes are:
• Marriage Children include: natural children, stepchildren,
• Divorce legally adopted children, children placed for adoption,
• Birth and children who you are legally appointed as
• Adoption guardian.
• Death
• Child reaching age 26 Disabled Child: an unmarried child who is mentally or
• Child’s loss of eligibility on another pan physically handicapped (handicap sustained before the
• Spouse’s gain or loss of other coverage age of 25) and incapable of engaging in self-sustaining
employment due to such incapacity and is listed as a
NOTE: A family status change allows a plan change. dependent on your IRS tax return.

All payroll deductions/refunds due resulting from plan A child is terminated from medical, dental, vision and
changes will be taken on the next paycheck. Deductions life insurance coverages the last day of the month
and refunds are based on the effective date of the change. he/she attains age 26.

Eligible Documents Required Due
Dependents for Enrollment Date

Spouse Marriage License 30 Days
*Child/Stepchild Birth Certificate 30 Days 30 Days
Adoption Documents & Birth
*Adopted Child 30 Days
Certificate
Placement Documents & Birth
*Child Placed for Adoption 30 Days
Certificate
Notification from State Attorney
*Qualified Medial Support Order As directed by AG’s notice
General
Child age 26 or over incapable of
self-sustaining employment due to Attending Physician Statement 30 Days
a mental or physical disability
*Dependent must be less than 26 years old

Note:
Enrolling someone who is not qualified as a dependent is considered insurance fraud.

2022 Down East Wood Ducks Benefit Guide Page 4