Page 3 - Northbridge Companies 2018 OE Guide_Fomatting corrections (002)HLD

Why Open Enrollment period is
important to you.

Elections you make during this Open Enrollment will
become effective January 1, 2018 and will remain in
effect until December 31, 2018. You may not make
changes to your elections outside the annual Open
Enrollment period unless you experience a
“Qualified Life Event”.

Qualified Life Events include:

• A change in the size of your family (resulting
from marriage, divorce, legal separation, annul-
ment, birth, adoption, placement for adoption, or
death of a covered family member).
Who can enroll in benefits?
• A dependent no longer satisfies the definition of You are eligible for benefits if you are working 30 or more
eligible dependent due to age.
hours per week. New employee waiting periods must
• You or your spouse experiences a substantial be satisfied regardless of open enrollment.
change in employment (such as changing be-
tween full-time and part-time employment, or
commencement of or return from an unpaid Dependent Eligibility
leave of absence). You may also cover your eligible dependents on your
health benefit plans.
• Your spouse gains employment or loses a job.
Eligible dependents include:
• Your spouse or dependent experiences a
significant change in health coverage • Legal spouse
attributable to his or her employment.
• Domestic Partners
• You or your eligible dependent becomes eligible
for Medicare or Medicaid (other than solely for • Ex-Spouse
pediatric vaccines), or you lose your eligibility for • Child(ren) up to age 26
either of these programs.
• Disabled children age 26 or older who meet the
• The employer of your spouse offers benefits with following requirements:
a different Open Enrollment period. (a) is currently disabled;
• A court-issued judgment, decree, or order (b) was disabled prior to his or her 26th birthday;
(including a Qualified Medical Child Support (c) lives either with you or your spouse, or in a licensed
Order) resulting from divorce, legal separation, institution; and
annulment, or change in legal custody that (d) remains financially dependent on you.
requires health coverage of your dependent
child. • Children who have met the eligibility requirements
listed above for whom you are directed to cover under
the terms of a Qualified Medical Child Support Order.
Should you experience a Qualified Life Event,
you must notify Human Resources and request • If you are enrolling an eligible dependent on any of
your benefit changes within 31 days of the event. the plans, in addition to the enrollment election you
may be asked to submit a legal document that
shows your relationship to the eligible person. This
could include a marriage certificate, birth certificate,
Open Enrollment Elections and and adoption certificate or legal adoption placement
related forms must be submitted document. For domestic partners, an affidavit of do-
to your Business Office Director mestic partnership must be signed and submitted.
by December 8, 2017.

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