- Employee
Number. The
employee whose contact, beneficiary, or dependent, is being defined is
in the Employee Number field.
Contact Name and Address
- Last Name. The
legal last name of the contact (surname), as
provided by the employee on a form or through employee self-service.
- First Name. The
legal first name of the contact, as
provided by the employee on a form or through employee self-service.
- Middle Name. The
legal middle name of the contact (if any), as
provided by the employee on a form or through employee self-service.
- Use Employee Address? If
the contact has the same mailing address, select Use
Employee Address and leave the other address information blank.
- Address 1, Address 2, City, State, and Zip Code. If
you leave Use Employee Address
clear, enter the address information: Address 1, Address 2, City, State,
and Zip Code.
- Work
Phone. Enter
the contact's work phone number.
- Home
Phone.
Enter
the contact's home phone number.
- Cell Phone. Enter
the contact's cell phone number.
- Relationship Code(required).
The
selection that best represents the relationship of this contact to
the employee. Options are from
the Relation Code validation table.
- Gender.Select the gender of the contact. Options are from
the Gender codes validation table.
- Email. Enter
the contact's email address.
Dependent/Beneficiary Info
- Social
Security No. For
a dependent or beneficiary, the Social Security number is needed for identification.
- Birth
Date. Record
the dependent/beneficiary's
birth date in MM/dd/YYYY format.
If a dependent becomes ineligible, verify
that any action you take complies with COBRA regulatory guidelines. Adjust
entries on the Benefit Plans screen as necessary.
Select the checkboxes as appropriate for
this contact.
- Benefit
Eligible?
If
this person is eligible for coverage under the employee's benefit plans, as defined by the plan
guidelines, select this checkbox. For enrollment, a contact record needs "Benefit Eligible" to be selected for
the contact to display as a potential beneficiary or dependent.
- Beneficiary?
If
this person is eligible for coverage under the employee's benefit plans, as defined by the plan
guidelines, select this
checkbox.
- Spouse/Domestic Partner? If
this person is a
spouse or domestic partner of this employee, select this checkbox.
- Child
Dependent? If
this person is a
child dependent of this employee
for benefit enrollment purposes, select this checkbox.
For self-service online benefit enrollment,
a contact record needs to be marked "Child Dependent" for the
contact to display as a dependent for benefit purposes. An employee may
also add dependents through the online benefit enrollment.
- Emergency
Contact? If
this person is to be contacted in case of an emergency
for this employee, select the Emergency
Contact checkbox.
- Student? Select the Student
checkbox if this dependent is a qualified student for benefit plan purposes.
- Smoker? If
this dependent smokes or uses tobacco, select the Smoker
checkbox to fulfill the requirement by some insurance plans to report
this disclosure for all covered individuals.
- Disabled?
If the
dependent is disabled according to benefit plan definitions, select the
Disabled checkbox. To find out
if your benefit plan guidelines require this disclosure, consult your
Benefit Plan Administrator.