Important Benefit Information

Qualifying Events

Your elections for Medical, Dental, and Vision benefits remain in place until the next Open Enrollment period unless you experience a qualifying event. If you experience a qualifying event, you must submit the necessary benefit changes within 30 days of the event date.

Spousal and/or Dependent Coverage

If you are selecting spousal and/or dependent coverage and you are adding a new spouse or dependent, then you must provide the following information: Social Security number(s), date(s) of birth, and documentation for proof as to the legal status of such dependents.

• For a spouse, you will need to submit the original or a certified copy of the original marriage certificate or marriage license and the Social Security card.
• For dependent children, you will need to submit the original or a certified copy of the birth certificate, or court adoption order if it is a legal adoption, and the Social Security card.

Proof of legal status of a dependent is required by all plan participants.

Important Note: Documentation is only required for dependents being added to the plan for the first time. If your spouse or dependents are already covered under your current plan, you do not need to resubmit proof of eligibility.