Employee Contacts

• 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.