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ANNUAL ENROLLMENT FOR BENEFIT ELIGIBLE EMPLOYEES
• During the annual benefits enrollment period, held in October of each year, you can enroll or make changes for medical
insurance, dental insurance, vision insurance, voluntary life/short term disability (STD) insurance, AFLAC products, and
elect or waive Flexible Spending Account (Medical and/or Dependent Care) contributions for the coming plan year,
January 1, 2017 through December 31, 2017. Evidence of insurability may be required to add/increase short term
disability (STD) and/or voluntary life.
• Your benefit elections will remain in place throughout the entire plan year unless you experience a qualifying event.
• Complete your benefit enrollment forms. Your HR Representative may follow up with you for any additional
enrollment requirements.
• FAILURE to complete the enrollment will result in waiver of benefits. You will not be able to enroll until the next
annual benefits enrollment period.
NEW HIRE ENROLLMENT
• Regular employees (working 30 hours or more) are eligible for insurance benefits. Coverage begins on the first of the
month following 30 days of continuous employment.
• Your HR Representative will provide a benefit information package during new employee orientation. The package
will describe your insurance benefits and provide instructions on completing documents.
• All completed and signed documents MUST be submitted to your HR Representative within 30 days of your hire
date. FAILURE to return documents will result in waiver of benefits. You will not be able to enroll until the next
annual enrollment period.
• Remember, your benefit elections will remain in place throughout the entire plan year (January 1, 2017 to
December 31, 2017) unless you experience a qualifying event.
ELIGIBILITY AND COVERAGE
• All regular employees (working 30 hours or more) are eligible for benefits described in this brochure. Coverage
begins on the first day of the month following completion of 30 days of continuous employment.
• You may elect various insurance options for yourself and eligible dependents. Eligible dependents include:
• Your spouse or domestic partner
• Your dependent child(ren) with no other source of coverage:
• Medical - up to age 26
• Dental - up to age 19 or 24 if full time student • Vision - up to age 19 or 23 if full time student
• Voluntary Dependent Life - Age 14 days to age 26
DOMESTIC PARTNERS
• You may enroll your domestic partner in your insurance benefits if all IRS requirements are met.
• The requirements are listed on the Domestic Partnership Affidavit, which you must complete and sign.
• You can obtain the Affidavit from your HR Representative.
• The portion of premium payroll deducted for Domestic Partner coverage cannot be deducted pre-tax.
QUALIFYING EVENTS
YOU MUST NOTIFY YOUR HR REPRESENTATIVE WITHIN 31 DAYS OF THE QUALIFYING EVENT
• Section 125 Pre-tax program allows you to pay for benefits with pre-tax dollars; IRS has certain rules about when you
can make changes.
• In most cases, you may only make benefit changes during annual enrollment.
• You may make changes during the year if you experience a qualifying event - an event that causes you or a covered
dependent to gain or lose eligibility for coverage.
• For a complete list of Qualifying Events contact your HR Representative.
The following are some examples of Qualifying Events:
• Marriage
• Legal separation
• Divorce
Remember
... Notify your HR Representative with changes to your name, address, dependent age or beneficiary records.
• Birth
• Adoption
• You, your spouse, or dependent starts or ends employment that affects eligibility for benefits