*Employees are eligible 1st of the month following date of hire. If hired on the 1st, employee is eligible the following month.

EMPLOYEE ELIGIBILITY: If you do not enroll during this Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event. If you experience a Qualifying Life Event (i.e., birth or adoption of a child, marriage, divorce, loss of other coverage, etc.) you must enroll within 30 days of the Qualifying Event.

DEPENDENT ELIGIBILITY: You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse.

What is a Qualifying Life Event?

• Marriage

• Divorce

• Birth/Adoption of a child

• Death of a spouse or other enrolled dependent

• Change in spouse’s benefits or employment status

• A dependent becomes eligible for Medicare or Medicaid

If you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.