Page 6 - Burke Hospital 2022 Benefits Summary

Eligibility
Benefits eligible employees must complete 59 days of employment before being eligible to enroll in Burke’s health and welfare plans. Once the employee and his/her dependents are enrolled, benefits become effective on the 1st of the month following 59 days
of employment. (Ex. – A full-time employee hired
on November 25th would complete 2 months of employment on January 25th. Assuming the employee enrolls in the plans, benefits would become effective on February 1st.)
to attaining the limiting age and the child is chiefly dependent upon the subscriber for economic support and maintenance. Proof of such incapacity and dependency must be furnished to Empire.
Dependent Verification: To enroll a family member onto the health plan, you will be required to show proof that the dependent you are enrolling is an eligible dependent.
If Married:
A copy of your marriage certificate (or 2019 or 2020 tax return showing you filed as married).
If Adding Children:
• Copy of Birth Certificate for each child showing relationship to employee
• Copy of Adoption Paperwork
• Copy of court papers conveying legal guardianship
If Adding a Domestic Partner:
Contact Human Resources for necessary paperwork.
You have the opportunity to add or remove a dependent and/or enroll in Burke’s benefit plan offerings annually at Open Enrollment. Your enrollment decisions are binding unless you have a mid-year qualifying event (such as marriage, divorce or birth of a child). If you experience a mid-year life status change, you are required to notify Kia Morgan, Benefits Manager, within 30 days of the event or you will not be permitted to make changes to your benefit election. Kia can be reached at 914-597-2295 or kmorgan@burke.org.
Eligible dependents are defined as follows: A legal spouse and any child who has not reached age 26, and who is chiefly dependent upon the employee
for support.
The term “child” means the employee’s children, including any legal stepchild, adopted child, or child for whom the employee or employee’s spouse is the court- appointed legal guardian. A prospective adopted child
is eligible for coverage on the same basis as a natural child during any waiting period prior to the finalization of the child’s adoption.
If a child cannot support himself/herself due to intellectual disability or physical handicap, the age limitation requirement for such a child is waived provided that the disability or handicap arose prior
Your enrollment decisions are binding unless you have a mid-year qualifying event (such as marriage, divorce or birth of a child).”
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