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Section I: Enrollment of A New Employee
When to Enroll
Enrollment Procedure
Procedure to Waive
Procedure to File the Form
Exhibits
Section II: Termination of Employee Coverage
Termination of Employment
Other Uses of the Termination Form
COBRA Considerations for Companies with 20 or More Employees
NC State Continuation for Companies with Fewer than 20 Employees
Exhibits
Section III: Change of Employee Status
Procedure to Enroll an Employee who Becomes Eligible Due to a Change in Hours
Procedure to Waive Coverage
Procedure to Terminate Benefits for an Employee who has a Reduction in Hours
Procedure to File the Form
Exhibits
Section IV: Change of Employee’s Dependent(s)
Procedure to Add Dependent(s) at the time of a Qualifying Event
Procedure to Add Dependent(s) during an Annual Enrollment
Procedure to Drop Dependent(s) at the time of a Qualifying Event
Procedure to Drop Dependent(s) during an Annual Enrollment
Procedure to Drop Dependent(s) for Non-Payment of Premiums
Exhibits
Section V: Change of Personal Information
Procedure to Change Information Using the Enrollment Form
Procedure to Change Information Using a Change of Address Form
Exhibits
Section VI: Q&A for The Annual Enrollment Period
Section VII: Q&A for Enrolling Employees
Section VIII: Medical/Vision/Pharmacy Claims Information
Medical/Vision Claims Questions
Submitting a Medical/Vision Claim for Member Reimbursement
Submitting a Pharmacy Claim for Member Reimbursement
Obtaining a Pharmacy Reimbursement Directly from the Pharmacy
Exhibits
Section IX: Sample Blank forms