Page 4 - 2019 Blacoh Benefit Guide Final 11/13/18

Enrollment Information

Who May Enroll
All active, employees scheduled to work a minimum of 30 hours per week and their eligible dependents may participate in
Blacoh Industries benefits program. Eligible dependents include:
• Legal spouse or legally registered domestic partner (RDP)
• Children (natural, adopted, and step children) from birth up to the age of 26
• A handicapped child over the age of 26, if they were actively enrolled in the plan at the time they became disabled/
handicapped
• Your registered domestic partner’s eligible children

When You Can Enroll
Eligible employees may enroll at the following times:
• As a new hire, you may participate in the Blacoh Industries medical benefit plans on the first day of the month following
30 days of full-time employment
• Each year, during annual open enrollment
• Within 30 days of a qualified change in family status as defined by the IRS - see Changes to Enrollment below

Paying For Your Coverage

You and Blacoh Industries share in the cost of your benefits. Premium rates and cost to employees are shown in your
account on the online portal EaseCentral.

Changes To Enrollment
Our benefit plans are effective December 1st through November 30th of each year. There is an annual open enrollment
period each year, during which you can make new benefit elections for the following December 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
• Birth or adoption of a child options 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
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 Ease Central 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.

Video – Learn About Medical Plan Terms
Medical plan terms, such as deductibles, copays, coinsurance and out-of-pocket maximums, can sometimes
be confusing. For a quick video that shows how these work, visit http://video.burnhambenefits.com/terms

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