Page 4 - Burlingame EE Guide 12-17

ENROLLMENT INFORMATION

Who May Enroll Examples of qualifying events include, but are not limited to
the following:
If you are a regular full‐time employee working at least 30 • Marriage, divorce, legal separation or annulment
hours per week, you and your eligible dependents may • Birth or adoption of a child
participate in Burlingame Industries’ health plan. • A qualified medical child support order
• Death of a spouse or child
Your eligible dependents include: • A change in your dependent’s eligibility status
• Legally married spouse • Loss of coverage from another health plan
• Registered domestic partner • Change in your residence or workplace (if your benefit
• Children under the age of 26, regardless of student or
options change)
marital status • Loss of coverage through Medicaid or Children’s Health
Insurance Program (CHIP)
When You Can Enroll • Becoming eligible for a state’s premium assistance
program under Medicaid or CHIP
As an eligible employee, you may enroll at the following
times:
• As a new hire, you may participate in the company’s Please note that coverage for a new dependent is not
automatic. If you experience a qualifying event, you have 30
health plan on the first day of the month following the
days to update your coverage. Please contact the Human
completion of 60 days of full‐time employment
• Each year, during open enrollment Resources Department immediately following a qualifying
• Within 30 days of a qualifying event as defined by the event to complete the appropriate election forms as needed.
If you do not update your coverage within 30 days from the
IRS (see Changes To Enrollment below)
qualifying event, you must wait until the next annual open
enrollment period to update your coverage.
Changes To Enrollment

Our health plan is effective December 1st through November Paying For Your Coverage
30th of each year. There is an annual open enrollment period
The Employee Assistance Program, Basic Life/AD&D, Short
each year, during which you can make new insurance
Term Disability, and Long Term Disability benefits are
elections for the following December 1st effective date. Once provided at no cost to you and are paid entirely by
you make your insurance elections, you cannot change them Burlingame Industries. You and the company share in the
during the year unless you experience a qualifying event as cost of the Medical, Dental, and Vision benefits you elect.
defined by the IRS.
Any Voluntary Life/AD&D benefits you elect will be paid by
you at discounted group rates.

Section 125 Advantage

Your premium contributions are governed by Section 125 of the Internal Revenue Code. Burlingame Industries - Section 125 Cafeteria
Plan allows health-related premium contributions to be taken from your paycheck on a pre-tax basis. As a result, you may increase
your take home pay. The example below explains how the take home-pay was increased for an employee earning $30,000 per year.

Section 125 Savings Example No Pre-Tax Savings With Pre-Tax Savings

Annual Salary $30,000 $30,000
Less Pre-Tax: Health Premiums (assumed at $250 per month) N/A ($3,000)
Taxable Income $30,000 $27,000
Less Taxes (assumed at 25% based on federal income tax) ($7,500) ($6,750)
Less Post-Tax: Health Premiums (assumed at $250 per month) ($3,000) N/A
Spendable Income $19,500 $20,250
Annual Savings with Pre-Tax Deductions $750

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