Page 3 - OrangeTheory Benefits Guide 07-2019_FINAL - NonCA

Enrollment Information

Who May Enroll
If you are a regular full‐time employee working at least 30 hours per week, you and your eligible dependents may
participate in West Coast Fitness LLC (DBA Orangetheory® Fitness) benefits program. Your eligible dependents include:
 Legally married spouse
 Registered domestic partner
 Children under the age of 26, regardless of student or marital status

Your spouse, domestic partner and children can be enrolled in our medical, dental, vision, voluntary life/ad&d, and
supplemental insurance plans.

Required Information
At enrollment you are required to enter the Social Security Number for all covered dependents. Health Care Reform law
requires the company to report this information to the IRS each year to show that you and your dependents have coverage
and are not subject to a penalty. This information will be securely submitted to the IRS and will remain confidential.

When You Can Enroll

As an eligible employee, you may enroll at the following times:
• As a new hire, you may participate in the company’s benefits program on the first day of the month following the
completion of 30 days of full‐time employment
• Each year, during open enrollment
• Within one month of a qualifying event as defined by the IRS (see Changes To Enrollment below)

Paying For Your Coverage

The Basic Life/AD&D and Employee Assistance Program benefits are provided at no cost to you and are funded entirely by
West Coast Fitness LLC (DBA Orangetheory® Fitness). You and the company share in the cost of the medical, dental, and
vision benefits you elect. Any voluntary benefits you elect will be paid by you at discounted group rates. Your medical,
dental, and vision 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.

Changes To Enrollment
Our benefit plans are effective July 1st, 2019 through June 30th, 2020. There is an annual open enrollment period each
year, during which you can make new benefit elections for the following July 1st effective date. Once you make your benefit
elections, you cannot change them during the year unless you experience a qualifying event as defined by the IRS. Examples
include, but are not limited to the following:

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

Coverage for a new dependent is not automatic. If you experience a qualifying event, you have one month to update your
coverage. Please contact the Human Resources Department immediately following a qualifying event to receive instructions
on how to make changes to your benefits. You may login to Paycom to update your dependent information as needed. If you
do not update your coverage within the one month period from the qualifying event, you must wait until the next annual
open enrollment period to update your coverage.

3