BENEFIT ELECTIONS Sample Clauses

BENEFIT ELECTIONS. See marketing materials for benefit options available by group size. ❑ Health Connections Medical - ConnectiCare HealthEquity HRA/HSA Integrated Accounts [indicate your choice(s)] ❑ Employee HSA Accounts ❑ Employee HRA Accounts ❑ Other: please specify If HealthEquity HRA or HSA services are selected, you or your broker must complete the HealthEquity HRA/HSA ❑ Group Basic Life ❑ Supplemental Life (2 to 9 eligible employees) ❑ Voluntary Life ❑ Group Dental Prior dental coverage? ❑ Yes ❑ No ❑ 10+ eligible employees; with orthodontia? ❑ Yes ❑ No ❑ 3 to 9 eligible employees (orthodontia not available) ❑ Voluntary Dental ❑ Voluntary Accident & Illness Benefits ❑ Voluntary Vision - select one ❑ 12/12/12 ❑ 12/12/24 ❑ Other ConnectiCare Medical Plans (can be offered with Health Connections medical above) ❑ Short-term Disability* select one ❑ Group ❑ Voluntary ❑ Long-term Disability* select one ❑ Group ❑ Voluntary Note: LTD is not available to employees who work fewer than 30 hours per week. The following are ConnectiCare-direct plans, underwritten by ConnectiCare Benefits, Inc. (CBI), and are not part of the CBIA Service Corporation (CBIASC) policy: Passage Gold POS PCP, Choice Silver POS, Choice Silver POS HSA, Choice Bronze POS HSA, Choice Bronze POS. These plans may be purchased by Health Connections * If electing STD or LTD coverage an original completed Tax Service Agreement must be submitted. Separate Tax Service Agreements are required if electing both STD and LTD coverage. ❑ Identity Theft Protection program participants with aggregated billing and administration. Note: These plans are not integrated with HealthEquity HRA or HSA services. If you choose to include these CBI plans in your medical product offering, a separate 2021 CT CBI Small Group Employer Application must be completed and submitted at time of new-business installation or renewal. ❑ Employer paid ❑ Gold ❑ Platinum ❑ Employee only ❑ Employee & family ❑ Employee paid ❑ CBIA COBRA/State Continuation Administration Separate form required Are you selecting retiree coverage? ❑ Yes ❑ No Check the retiree group you are selecting coverage for: ❑ Existing and future retired employees ❑ Existing only ❑ Future only Check all the retiree coverages you are applying for: ❑ Medical ❑ Dental ❑ Group Basic Life (AD&D discontinued at retirement) ❑ Voluntary Dental ❑ Voluntary Vision Retirees are only eligible for coverage in Medicare plans offered in CBIA Health Connections. I designate Agent of Record as: Add...

BENEFIT ELECTIONS. To the extent that Graduate Workers are eligible to elect benefits, the University will ensure that there will be sufficient enrollment opportunities to do so.

BENEFIT ELECTIONS. See marketing materials for benefit options available by group size.

BENEFIT ELECTIONS. The form of payment of Director's Normal Retirement Benefit, Disability Benefit and Change of Control Benefit in effect on December 31, 2007, on the Form of Benefit Election attached as Exhibit II to the Agreement is irrevocable as of December 31, 2007, and may not be subsequently changed except in accordance with the following restrictions:

BENEFIT ELECTIONS. A copy of the sold proposal for Life and Disability benefits must be signed and attached.

BENEFIT ELECTIONS. 36 7.04 Distributions Under Domestic Relations Orders ............... 37 7.05

BENEFIT ELECTIONS. Not earlier than 90 days, but not later than 30 days, before a Participant's or Beneficiary's Annuity Starting Date, the Plan Administrative Committee must provide a benefit notice to a Participant or Beneficiary who is eligible to make an election under Section 7.01. The benefit notice must explain the form of benefit distribution available under the Plan and the Participant's or Beneficiary's right to defer distribution. If a Participant or Beneficiary makes a valid election prescribed by this Section 7.03, the Plan Administrative Committee shall direct the Trustee to distribute the Participant's Nonforfeitable Accrued Benefit in accordance with the election. The Participant or Beneficiary must make an election under this Section 7.03 by filing his election form with the Plan Administrative Committee before the Trustee otherwise would commence to pay a Participant's Accrued Benefit in accordance with the requirements of this Article VII.