Life Events

Address Change You Get Married Birth, Adoption, Legal Guardian New Hire Leave of Absence

You Become Disabled Dependents Lose Coverage Partner Terminates Job Job Transfer Leave Employment

If You Die Separation or Divorce Dependent Dies Status Change Retirement

There are events in your life that often require you to make changes to your employment information. There are times you need to know about the programs and services available to you. Sometimes these changes impact your benefit coverage.

Here is what you should do if one of the following happens in your life.

Address Change

As soon as you have your new address:

Contact Your Human Resources Department so that they may notify the health, dental, and retirement plans of your address change.

The Impact on Your Benefits:

Health and/or Dental

You need to submit an address change with your health and/or dental plan

If you are an HMO, Preferred Provider Organization, or Point of Service participant, you should contact your plan's Membership Services department to see if your new residence is within your Primary Care Physician's (PCP) service area.

If you move out of their service area, you may need to change your health plan (may not be an option with the current company plan)

You should change your address within 30 days of your move

If you move out of your plan's service area, select a new health plan within 30 days of your move (may not be an option with the current company plan)

Contact the Human Resources department to request the necessary change of address form(s) or on line as soon as possible. Complete and return the form(s) to the H.R. department.

Retirement

You need to change your address with your Retirement vendor(s) as soon as possible after you move.

Contact your retirement vendor directly to have your address changed.

 

If You Become Disabled

To Apply for Long Term Disability (should your employer have a LTD plan)

Contact the Human Resource department to complete the necessary paperwork or down load from the site.

Provide the Human Resource department with documentation from your physician.

To Return from Disability Leave:

You must submit a physician's statement releasing you to return to work to the Human Resources department.

The Impact on Your Benefits:

Health, Dental and/or Life

You can elect to continue these benefits when you are on LTD

You should contact the Human resource department during the second month of your leave.

Contact the Human Resource department to complete the necessary paperwork.

Flexible Spending Accounts (should your employer have an FSA)

You can continue to submit claims for expenses incurred prior to the date you go on leave of absence.

You must submit all claims by no later than the end of the FSA calendar year.

Contact the Human Resource department to request a claim form, or download a claim form.

Submit a copy of your itemized bill or an insurance form with the claim form to the Human Resource department.

Your Contributions to your FSA stop on your first day of LTD.

Retirement

Check with your Human Resource department, some employer plans may continue to make contributions.

What Your Dependents Should Know If You Die

Your family should notify your Employer/Human Resource department as soon as possible

The Impact on Your Benefits:

Health and/or Dental

Your dependents can choose to continue on a self-pay basis their health and/or dental coverage through COBRA for up to 36 months (should your employer be large enough - 20 or more employees in 6 month consecutive period).

Your dependents have 60 days to elect COBRA coverage from the date of your COBRA qualifying event.

Initial payment is required within 45 days of election date in order for benefits to be provided under COBRA

Complete the Application for Continuation of Benefits Form and return the form to the Human Resources department within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be in the form of a check or money order and made payable to COBRA administrator (check with the Human Resource department).

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month in which coverage is intended) in order for benefits to continue.

If your dependents do not choose COBRA, their health and dental coverage stops.

For more information on COBRA, contact your Human Resource department.

Flexible Spending Accounts (should your employer have an FSA's)

Your participation in the FSAs stops the day you die. However, your dependents may continue to submit claims for the expenses you or a dependent incurred prior to your death.

Claims may be submitted up to the end of the FSA calendar year.

Contact the Human Resource department to request a claim form, or download a claim form

Submit a copy of your itemized bill or an insurance form with the claim form to the Human Resource department

Retirement Benefits

Your dependents should notify the Human Resource department of your death as soon as possible after your death.

The Human Resource department will notify the appropriate vendor, who will contact your designated beneficiary.

Life Insurance

Your coverage stops on the day you die, but a benefit may be payable to your designated beneficiary. The Human Resource department will notify your carrier and the carrier will then contact your designated beneficiary.

Long Term Disability

Your Long Term Disability coverage stops on the day you die.

You Get Married

Contact the Human Resources department to change your:

• Marital status in the payroll system
• Name, If applicable
• Tax withholding status, if you choose Make the appropriate changes to your benefits. Marriage certificate is required to make changes to your benefits.

The Impact on Your Benefits:

Health and/or Dental

You may wish to add your spouse to your coverage, or drop your coverage (if your spouse is going to cover you under his or her plan).

You must contact the Human Resource department within 30 days of your marriage.

Contact the Human Resource department to request the appropriate health and/or dental change form(s) or download the form(s).

Complete and return the form(s) to the Human Resource department.

Flexible Spending Accounts (should your employer have an FSA)

If you anticipate changes to your health care or dependent expenses in the upcoming months due to your change in marital status, you may want to:

• Begin participating in the FSA
• Increase your current contributions to your FSA

Changes should be made within 30 days of your marriage How To enroll: Contact the Human Resources department to request an FSA enrollment form.

To change your current contribution: Contact the Human Resources department to request a change form. Complete the form and return it to the Human Resources department.

Retirement Benefits

When you get married, you are required to update your marital status with your retirement vendor and provide information about your spouse, so your beneficiary designation can be updated.

You may also need to change your address or other personal information with your address or other personal information with your retirement vendor, if applicable.

Within 30 days of your marriage, you should contact the Human Resources department to obtain the appropriate form(s).

Life Insurance

You may want to change your beneficiary information.

You may want to increase the level of your coverage.

Anytime during the year. Contact the Human Recourses department to request the appropriate form(s) or download the form(s).

Complete and return the form(s) to the Human Resources department.

Your Dependents Lose Health Care Coverage

Your Dependent(s) lost Health Care Coverage due to one of the following events:

• Marriage
• Reaching the age of 23 or 25 (depending upon the employers contract)
• Divorce
• End your Domestic Partnership

The Employee should notify: the Human Resources department and complete a Benefits Enrollment Form.

If additional Health Care Coverage is Required, you or your Dependent(s) should notify the Human Resources department

The Impact on Your Benefits:

Health and/or Dental (provided your employer qualifies for COBRA)

Your depends can choose to continue on a self-pay basis their health and/or dental coverage through COBRA for up to 36 months.

Your dependents have 60 days to elect COBRA coverage from the date of your COBRA qualifying event.

Initial payment is required within 45 days of election date in order for benefits to be provided under COBRA.

Complete the Application for Continuation of Benefits Form and return the form to the Human Resources department or COBRA administrator within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be made in the form of a check or money order.

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month in which coverage is intended) in order for benefits to continue.

If your dependents do not choose COBRA, their health and dental coverage stops.

You legally separate or get divorced

Contact the Human Resources department to change your:

• Marital status in the payroll system
• Name, If applicable
• Tax withholding status (W-4)

Complete and return the form(s) that the Human Resources department provides within 10 days of your status change.

Notify the Human Resources department within 30 days of your legal separation or divorce, (divorce decree is required). Make the appropriate changes to your benefits.

The Impact on Your Benefits:

Health and/or Dental

You must contact the Human Resources department within 30 days of your separation or divorce.

Contact the Human resources department to request the appropriate health and / or dental change form(s) .

Complete and return the form(s) to the Human Resources department.

If you do not drop coverage for your spouse, you may be held liable for any health and/or dental costs he or she may have incurred.

For information on how your spouse can continue to receive health coverage through COBRA, check with your Human Resources department (should your employer qualify for COBRA).

Flexible Spending Accounts (should your employer have an FSA)

If you anticipate changes to your health care or dependents expenses in the upcoming months due to your change in marital status, you may want to:

• Begin participating in FSA
• Increase or decrease your current contributions to your FSA

Changes should be made within 30 days of your legal separation or divorce.

To enroll: Contact the Human Resources department to request an FSA enrollment form.

To change your current contribution: Contact the Human Resources department to request a change form. Complete the form and return it to the Human Resources department.

Retirement Benefits

You may want to change your beneficiary designation for your retirement funds.

As soon as the divorce is finalized.

To enroll: Contact the Human Resources department to obtain the appropriate form(s).

Life Insurance

You may want to change your beneficiary information.

You may want to increase the level of your coverage.

Any time during the year.

• Contact the Human Resources department to request the appropriate form(s).
• Complete and return the form(s) to the Human Resources Department.

You Give Birth, Adopt, or Receive Legal Guardianship of a Child

When you have a new dependent child:

• Contact the Human Resource department to change your tax withholding status, if you choose.
• Make the appropriate changes to your benefits. A birth certificate or adoption papers are required to make changes to your benefits.

The Impact on Your Benefits:

Health and/or Dental

You may wish to increase your health and /or dental coverage to include your child.

You must contact the Human Resource department within 30 days of the child's birth, adoption or the state you were granted legal guardianship.

Contact the Human Resource department to request the appropriate health and/or dental change form(s) or download the form(s).

Complete and return the form(s) to the Human Resource department.

If you are adopting or receiving legal guardianship, you must provide legal documentation.

Retirement Benefits

You may want to change your beneficiary designation for your retirement funds.

Anytime during the year.

• Contact the Human Recourses department to request the appropriate form(s) or download the form(s).
• Complete and return the form(s) to the Human Resources department.

Flexible Spending Accounts (should your employer have an FSA)

If you are not enrolled in a Flexible Spending Account, you may want to enroll in the :

• Health Care Flexible Spending Account (FSA) and/or
• Dependent Care FSA

If you already participate in an FSA, you may want to: * Change the amount you contribute.

You must make the change within 30 days of the child's birth, adoption or the date you were granted legal guardianship.

Contact the Human Resources department to obtain the appropriate form(s). Complete the form(s) and return it to the Human Resources department.

Life Insurance

You may want to change your beneficiary information.

You may want to increase the level of your coverage. If you are not currently participating in these plans, you can elect coverage.

Anytime during the year.

• Contact the Human Recourses department to request the appropriate form(s) or download the form(s).
• Complete and return the form(s) to the Human Resources department.

Your Spouse or Domestic Partner Starts or Terminates a Job

Contact the Human Resource department to change your tax withholding status, if you choose.

Make the appropriate changes to your benefits. In order to make changes to your benefits, one of the following documents may be needed:

• Document of spouse's hire or release
• Or copy of insurance card required if trying to waive coverage.

The Impact on Your Benefits:

Health and/or Dental (please check with H.R. about the state law and carrier contracts concerning Domestic Partners)

If your Spouse or Domestic Partner Starts a New Job:

• You can terminate coverage for your spouse or domestic partner.

If your Spouse or Domestic Partner Loses a Job:

• You can add your spouse or domestic partner to your coverage.

You must contact the Human Resources department within 30 days of the date your spouse or domestic partner's job status change.

Contact the Human Resources department to request the appropriate health and/or dental change form(s).

Complete and return the form(s) to the Human Resources department.

If you are adopting a child or receiving legal guardianship, you must provide legal documentation.

Flexible Spending Accounts (should your employer have an FSA)

If your spouse or domestic partner starts a new job, you can choose to participate in the Dependent Care Flexible Spending Account for the remainder of the year (check with the administrator or the Human Resources department).

If you were contributing to the Dependent care Flexible Spending Account, you may no longer contribute to that account after your spouse or domestic partner terminates his or her job unless you or your spouse or your domestic partner is disabled or a full-time student at least five months of the year.

You must make the change within 30 days of the change on your spouse or domestic partner's job status.

Contact the Human Resources department to obtain the appropriate form(s). Complete the form(s) and return it to the Human Resources department.

Your Dependent Dies

Contact the Human Resources department to change your:

• Marital status in the payroll system
• Tax withholding status (W-4)

Make the appropriate changes to your benefits. A copy of the death certificate is required to make changes to your benefits.

The Impact on Your Benefits:

Health and/or Dental

You should change the level of your health and/or dental coverage.

You must contact the Human Resources department within 30 days of the death.

Contact the Human Resources department to request the appropriate health and/or dental change form(s).

Complete and return the form(s) to the Human Resources department.

Flexible Spending Accounts (should your employer have an FSA's)

Due to the change in your family status, you may want to:

• Begin participating in FSA
• Increase or decrease your current contributions to your FSA

Changes should be made within 30 days of the death.

To enroll: Contact the Human Resource department to request an FSA enrollment form(s). To change your current contribution: Contact the Human Resources department to request a change form. Complete the form and return it to the Human Resources department.

Retirement Benefits

You may want to change your beneficiary information.

As soon as possible following the date of death.

Contact the Human Resource department to obtain the appropriate form(s).

Life Insurance

You may want to change your beneficiary information.

You may want to increase the level of your coverage.

Anytime during the year.

• Contact the Human Resource department to obtain the appropriate form(s).
• Complete and return the form(s) to the Human Resource department.

You are a New Hire

Complete and submit the following:

• US Department of Justice Employment Eligibility Verification Form (Form I-9) - must be completed within first 3 days of work.
• State and Federal Withholding Form (Form W-4).
• Attend a new Staff Orientation.
• Review the information in the benefits package given to you during New Hire Orientation (forms must be turned in before the plans probationary period).

You Transfer to Another Job

If your status has changed from a full-time to part-time (or vice versa) contact the Human Resources department.

You Change to Full-Time or Part-Time Status…

If you Change from Full-Time to Part-Time Status (or vice versa);

• Ask your supervisor to submit the appropriate paperwork to change your employment status in the payroll system.
• Make the appropriate changes to your benefits.

Definitions

• You are considered a full-time, benefits-eligible employee if your standard hours per week are 30 or more.
• You are considered part-time, if your standard hours are 20 hours (but less than 30 hours) per week.

If you change from Full-Time to Part-Time status

The Impact on Your Benefits:

Health and/or Dental (provided your employer is COBRA eligible)

You may choose to continue on a self-pay basis your health and/or dental coverage through COBRA for 18 months.

You have 60 days to elect COBRA coverage from the date of your COBRA qualifying event.

Initial payment is required within 45 days of election date in order for benefits to be provided under COBRA.

Complete the Application for Continuation of Benefits Form and return the form to the Human Resources department within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be in the form of a check or money order.

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month on which coverage is intended) in order for benefits to continue.

Employees health and dental coverage ends on midnight of the last day of employment.

You Take a Leave of Absence

If you take a Leave of Absence:

• Contact your departmental advisor to request a leave of absence at least three months in advance.
• Wait for approval of your leave.
• You must use your personal, vacation and sick time before you leave of absence officially begins.

If you return from a Leave of Absence:

• Notify your departmental administrator of your intent to return to work one month before your scheduled return date.

If you take a leave under Family Medical Leave Act (FMLA):

• Complete and return the Family Medical Leave of Absence Request form to your administrator along with a completed Certificate of Health Care Provider form from your health provider, if you are taking a leave for medical reason.

The Impact on Your Benefits:

Flexible Spending Accounts (should your employer have an FSA)

Your contributions to the Personal Spending Accounts through your payroll stop. Therefore you can only file claims for reimbursement expenses incurred during the time you were contributing.

The account remains active during your unpaid leave of absence.

Retirement Benefits

You Cannot continue to contribute to your retirement accounts during your leave. However, your accumulated retirement funds will remain invested at your direction.

Complete the Application for Continuation of Benefits Form and return the form to the Human Resources department within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be in the form of a check or money order.

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month on which coverage is intended) in order for benefits to continue.

Employees health and dental coverage ends on midnight of the last day of employment.

You Leave Employment

Before you leave:

• Contact your supervisor. Let him or her know in writing that you will be leaving the company
• Let the Human Resources department know what your new mailing address is as soon as possible, if it is changing.
• Return any employer property to your departmental administrator on your last day of work.
• Make the appropriate changes to your benefits.
• Set up an exit interview with your Human Resources department.

The Impact on Your Benefits:

Health and/or Dental (should your employer qualify for COBRA)

You may choose to continue on a self-pay basis your health and/or dental coverage through COBRA for 18 months.

You have 60 days to elect COBRA coverage from the date of your
COBRA qualifying event.

Initial payment is required within 45 days of election date in order for benefits to be provided under COBRA.

Complete the Application for Continuation of Benefits Form and return it to the Human Resources department within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be in the form of a check or money order.

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month on which coverage is intended) on order for benefits to continue.

Employee health and dental ends on midnight of the last day of
employment or it could be the last day of the month (contact your Human Resources department).

Contact the Human Resources department should you have any questions.

Retirement Benefits (should your employer have a Retirement Plan)

You may withdraw or transfer any or all your retirement funds after you leave your employer. You may also choose to leave your funds with your vendor.

You may withdraw or transfer retirement funds at any time after you
leave.

Contact your Retirement vendor to obtain the appropriate form(s).

You Retire

Before you leave:

• Contact your supervisor. Let him or her know that you will be retiring
• Let the Human Resources department know what your new mailing address is as soon as possible, if it is changing.
• Return any employer property to your departmental administrator on your last day of work.
• Make the appropriate changes to your benefits.
• Set up an exit interview with your Human Resources department.

The Impact on Your Benefits:

Health and/or Dental (should your employer qualify for COBRA)

You may choose to continue on a self-pay basis your health and/or dental coverage through COBRA for 18 months.

You have 60 days to elect COBRA coverage from the date of your COBRA qualifying event.

Initial payment is required within 45 days of election date in order for benefits to be provided under COBRA.

Complete the Application for Continuation of Benefits Form and return it to the Human Resources department within 60 days of your COBRA event date.

The initial payment must include premiums from the first day of COBRA coverage through the current month in which your initial payment is made.

Payments must be in the form of a check or money order.

After an initial payment is made, thereafter, monthly payments in full are mandatory and due by the 1st of each month (for the month on which coverage is intended) in order for benefits to continue.

Employee health and dental ends on midnight of the last day of employment or it could be the last day of the month (contact your Human Resources department).

Contact the Human Resources department should you have any questions.

Flexible Spending Accounts (should your employer have an FSA)

You can continue to submit claims for expenses that you incurred prior to the date you leave employment. You may be eligible to continue your FSA through COBRA.

You must submit all PSA claims by no later than the last day of the FSA calendar year.

Contact the Human Resources department to request an FSA claim form.

Submit a copy of your Explanation of Benefits form with the claim form to the Human Resources department.

Your contributions to your FSAs stop on your last day of work unless you are eligible to elect to continue contributions to your health FSA under COBRA.

Retirement Benefits

You may withdraw or transfer any or all of your retirement funds after you leave. You may also choose to leave your retirement funds with your vendor.

You may withdraw or transfer retirement funds at any time after you retire.

Contact your Retirement vendor to obtain a retirement distribution kit.

Employees health and dental coverage ends on midnight of the last day of employment.