Domestic Partner Imputed Income STATUS CHANGES If you choose to add your domestic partner to Current team members who your medical and/or dental coverage, you will be are newly bene昀椀t eligible responsible for imputed income tax on the difference have 30 days from their in the employer premium for the additional coverage. status change date to enroll in bene昀椀ts. If moving from a Status and Bene昀椀t Changes full-time to part-time position You can change your coverage during the year if or vice versa you have 30 you have a qualifying life event. The changes you may days from status change date make depend on the type of qualifying event that occurs. to request a change to your If you experience a qualifying life event and wish to health insurance through make changes to your bene昀椀ts, you must declare a life AskHR. event through Lawson within 30 days from the date of the event (60 days for the birth of a child, adoption, or LIFE EVENT GUIDE adoption placement). Team members are allowed to make changes mid- For additional information year between plan options under health insurance or check out the Quali昀椀ed dental insurance. For example you may change from Life Event Guide the Network Plan to the Health Savings Plan (HSA) or vice versa. Note: Deductible and maximum out of pocket accumulators will not transfer between plan options, team members will be responsible for any Transferring Employment Within excess health saving account contributions and team UPH Af昀椀liates members are not able to change 昀氀exible spending account annual election amounts. If you transfer employment to another UnityPoint Health af昀椀liate, your bene昀椀ts will Qualifying Life Events continue unchanged if you continue to meet eligibility requirements. You cannot make › Marriage, divorce, or legal separation changes to your bene昀椀t elections if you › Birth or addition of an eligible child transfer employment as this is not a qualifying › event for making changes during the year. Loss of other coverage › New eligibility for other coverage › Dependent Eligibility Quali昀椀ed medical child support order › Eligibility for your dependent begins Status changes › or ends with: Commencement or return from an unpaid leave of absence › Change in residence or place of work resulting in change in health insurance availability › Death of spouse/domestic partner or child | 3 |