Page 5 - Benefit Guide 2019.2020 - Final

ENROLLMENT INFORMATION

WHO MAY ENROLL CHANGES TO ENROLLMENT

If you are a regular full‐time employee working at least 30 hours Our Medical and Dental benefit plans are effective September 1st
per week, you and your eligible dependents may participate in through August 31st and our Life and Disability benefit plans are
Total Vision’s benefits program. effective January 1st through December 31st. There will be an
annual open enrollment period each year, during which you can
Your eligible dependents include: make new benefit elections for the following effective dates. Once
 Legally married spouse you make your benefit elections, you cannot change them
 Domestic partner throughout the year unless you experience a qualifying event as
 Children under the age of 26, regardless of student or marital defined by the IRS.
status
Examples include, but are not limited to the following:
 Marriage, divorce, legal separation or annulment

WHEN YOU CAN ENROLL  Birth or adoption of a child
A qualified medical child support order
As an eligible employee, you may enroll at the following times:  Death of a spouse or child
 As a new hire, you may participate in the company’s benefits  A change in your dependent’s eligibility status
program on the first day of the month following date of hire.  Loss of coverage from another health plan
 Each year, during open enrollment.  Change in your residence or workplace (if your benefit options
 Within 30 days of a qualifying event as defined by the IRS (see change)
Changes To Enrollment below). 
 You may enroll in Voluntary Life and AD&D insurance at any Loss of coverage through Medicaid or Children’s Health
Insurance Program (CHIP)
time, subject to proof of good health and carrier approval.  Becoming eligible for a state’s premium assistance program
under Medicaid or CHIP

HOW TO ENROLL Coverage for a new dependent is not automatic. If you experience
a qualifying event, you have 30 days to update your coverage. You
Our benefits, payroll, time and attendance are all managed by
DayForce. Login to https://www.dayforcehcm.com. may log in to Dayforce to update your dependent information as
needed. If you do not update your coverage within 30 days of the
qualifying event, you must wait until the next annual open
enrollment period to update your coverage.

PAYING FOR YOUR COVERAGE
The Basic Life and AD&D, Long Term Disability, Employee Assistance Program, Identity Theft and Travel Assistance Plan benefits are
provided at no cost to you and are funded entirely by Total Vision. You and the company share in the cost of the Medical and Dental
benefits you elect. Any Voluntary Life and AD&D, Short Term Disability and Accident will be paid by you.

Your Medical and Dental contributions are deducted before taxes are withheld, which saves you tax dollars. Paying for benefits before‐tax
means that your share of the costs are deducted before taxes are determined, resulting in more take‐home pay for you. As a result, the IRS
requires that your elections remain in effect for the entire year. You cannot drop or change coverage unless you experience a qualifying
event.

ANTHEM BLUE CROSS RESOURCES
Take advantage of the online resources available through Anthem Blue Cross. You can locate network
providers, manage your claims, obtain health and wellness information, and much more!

Go to www.anthem.com/ca for more information.

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