Eligibility

Full-time employees working [30 hours] or more per week and their dependents are eligible for benefits on the [first day of the month following or coinciding with date of hire]. Eligible dependents include:

• Your legal spouse [or your same/opposite-sex domestic partner]
• Children up to age 26

Making Changes

The choices you make when you first become eligible are in effect for the remainder of the plan year. Once you are enrolled, you must wait until the next open enrollment period to change your benefits or add/remove coverage for dependents, unless you have a qualified change in family status as defined by the IRS. Examples include, but are not limited to, the following:

• Marriage, divorce, legal separation, [dissolution of domestic partnership]
• Birth or adoption of a child
• Change in your work status that affects your benefits
• Change in eligibility for Medicaid or Medicare

Note: You have [30] days from the life event date to make changes to your coverage.