Qualifying Event Checklist

Changing Your Benefit Elections

Each year during Open Enrollment you will have the opportunity to review the benefits offered by the Company to decide which plans best fit your needs for the coming year. During Open Enrollment you will be allowed the opportunity to:

• Enroll on any of the plans for the first time
• Change between plan offerings
• Add or delete coverage
• Add or delete dependent coverage
• Increase or decrease your FSA elections

Qualified family status change

Once your benefit elections have been made, you cannot make changes during the plan year unless you experience a Qualified Family Status Change. Qualified Family Status Changes include:

• Change of participants legal marital status, including:
• Marriage
• Death of a spouse
• Divorce
• Legal Separation
• Annulment
• Loss of or gain other coverage elsewhere
• The birth or placement of a child
• A change to the eligibility of a dependent child such as attaining the dependent age limit
• A Qualified Medical Child Support Order
• A reduction or increase in hours of employment, including a switch between part-time and full-time status

If you experience a Qualified Family Status Change, and would like to request a change, you must notify Human Resources within 30 days from the date of the change in family status or qualifying event, and provide the appropriate documentation. If you have questions about specific documentation requirements, please contact the Benefits Service Center at (855) 262-2999.