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Philip Shin

From: Chris Kim
Sent: Wednesday, June 23, 2021 11:37 AM
To: ACI.ALL
Cc: Michael Hwang; 'John Park'; Stephen Yun
Subject: MEMORANDUM # 150 < Open Enrollment ( Health, Dental & Vision) Insurance
Renewal – 2021 >
Attachments: Open Enrollment Overview and Summary '21.pdf; ACI BENEFIT GUIDE 2021.pdf; UHC
(Health & Dental) - HUMANA (Vision) Employee Enrollment.pdf; WAIVER.PDF; UHC
HUMANA Employee Enrollment.pdf

To: ACI ALL
< Open Enrollment ( Health, Dental & Vision) Insurance Renewal – 2021 >

The Annual Health Insurance Open Enrollment (2021) has just begun!
This is the Open Enrollment Period to add Yourself or Family Members for this year.

 Open enrollment forms are due to Chris Kim, HR no later than [07/09/2021].
 It is same Medical Plan but some yearly benefit modifications from UHC for your acknowledgment.
New enrollments and changes will take effect August 1, 2021.
Please note that if you do not enroll this time, you may not be able to enroll until July 2022 unless you have a
qualifying event. (see NOTE below)
If you decline the company insurance benefit, it is required to submit the attached signed Waiver form (Medical,
Dental & Vision Enrollment Form‐Page 3: E. Waiver of Coverage)

YOUR RESPONSIBILITIES DURING OPEN ENROLLMENT
If you don’t want to make any changes to your current benefit elections, and you do not participate in the
enrollment, you don’t need to take any action. All of your current benefit elections will automatically carry over
and remain effective for 2021.

If you want to make any changes to your current benefit elections, you will need to complete attached enrollment
form and submit to Mr. Chris Kim, HR, no later than [07/09/2021].

NOTE (qualifying event): After open enrollment, you cannot make changes to your coverage during the year
unless you experience a change in family status, such as:
 Loss or gain of coverage through your spouse
 Loss of eligibility of a covered dependent
 Death of your covered spouse or child
 Birth or adoption of a child
 Marriage, divorce or legal separation
 Switch from part‐time employment to full‐time employment

[Please find the attached]
 “BENEFIT GUIDE 2021”
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