Page 4 - QSC Benefit Summary 7-18 COLORADO
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ENROLLMENT INFORMATION



        Who May Enroll                                          Paying For Your Coverage

        You are eligible for QSC’s benefits on the first day of the   The Basic Life and AD&D, Long Term Disability, Employee
        month following one month of full-time employment if you   Assistance Program and Travel Assistance benefits are
        are a full-time employee scheduled to work 30 hours or   provided at no cost to you and are paid entirely by QSC.
        more per week.                                          You and the company share in the cost of the Medical, Vision
                                                                and Dental benefits you elect. Any Voluntary benefits you
        You may enroll your eligible dependents in the same plans   elect will be paid by you at group discounted rates.
        you choose for yourself. Eligible dependents include your
        legal spouse or registered domestic partner and your children   You have the option for your Medical, HSA, Vision, Dental
        up to age 26.                                           and Flexible Spending Account premiums to be deducted
                                                                from your paycheck on a pre-tax or post-tax basis. If you
        When You Can Enroll                                     elect pre-tax, your premiums will be deducted from your

        Eligible employees may enroll at the following times:   paycheck before federal (and in some cases, state) income
        •   Annually, during open enrollment.                   and Social Security taxes are deducted, thereby lowering
        •   As a new hire, you may enroll in the Medical, Vision,   your taxes and increasing the amount of your take-home pay.
            Dental and Flexible Spending Account within 30 days
            of your eligibility date. If you do not enroll in coverage   Please note that unless your domestic partner qualifies as
            within 30 days of your eligibility date, you will not be   your tax dependent for health care purposes under the
            allowed to enroll in health coverage during the plan year   Internal Revenue Code, Federal Tax Law requires that the
            unless you experience a qualifying event (see Changes   premium cost for your domestic partner and his/her children
            To Enrollment for details).                         will be deducted from your paycheck on an after-tax basis.
        •   Within 30 days of a qualifying event as defined by the   The value of QSC’s portion of the premium will result in
            IRS (see Changes To Enrollment for details).        “Imputed Income” to you. This amount will be included as
        •   You may enroll in all Voluntary plans anytime during the   an additional wage paid to you on your pay stub for the
            year. Please note that you may be subject to evidence of   cost of the domestic partner’s premium on which you will
            insurability for certain plans unless you are a new hire.  pay Federal Taxes.

        Changes To Enrollment
        The choices you make when you first become eligible will remain in effect for the entire plan year July 1, 2018 through June
        30, 2019 unless you are a new hire during the plan year. Once you are enrolled, you must wait until the next Open Enrollment
        period to change your benefits or add or remove coverage for dependents, unless you experience a qualifying event as
        defined by the IRS. Examples of qualifying events include, but are not limited to the following:
        •   Marriage, divorce, legal separation or annulment
        •   Birth or adoption of a child
        •   A qualified medical child support order
        •   Death of a spouse or child
        •   A change in your dependent’s eligibility status
        •   Gain or loss of coverage from another health plan
        •   Change in your residence or workplace (if your benefit options change)
        •   Loss of coverage through Medicaid or Children’s Health Insurance Program (CHIP)
        •   Becoming eligible for a state’s premium assistance program under Medicaid or CHIP



                   Please note that coverage for a new spouse or newborn child is not automatic. If you experience a qualifying
                   event, you have 30 days to update your coverage. Please contact the Human Resources Department
                   immediately or make a life event change in UltiPro. If you do not update your coverage within 30 days from
                   the qualifying event, you must wait until the next annual open enrollment period to update your coverage.


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