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• Martin County Board of County Commissioners I Employee Benefit Highlights 12021 Qualifying Events and Section 125 Section 125 of the Internal Revenue Code N, Premiums for medical, dental, vision insurance, contributions to Flexible Spending Accounts and/or certain supplemental policies are deducted through IMPORTANT NOTES • a Cafeteria Plan established under Section 125 of the Internal Revenue Code and are pre-taxed to the extent permitted. Under Section 125, changes to If employee experiences a Qualifying Event,the Benefits Specialist employee's pre-tax benefits can be made ONLY during the Open Enrollment must be contacted within 30 days of the Qualifying Event to period unless the employee or qualified dependent(s) experience(s) a make the appropriate changes to employee's coverage. Beyond 30 Qualifying Event and the request to make a change is made within 30 days of days,requests will be denied and employee may be responsible,both the Qualifying Event. legally and financially,for any claim and/or expense incurred as a result Under certain circumstances, employee may be allowed to make changes of employee or dependent who continues to be enrolled but no longer to benefit elections during the plan year if the event affects the employee, meets eligibility requirements.If approved,changes may be effective spouse or dependent's coverage eligibility. An "eligible" Qualifying Event the date of the Qualifying Event or the first of the month following is determined by Section 125 of the Internal Revenue Code.Any requested the Qualifying Event. Newborns are effective on the date of birth. changes must be consistent with and due to the Qualifying Event. Cancellations will be processed at the end of the month.In the event of death,coverage terminates the day following the death.Employees Examples of Qualifying Events: may be required to furnish valid documentation supporting a change • Employee gets married or divorced in status or"Qualifying Event:' • Birth of a child • Employee gains legal custody or adopts a child • Employee's spouse and/or other dependent(s)die(s) Summary of Benefits and Coverage • Loss or gain of coverage due to employee,employee's spouse and/ A Summary of Benefits&Coverage(SBC)for the Medical Plan is provided as a or dependent(s)termination or start of employment supplement to this booklet being distributed to new hires and existing employees during the Open Enrollment period. The summary is an important item in • An increase or decrease in employee's work hours causes eligibility understanding employee's benefit options.A free paper copy of the SBC document or ineligibility may be requested or is also available as follows: • A covered dependent no longer meets eligibility criteria for coverage • A child gains or loses coverage with other parent or legal guardian From: Benefits Specialist • Change of coverage under an employer's plan Address: 2401 SE Monterey Rd. • Gain or loss of Medicare coverage Stuart,FL 34996 • Losing or becoming eligible for coverage under a State Medicaid Phone: (772)320-3029 or CHIP(including Florida Kid Care)program (60 day notification Email: blafave@martin.fl.us period) Website URL: www.mybentek.com/martincounty The SBC is only a summary of the plan's coverage.A copy of the plan document,policy, or certificate of coverage should be consulted to determine the governing contractual provisions of the coverage.A copy of the group certificate of coverage can be reviewed and obtained by contacting the Benefits Specialist. If there are any questions about the plan offerings or coverage options,please contact the Benefits Specialist at(772)320-3029. 86 4 ©2016,Gehring Group,Inc.,All Rights Reserved