Page 3 - NickCo Hospitality_2017 EE Benefits Guide_Hourly Associates_12.08.16

ENROLLMENT INFORMATION

Who May Enroll
Per ACA requirement, Nick’s Restaurant looks back over a defined period of me (measurement period) to determine if the
employee averaged at least 30 hours per week. Once the employee is determined with an average of 30 or more hours of service
per week or 130 hours of service per month during the measurement period, you and your eligible dependents may par cipate in
Nick’s Restaurants benefits program. Your eligible dependents include:

 Legally married spouse
 Registered domes c partner
 Children under the age of 26, regardless of student or marital status

When You Can Enroll
As an eligible Associate, you may enroll at the following mes:
 As a new hire, you may par cipate in the company’s benefits program on the first day of the month following the comple on
of 60 days of full‐ me employment
 Each year, during open enrollment
 Within 30 days of a qualifying event as defined by the IRS (see Changes To Enrollment below)

Paying For Your Coverage
You and the company share in the cost of the Medical and Dental benefits you elect. Any Vision benefits you elect will be paid by
you at discounted group rates. Our Medical, Dental, and Vision contribu ons 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,
resul ng in more take‐home pay for you. As a result, the IRS requires that your elec ons remain in effect for the en re year. You
cannot drop or change coverage unless you experience a qualifying event.

Changes To Enrollment

 Marriage, divorce, legal separa on or annulment  Change in your residence or workplace (if your benefit
 Birth or adop on of a child op ons change)
 A qualified medical child support order  Loss of coverage through Medicaid or Children’s Health
 Death of a spouse or child Insurance Program (CHIP)
 A change in your dependent’s eligibility status  Becoming eligible for a state’s premium assistance
 Loss of coverage from another health plan program under Medicaid or CHIP

Coverage for a new dependent is not automa c. If you experience a qualifying event, you have 30 days to update your coverage.
Please contact the Home Office immediately following a qualifying event to complete the appropriate elec on forms as needed.
You may login to PlanSource to update your dependent informa on as needed. PlanSource login informa on is located on page 10
of this guide. If you do not update your coverage within 30 days from the qualifying event, you must wait un l the next annual
open enrollment period to update your coverage.

Online Benefits Information

You can access your benefits informa on whenever you want, from home or any place
where you have internet access, by visi ng PlanSource. You’ll find documents posted such
as the Summary of Benefits and Coverage (SBC), annual no ces, carrier benefit summaries,
evidence of coverage booklets, claim forms, and much more.

PlanSource login informa on is located on page 9 of this guide.

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