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MRCY_BRC-Open Enrollment Guide(final) - Mercy

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Who Is Eligible<br />

For Benefits?<br />

• Full-time co-workers who regularly work at least 72<br />

hours per pay period.<br />

• Part-time co-workers who regularly work at least 32<br />

hours per pay period.<br />

• Your lawfully married spouse of the opposite sex.<br />

• Your common law spouse (in the state of Oklahoma<br />

only).<br />

• Your children, married or unmarried, up to age 26:<br />

• Natural child<br />

• Legally adopted child<br />

• A child placed with you for adoption<br />

• Your step-child<br />

• A child who has been legally placed with you by an<br />

authorized placement agency or by judgment,<br />

decree or other order of any court of competent<br />

jurisdiction, including a foster child.<br />

You don’t have to cover the same dependents in each plan. For<br />

example, you may cover your entire family for medical and only<br />

yourself for dental.<br />

<strong>Mercy</strong> requires co-workers to provide specific<br />

documentation when covering their eligible dependents.<br />

Without the required documents, co-workers will not be<br />

allowed to add dependents.<br />

Change In Family Status<br />

The choices you make now remain in effect for 2012 unless<br />

you experience a change in family status event. This applies to<br />

medical, dental, vision, supplemental life, LTD and FSA<br />

elections. A change in family status includes:<br />

• Marriage or divorce.<br />

• Birth, adoption or placement for adoption of a child.<br />

• Death of a spouse and/or dependent.<br />

• Loss or gain of coverage due to a change in your spouse’s<br />

employment status, or open enrollment with their<br />

employer.<br />

• Change of employment status from eligible to ineligible<br />

status, full-time to part-time, or vice versa.<br />

• A dependent’s loss of eligibility because he/she has<br />

reached age 26.<br />

• Any other change that is permissible under IRS regulations<br />

and rulings as determined by <strong>Mercy</strong>.

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