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42 views

Benefit Acknowledgment Form (9).doc_copia

Uploaded by

adaljisab
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Benefits Acknowledgement Form

Congratulations on joining The Kent Companies Team! Soon you may be eligible to enroll in
the benefit programs, so we would like to share some important information about eligibility and
key deadlines as well as instructions on how to complete your enrollment when the time comes.

Insurance Plans Offered:

➢ Medical
o Limited Medical (Fringe Benefits Group)
➢ Non-Corporate to include Team Members and Assistant Managers
o Major Medical (Blue Cross Blue Shield of Texas)
➢ Corporate to include Managers
➢ Health Plan
o Urgent Care Membership (Convenient Care Plus)
➢ Non-Corporate to include Team Members and Assistant Managers
➢ Dental (MetLife)
➢ Vision (VSP)
➢ Life and Accidental Death & Dismemberment (Lincoln Financial)
o $20,000 employee policies (separate Life and AD&D polices) paid for by the
company
o Options to enroll yourself and dependents in a Term Life policy and AD&D
➢ Supplemental Benefits (AFLAC)
o Accident
o Critical Illness
o Short Term Disability
o Hospital
o Cancer

Eligibility Requirements: You must be regularly scheduled to work 30 or more hours per work
and have completed 60 days of employment. Your hours are continually evaluated to ensure the
eligibility requirements are maintained each plan year.

Eligible Dependents: Legal Spouse, Domestic Partner and Children up to age 26 (includes
biological children, step children, children claimed as a dependent on your federal tax reports,
children for whom you have legal guardianship and disabled children regardless of their age).

Enrollment Deadline: Unless otherwise noted, you have 30 calendar days from your Date of
Hire to enroll for your Insurance Benefits. If you do not enroll at this time, you may be required
to wait until Annual Open Enrollment (generally held in November for an effective date of the
following January 1st). Typically, you are only permitted to enroll outside your 30-day window, if
you experience an IRS-defined qualifying life event such as marriage, divorce or death during
the year. Elections made are for the duration of the plan year unless you experience a life event.
How to Enroll:

As part of the benefit enrollment process, you must provide your email address to obtain plan
brochures and direct communications related to your benefit plan options. The documentation
sent to you via email will have applicable deadlines depending upon your specific date of hire.

You can expect to receive an email within the first week of employment with electronic copies of
the Benefits Guide and Forms. Completed Benefit Forms should be returned to the Benefits
Department or your immediate supervisor by the deadline noted within the documentation.

Note: You are still required to return the Benefit Forms even if you choose to waive the medical,
dental, vision or supplemental insurance programs. You must designate a Beneficiary for the
company-paid Life and AD&D policies. Forms will need to be turned in to your immediate
supervisor or the Benefits Department for processing.

How to Submit Completed and Signed Enrollment Forms:

Benefit Forms may be turned in for processing to your immediate supervisor or the Benefits
Department at the Corporate office, whichever is most convenient, or via one of the following
methods:

• Fax: 432-697-8911
• Email: [email protected]
o (Upload to HR)
• Mail: The Kent Companies
Attention: Benefits Department
3510 North A. Street Midland, TX 79705

Questions and Inquires about your Benefit Selections:

We are here to help!


If you need additional clarification on any benefit program, you should ask questions to ensure
your understanding of its provisions, coverage, claims procedures and cost. You may contact
Ana in the Benefits Department at 432-520-4000 ext. 1335 or email any questions to
[email protected].

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