You may enroll for health care coverage only at the following times:
You will receive enrollment materials when you are first eligible and at Open Enrollment each year. If you think you have experienced a qualified status change, contact Human Resources no later than 30 days following the event to make coverage changes.
You may enroll your eligible dependents in medical, dental, and vision coverage, as well as voluntary life insurance. Dependents are also eligible to receive
Employee Assistance Program (EAP) services.
Dependents include the following:
This is a brief description of the eligibility requirements and is not intended to modify or supersede the requirements of the plan documents. The plan documents will govern in the event of any conflict between this description and the plan documents.
You are responsible for notifying Human Resources of any changes in your dependent status during the plan year (marriage, birth, death, divorce, ineligibility of dependent child). Such notification must be made within 31 days of an allowable change of status event (event date + 30 days), and include applicable documentation (i.e. birth certificate for new child) Failure to submit notification in a timely manner may impact dependent eligibility for health care coverage and/or continuation under COBRA, and
may result in you incurring liability for medical expenses for non-eligible dependents.
For assistance with your health benefits, contact Human Resources at:(530) 621-7525 or email@example.com