Qualified Change-in-Status Chart

Transcription

1 Qualified Change-in-Status Chart Note: Benefit changes that appear in bold text may require you to verify (provide supporting documentation) that you and/or your have lost or gained coverage in a plan outside of the Halliburton Plan. Beginning or increasing coverage for life insurance and long-term disability during the year will be subject to any applicable evidence of insurability noted for re-enrollments or subsequent enrollments. All changes must be made in writing to Halliburton Benefits Center on or before the 60 th day in which the Change In-Status Event took place. The Halliburton Benefits Center can be contacted through the information below for more details: PHONE INFORMATION: AT&T access code (toll-free) (not toll-free) ON-LINE INFORMATION: Your Benefits Resources Web site: Link through Hal World or go to Benefits Web site: (toll-free within the U.S. & Canada) 1. You Gain a Dependent through Marriage, Childbirth, Adoption or Placement for Adoption Health Care You may increase/decrease coverage amount A child will be considered a new dependent on the date of paternity test results if an election is made within 60 days of the results.

2 2. You Get Divorced or Your Spouse Dies You must drop coverage for your spouse You may add or drop coverage for your dependent children You must end coverage 3. A Child Otherwise Gains or Regains Dependent Status You may add coverage for your dependent children and/or spouse 4. Your Dependent Child no Longer Qualifies as a Dependent or Dies Health Care You must drop coverage for your dependent You must end coverage of the dependent

3 5. You, Your Spouse or Your Dependent Lose Other Benefit Coverage as a Result of a Change in Your Spouse s or Dependent s Employment This also applies to situations where the spouse or dependent is also a PRL employee or where there is a change in a dependent s other parent s employment. 6. You, Your Spouse or Your Dependent Gain Other Benefit Coverage as a Result of a Change in Your Spouse s or Dependent s Employment Health Care You may end coverage You may drop coverage for your spouse and/or your 7. You, Your Spouse or Your Dependent Lose Other Benefit Coverage as a Result of Changes in Your Spouse s (or Other Parent s) Elections in Their Employer s Plan and the Other Plan Has a Different Enrollment Cycle You may add coverage for your spouse or your

4 8. You, Your Spouse or Your Dependent Gain Benefit Coverage as a Result of a Changes in Your Spouse s (or Other Parent s) Elections in Their Employer s Plan and the Other Plan Has a Different Enrollment Cycle Health Care You may end coverage You may drop coverage for your spouse or your 9. A Judgment, Decree or Court Order (after approved by Halliburton as a QMSCO) Requires You to Provide Coverage for your Dependent(s) You may add coverage for the affected 10. A Judgment, Decree or Court Order (QMSCO) Requires Your Spouse to Provide Coverage for your Dependent Children Health Care You may drop coverage for affected dependent children The child must already have coverage under the other parent s coverage before the child may be dropped. 11. You Begin a Leave of Absence Health Care You may end coverage 12. You Return from a Leave of Absence Health Care You may begin coverage

5 Changes are not allowed if you experience an increase in cost for your existing provider and your existing provider is a relative. 13. You Are an International Expatriate and Become Localized After Three Years Health Care You may end current coverage You may add coverage in newly available options your 14. You Are Rehired More Than 30 Days After of your Termination, But Within the Same Plan Year That You Terminated All benefits Your prior coverage, if any, will be reinstated subject to your right to change to any election available to new hires 15. You Are Rehired Less Than 30 Days After Your Termination, and Within the Same Plan Year That You Terminated All benefits Your prior coverage, if any, will be reinstated If you are rehired in a new Calendar year you will need to make new benefit elections. 16. You Lose Other Government or Educational Institution Coverage Such as Tribal Coverage, State Health Benefits Risk Pool, or Foreign Government Plan 17. Your Spouse or Dependent(s) Lose Other Government or Educational Institution Coverage Such as SCHIP, Tribal Coverage, State Health Benefits Risk Pool, or Foreign Government Plan 18. You, Your Spouse, or Dependent(s) Meet or Exceed the Lifetime Limit for All Health Plan Benefits in a PRL Plan, or Another Employer s Plan Health Care You may end coverage (only if no other coverage is available) You may begin coverage Global Benefits Revised July 16, 2007