Page 5 - FSSI EE Guide 07-19 - OOS

Who may enroll

FSSI Employees
• Regular, full-time employees working at least 30 hours per week

Dependents

• Your legally married spouse
• Your registered domestic partner
• Your children, stepchildren or children of your registered domestic partner to age 26, regardless of marital or
student status
• Any children for whom you are required to provide coverage under a Qualified Medical Child Support Order
• Your unmarried children, step-children or children of your registered domestic partner of any age, if they are
incapable of self-care due to a physical or mental disability

Your spouse, domestic partner and children can be enrolled in our medical,

dental, vision, and voluntary life/ad&d.

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 may enroll

Benefits Plan Year:
July 1 - June 30 As an Eligible Employee
As a new hire, you may participate in the company’s
•
benefits on the first day of the month following the
completion of 60 days of full-time employment
• As a new hire, you are eligible for the company’s 401(k)
plan starting the first quarter following 60 days of
continuous service
• Each year, during open enrollment
• Within 30 days of a qualifying event as defined by the IRS
• You may enroll in Voluntary Life/AD&D insurance at any
time, subject to proof of good health and carrier approval