1 New Hire (newly eligible) As a newly eligible Employee Partner enrolling in benefits, you will need to have your information and any covered dependent information handy as it may be requried during the enrollment process. Information you should have readily available is: Dates of Birth Social Security Numbers This online enrollment process should take approximtely 20 mintues for you to complete. Enrollment Instructions 1. From the Benefits Landing page, click on the Change Benefit Elections button under the Enroll Now heading 2. Select the Create Contact button if you will be enrolling any dependents and/designating any beneficiairy(ies) a. If you are not enrolling dependents and/or designating beneficiary(ies), select the Continue button at the top right hand side of the page 3. On the Create Contact page, enter the requeted informatino into following required fields: a. Effective Start Date b. Last Name c. First Name d. Marital Status e. Gender f. Date of Birth (not required for beneficiaries) g. Relationship Only a spouse, child, adoped child, foster child and step child are eligible dependents for medical, dental and vision coverage i. Adopted Child ii. Brother iii. Child iv. Contact v. Domestic Partner vi. Domestic Partner Child vii. Foster Child viii. Friend ix. Nephew x. Niece xi. Parent xii. Sister xiii. Spouse xiv. Step Child 4. Select the Save button at the top right hand corner 5. Once you have added all of your Contacts [dependents and/or beneficiay(ies)], select Continue at the top right hand side of the page. 6. A Warining will pop up reminding you to add dependents, select Continue Enrollment if you have added all of your dependents a. Select Cancel if you need to add more dependents
2 Enrollment Instructions - New Hire Enrollment Authorization Page 7. Select Accept to continue with enrollment process. a. Accepting the authorizaiton is your electronic signature aggreeing to payroll deductions based on your benefit elections. b. If you select Decline, the enrollment process will stop. c. You can also print the Authorization page for your records. The Authorization is below: I authorize ClubCorp USA, Inc. ( ClubCorp ) and my employer, if an affiliate of ClubCorp, to deduct from each paycheck any contributions or other amounts authorized by me, in writing or orally, in relation to any of the ClubCorp sponsored employee benefit plans ( Plans ). I will follow any guidelines for making contributions, withholding, coverage elections and other designations under the above Plans as communicated to me. I understand that Payroll deductions for benefit elections are not pro-rated based on coverage effective or end dates. Payroll deductions for any change in benefit elections due to a status change or special enrollment event are processed when received and I understand that I will not be charged for any increases in coverage that are effective before the date my change is submitted as the result of the change. I also understand that I will not receive any refund for changes when dropping coverage for any period prior to my submission of the change request even though coverage will be changed as of the effective or end dates related to the event triggering the change. I understand that I am responsible for timely submitting my change and that the date I submit the change election determines when the change to my payroll deductions will occur and that there will not be any retroactive adjustments to my payroll deductions. I understand that I must submit my change election due to a qualifying event within 31 days of the event triggering the change, except events of becoming covered or losing coverage under Medicaid or CHIP, and these changes must be submitted within 60 days of the change in such coverage. I further agree to be bound by any oral elections, instruction, or notice made under these Plans.
3 Enrollment Instructions - New Hire Enrollment Benefit Enrollment Pages 8. Check the box next to your Tobacco User Status from one of the four options. You are required to make your Tobacco User designation, even if you are not enrolling in the any medical plan. a. Employee Partner Uses Tobacco b. Spouse Uses Tobacco c. Employee Partner & Spouse Tobacco Users d. No Tobacco Users in Family Tobacco User Verification If you are enrolling in the any of the three medical plans you must complete the Tobacco User test. For more information about the Tobacco User test, go to www.clubcorp.com/benefits and select the Tobacco User Test/Tobacco Cessation link. Dependent Verification If you are enrolling dependents for the first time in medical, your dependents will not be covered and their election will be suspended until you have provided the documents for dependent verification. For more information, go to www.clubcorp/benefits and selet the Eligibility (EP & Dependents) link. 9. Select Next to continue with enrollment process. You will go to the Medical election page a. You will be requried to go through all benefit election pages. You cannot skip a page. 10. Select the box next to the medical plan. Note that you will be chosing between Tobacco User and Non-Tobacco User as well as the medical plan option. Once you make your election, the amount per pay period will be visible in the Total Cost to You box at the top right. a. If you are not enrolling in Medical, confirm the Waive Medical box is checked at the very bottom of thepage 11. Select Next to move to the Dental election page
Enrollment Instructions - New Hire Enrollment Benefit Enrollment Pages 12. Check the box for Dental a. You may only see the DPO option available to you which is correct if you do not lieve in one of the states below. 4 AL, AR, AZ, CA, CO, DC, FL, GA, KS, KY, LA, MD, MI, MS, NV, NY, OH, PE, SC*, TN, TX, WA, WS, WV 13. Select Next at right hand top of the page 14. Check the appropriate box for Vision 15. Select Next at the right hand top of the page
5 Enrollment Instructions - New Hire Enrollment Benefit Enrollment Pages 16. Check the box for Basic and Supplemental Employee, Spouse and/or Child Life a. You must enroll in Supplemental Employee Partner Life in order to elect Spouse or Child Life Evidence of Insurability (EOI) EOI is required for any Supplemental Life Employee Partner Life amount above $380,000 and Spouse Life insurance amount above $50,000. You can make the election, but it will be suspended until EOI is approved. 17. Select Next to move to the next election page - Disability 18. Check the box for Short Term Disability or Long Term Disability. a. The benefit identified on your page is the one for which you are eligible 19. Select Next to move to Additional Benefits (Dependent Care Flexible Spending Account and Health Savings Account) 20. Check the box to make your DCFSA and HSA election 21. Check the Next button at the top of page
Enrollment Instructions - New Hire Enrollment Designation Page You will select the dependents who will be enrolled in medical, dental and vision as well as designate your beneficiary(ies) on this page. 6 22. Select the check box under Cover to enroll your dependents in the appropriate corresponding plan 23. If you elected Basic and/or Supplemental Employee Partner Life Insurance, designate your beneficiary(ies) on this page as well. Dependents If you plan to add family members and others to your benefit plans as dependents and/or beneficiary(ies), add them as Contacts before your enroll. Click the Create Contact button above. Your eligible dependents in the ClubCorp benefit Plans include: Your legal spouse Your dependent children up to age 26 - Medical and Vision Plans Only Your dependent children up to age 25 - Dental, and Child Life Insurance Plans Your dependent children over age 25 who are medically certified as disabled Verification of eligibility is required for medical coverage for dependents before they will be enrolled. Proof of dependent status must be sent to the ClubCorp Benefits Department within 31 days after the effective date of coverage at psbenefit@clubcorp.com or by fax at 972-888-7558. Proof of Dependent Status documents may include: Spouse: State issued marriage certificate, joint banking account, mortgage/leasing agreements or tax returns. Dependent Child(ren): State issued birth certificate, QMSCO, adoption/legal ward papers, school enrollment records, medical and disability documentation. For further information and to access a Dependent Eligibility Form, click here. Beneficiary(ies) Designation If you have elected any life insurance coverage, you must designate your beneficiary(ies). You must designate a Primary beneficiary and can designate a Contingent beneficiary. Primary is a beneficiary who is first in line to receive death benefits. Contingent beneficiary will only receive benefits if the primary beneficiary has died. Primary and Contingent beneficiary percentages must equal 100% exclusively. You are the automatic beneficiary for Spouse and Child Life insurance. For more detailed information go to www.clubcorp.com/benefits.
7 Enrollment Instructions - New Hire Enrollment Designation Page You will select the dependents who will be enrolled in medical, dental and vision as well as designate your beneficiary(ies) on this page. 24. Click Next 25. Review your elections on the page, you may need to scroll down so see everything. a. If you need to make changes, select the Back button at the top of the page which will take you back page by page to where you want to edit your elections. 26. If you have completed your benefit elections, you MUST select the Submit button a. If you do not select the Submit button, your elections are lost and you are not enrolled in any benefits. 27. You have completed your enrollment and are now on your Confirmation page a. Click the Print button at the top of the page to keep for your records 28. After you have printed your Confirmation Statement, select the Done button at the top of the page. Important Remember Dependent Verification Verification of eligibility is required for medical coverage for dependents before they will be enrolled. Proof of dependent status must be sent to the ClubCorp Benefits Department within 31 days after the effective date of coverage at psbenefit@clubcorp.com or by fax at 972-888-7558. Tobacco User Verification If you are enrolling in the any of the three medical plans you must complete the Tobacco User test. For more information about the Tobacco User test, go to www.clubcorp.com/benefits and select the Tobacco User Test/Tobacco Cessation link.