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Eligibility for a   state’s premium   assistance   program under   Medicaid or CHIP   How Can I Enroll?   of this document.
                                               Once you make your benefit elections, you cannot change them throughout the year unless you experience a qualifying event as defined by the IRS. Examples







                                                                 Loss of coverage   through Medicaid   or Children’s   Health Insurance   Program (CHIP)



                 ELIGIBILITY & ENROLLMENT




                                                                 Change in your   residence or   workplace (if your   benefit options   change)   Enrollment is easy when you log into Paycom. Login information is located on page 4
                                      During our annual open enrollment period, you may make new benefit elections for the following July 1st effective date.







                                                                 Loss of coverage   from another   health plan
                               When can I change my benefits?









                                                                 Change in your   dependent’s   eligibility status  Coverage for a new dependent is not automatic. If you experience a qualifying event, you have 30 days to update your coverage. You may login to Paycom to  update your dependent information as needed. Paycom login information is located on page 4 of this guide. If you do not update your coverage within 30 days of










                                                                 Qualified Medical   Child Support   Order (QMCSO)  the qualifying event, you must wait until the next annual open enrollment period to update your coverage.









                                                                 Birth, adoption, or   death of a child or   spouse







                                   Open Enrollment       Qualifying Event                Marriage, divorce,   legal separation   EMPLOYEE BENEFITS   8
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