JOB AID A reference guide to Guardian Anytime tasks

JOB AID A reference guide to Guardian Anytime tasks Contents ADMINISTRATION... 3 HOW TO SELF-REGISTER FOR GUARDIAN ANYTIME... 3 HOW TO ASSIGN ACCESS TO AN INDIVIDUAL VIA GUARDIAN ANYTIME... 6 HOW TO ACCESS REPORTS... 8 HOW TO VIEW TRANSACTION LOG... 10 WHERE CAN I FIND FORMS & MATERIALS... 13 HOW TO CHECK EVIDENCE OF INSURABILITY STATUS... 14 ENROLLMENT/UPDATES...16 HOW TO ENROLL A NEW MEMBER... 16 HOW TO UPDATE A REHIRED EMPLOYEE... 19 HOW TO PROCESS A COBRA ENROLLMENT FOR A TERMINATED MEMBER... 23 HOW TO PROCESS MEMBER BENEFIT CHANGES... 25 HOW TO CHANGE MEMBER INFORMATION... 28 HOW TO ENROLL/ADD A NEW DEPENDENT... 30 HOW TO ENROLL A DEPENDENT WITH COBRA COVERAGE... 33 HOW TO UPDATE BENEFITS FOR A DEPENDENT... 35 HOW TO UPDATE A DEPENDENT S PERSONAL INFORMATION... 37 TERMINATION...40 HOW TO PROCESS A MEMBER TERMINATION... 40 HOW TO PROCESS A MEMBER TERMINATION AND ENROLL THE MEMBER ON COBRA... 42 HOW TO TERMINATE A DEPENDENT... 45 BILLING...47 HOW TO VIEW YOUR CURRENT BILLING STATEMENT... 47 HOW TO VIEW YOUR BILLING STATEMENTS... 49 HOW TO RECALCULATE YOUR BILLING STATEMENT... 52 HOW TO MAKE A PAYMENT... 54 HOW TO MAKE A PAYMENT ALTERNATE FUNDED... 56 HOW TO ESTABLISH AUTOMATIC EFT PAYMENTS... 58 HOW TO VIEW YOUR PAYMENT HISTORY... 60 HOW TO CHANGE YOUR BILLING OPTION... 61 GROUP INFORMATION OR PLAN CHANGES...62 HOW TO MAKE GROUP INFORMATION OR PLAN CHANGES... 62 DEPENDENT AGE LIMITS CHANGES... 65 PLAN NAME, ADDRESS, OR CORRESPONDENT CHANGES... 69 OPEN ENROLLMENT CHANGES... 74 HOW TO TERMINATE COVERAGE... 78 WAITING PERIOD CHANGES... 82

OTHER PLAN CHANGES... 86 AFFILIATE CHANGES... 88 ANNIVERSARY OR RENEWAL DATE CHANGES... 92 CLASSIFICATION CHANGES... 96 DOMESTIC PARTNERSHIP CHANGES... 100 EARNINGS DEFINITION FOR SALARY BASED COVERAGE(S)... 104 CHANGING HOURLY WORK REQUIREMENTS... 108 CHANGES TO ID CARDS... 110 CHANGING REDETERMINATION DATE FOR SALARY BASED COVERAGE(S)... 114 CHANGING REHIRE PROVISIONS... 118 TPA (THIRD PARTY ADMINISTATOR)... 122 CHANGES TO TAX IDENTIFICATION NUMBERS... 126 ALL OTHER CHANGES... 131 2

ADMINISTRATION HOW TO SELF-REGISTER FOR GUARDIAN ANYTIME Access Guardian Anytime (www.guardiananytime.com). Click Register Now. Select the appropriate User Role (Member, Dependent, Employer, Third Party Administrator, Agent/Broker, or Healthcare Professional). 3

Read the disclosure statement and click I Agree. 4

Complete all of the required fields. Required fields are marked with an asterisk (*). Each registrant must include contact information including first name, last name, personal or work email address, and also specify a user ID, password, and challenge question/answer. Additional data requirements are listed below by role. Click Submit. If the registration is successful, a confirmation message is displayed and you will receive an email, usually within one hour, with sign in instructions. If the registration is not successful, a failed registration message is displayed indicating that the information provided does not match our records. You will be provided with the toll free phone number for assistance and given the option to either review and change information or return to the Guardian Life homepage. 5

ADMINISTRATION HOW TO ASSIGN ACCESS TO AN INDIVIDUAL VIA GUARDIAN ANYTIME The Assign Access function within Guardian Anytime enables you to delegate one or more individual(s) within your company to perform all or a subset of the activities for which you are authorized. You may give the user full or partial access to the entitlements you have under your user ID. When you use the Assign Access function, you will pre-register the user, who will receive an email advising them to complete the pending registration. Please see the below steps to assign access: Log in to Guardian Anytime. Select the Personalize Tab. Select the User Management Tab. Select Assign Access. Pre-register the user by entering the required information the screen prompts you for: First and Last Name, Email Address, Telephone Number (optional.) Select the Role you want to assign the User. (You will have the ability to select any role you are currently registered for.) Click Continue. On the next page, which displays the details of the functionality you have access to, check the entitlements you want to offer to your co-worker. You may select all functionality or limit your selection to certain activities. Select Continue. 6

You will receive a Confirmation page where you can approve or edit your selections. An e-mail will be sent to the person you have delegated access to. The e-mail will advise the user to click on the activation code and complete the registration that you started. The individual to whom you are assigning access will need to create their own user ID, password and enter their own challenge question and answer. 7

ADMINISTRATION HOW TO ACCESS REPORTS Click the Reports tab. Click the Reports & Letters link. Under the View Reports and Letters section, select the coverage (Dental, Disability, or View All). Click Continue. A listing of available reports is displayed with options to View or Email the reports. 8

If no reports are available, a message is displayed stating "No Reports found for this Group ID and Division ID". 9

ADMINISTRATION HOW TO VIEW TRANSACTION LOG Click the Reports tab. Click the Transaction Logs link. The system will automatically display transactions submitted within the last 30 days. o If no transactions have been submitted in the last 30 days, the following message will be displayed No changes were submitted in the last 30 days. Select Advanced Search to search for transactions older than 30 days. Enter the search criteria (e.g. group ID, from/to dates, type of change, member name/id). o When entering from/to dates, the time period cannot be longer than 60 days. If a longer time period is entered, the system will display the error message "The time period cannot be longer than 60 days". o In order to ensure the stability of Guardian Anytime, the Group ID must be entered in the search during core business hours (9:00 a.m. to 4:00 p.m. Eastern Time). When the Group ID is not entered, a message is displayed advising that it is required. 10

Click Search. A listing is displayed that provides information regarding each transaction (e.g. date/time submitted, group ID, division ID, member name, type of change, transaction status/complete date, processed by, processed for). Explanations are provided at the bottom of the screen for the entries that appear in the Transaction Status/Complete Date field. If no matching records are found, a message is displayed that states: "There were no changes matching the search criteria". Click the link in the Type of Change field to view details of that transaction. 11

ADMINISTRATION WHERE CAN I FIND FORMS & MATERIALS On the Employer portal home page, click the Eligibility tab, and then click the Forms & Materials tab. Click Obtain Forms and Materials. Select the hyperlink for the forms or materials that are needed. All forms and materials applicable to your plan are displayed. Please note that if you have elected Electronic Documents/ID Cards, you will not be able to place an order on Guardian Anytime. You will only be able to view/print the documents/id cards. 13

ADMINISTRATION HOW TO CHECK EVIDENCE OF INSURABILITY STATUS On the Employer portal home page, click the Eligibility tab, and then click Evidence of Insurability Status. Guardian Anytime displays the EOIs found when the initiated date of the EOI is within 60 days from the current date. o To narrow the search or search for EOIs submitted during the last 6 months, enter the member's last name, and select the coverage, or select the EOI status (completed or in process), then click Search. The search results are displayed in a Status List and include the member's name, coverage, date the application was received, and EOI Status. The Status List can be emailed or printed by clicking on the appropriate button. Click the member's name to view details, including the applied amount and total amount, and coverage effective date. Dependent EOI status is included on this screen as well, if applicable. o A link is provided on this screen to view a copy of the most recent decision letter issued from Guardian. 14

Click on Return to List to return to the Status List and select another member if needed. 15

ENROLLMENT/UPDATES HOW TO ENROLL A NEW MEMBER On the Employer portal home page, click the Eligibility tab, and then click Enroll New Member. Enter the member information, employment information, and contact information, and then click Continue. Select benefits for the member/dependents, and then click Continue. 16

Enter any dependent information, and then click Continue. 17

Complete the Additional Information section (i.e. answer the tobacco question, enter beneficiary information, etc.), upload any supporting documentation and enter any special instructions* if needed, then click Continue. Verify that the information is correct, and then click Submit. 18

ENROLLMENT/UPDATES HOW TO UPDATE A REHIRED EMPLOYEE On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select Reinstate Member. 19

Complete the required fields: o Reason for Reinstatement o Date of Full Time Re-Hire o Re-hire Sign Date Click Continue. Please note: A new enrollment form (with the re-hire date) must be completed only if the member was re-hired more than 31 days from his/her termination date. Make any necessary changes to the Member Original Enrollment under the below tabs: o Member o Elected Benefits o Dependent 20

If applicable, attach documentation or enter any special instructions under the Additional Information tab. Click Continue. Review the Summary tab and verify the information submitted is correct. o If the information is correct, click Submit. o If not, click on the Edit Member, Edit Elected Benefit, or Edit Additional information to edit the entered information. 21

ENROLLMENT/UPDATES HOW TO PROCESS A COBRA ENROLLMENT FOR A TERMINATED MEMBER On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. Select Elect Continuation of Benefits. 23

Complete the required fields: o Select Federal or State Continuation. o Enter the date the continuation election was signed. o Select the benefits to be continued. o Update the member's address information, if needed. o Enter any special instructions, if needed. o Click Continue. Verify the continuation information, and then click Submit. 24

ENROLLMENT/UPDATES HOW TO PROCESS MEMBER BENEFIT CHANGES On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select Update Benefits. 25

Select the reason, effective date of change and the sign date, and then click Continue. 26

Enter the benefit changes, and then click Continue. Verify the benefit information, and then click Submit. 27

ENROLLMENT/UPDATES HOW TO CHANGE MEMBER INFORMATION On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select Change Member. 28

Update the Member Changes: Enter the effective date of the change. Edit the Member s personal information as needed (i.e. name, address, date of birth, phone/fax number, gender, email address). Edit the salary, hours worked, pay period, job title, location/department, class, or division as needed. Upload any supporting documentation and enter any special instructions, if needed. Click Continue. Verify the change information, and then click Submit. 29

ENROLLMENT/UPDATES HOW TO ENROLL/ADD A NEW DEPENDENT On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select the Dependent Information tab and then select Add Dependent. 30

Select the reason that the dependent is being added, and then click Continue. Select the benefits for the dependent, and then click Continue. Enter the sign date and dependent information (i.e. name, social security number, date of birth, etc.), then click Continue. 31

If needed, upload any supporting documentation and enter any special instructions, then click Continue. Verify the dependent information, and then click Submit. 32

ENROLLMENT/UPDATES HOW TO ENROLL A DEPENDENT WITH COBRA COVERAGE On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select the Dependent Information tab and then select Elect Continuation of Benefits. 33

Complete the required fields. If needed, upload any supporting documentation and enter any special instructions, then click Continue. Verify the information, and then click Submit. 34

ENROLLMENT/UPDATES HOW TO UPDATE BENEFITS FOR A DEPENDENT On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select the Dependent Information tab and then select Update Benefits. 35

Select the reason that the dependent is being added, the effective date of change and the sign date. Click Continue. Select the benefits for the dependent, and then click Continue. If needed, upload any supporting documentation and enter any special instructions, then click Continue. Verify the dependent information, and then click Submit. 36

ENROLLMENT/UPDATES HOW TO UPDATE A DEPENDENT S PERSONAL INFORMATION On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select the Dependent Information tab and then select Update Dependent. 37

Select the dependents to be updated. Click Continue. Update the dependent s information. 38

If needed, upload any supporting documentation and enter any special instructions, then click Continue. Verify the information, and then click Submit. 39

TERMINATION HOW TO PROCESS A MEMBER TERMINATION On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select Terminate Member. 40

Enter the last day worked and select a reason for termination, then click Continue. Verify the termination information, and then click Submit. 41

TERMINATION HOW TO PROCESS A MEMBER TERMINATION AND ENROLL THE MEMBER ON COBRA On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select Terminate Member. 42

Enter the last day worked and select a reason for termination, then click Continue. Verify the termination information, and then click Submit. Go back to the Member Information screen, select Elect Continuation of Benefits. 43

TERMINATION HOW TO TERMINATE A DEPENDENT On the Employer portal home page, click the Eligibility tab, and then click View/Change Member. Enter the search criteria (member's last name, class, location/department; or select from the Status options). If only one match is found, the Member Information screen is displayed. If there are multiple matches, a Search Results screen is displayed. Click the member's name to view their Member Information screen. On the Member Information screen, select the Dependent Information tab and then select Terminate Dependent. 45

Select the reason that the dependent is being terminated and the effective date of change. If needed, upload any supporting documentation and enter any special instructions, then click Continue. Verify the information, and then click Submit. 46

BILLING HOW TO VIEW YOUR CURRENT BILLING STATEMENT On the Employer portal home page, click the Billing tab, and then click on Current Bill. The Payment Summary screen is displayed for the current due date. Click on the Download Bill, Print Bill, or Print Page buttons if needed. Please note that it does take a few moments for the billing statement to be converted to Excel or the PDF format. o Download Bill - allows Excel upload format to provide more detailed information from the bill. Including volumes, class, location codes, family indicators, and premiums. o Print Bill - allows the bill in a printable invoice format. Including notices section, coverages for each employee, and continued coverage section for COBRA. o Print Page - allows you to print the Payment Summary, Summary Notice, Advanced Notice of Change or Bill Premium detail on an individual basis. 47

Links are provided to view: o Summary Information - lists coverages, previous and current number of lives, current premium, premium adjustments, and premium by class information. o Advanced Notice of Change - view member/dependent changes prior to the effective date of the change. o Bill Premium Detail - lists the premium type, member name, class, location, effective date, reason, and total amount. 48

BILLING HOW TO VIEW YOUR BILLING STATEMENTS On the Employer portal home page, click the Billing tab, then click the View Billing Statements link. A list of available statements is displayed sorted by due date. Click on a due date to view the Payment Summary for that billing statement. The Summary Information, Advanced Notice of Change, and Bill Premium Detail links are also provided. o Summary Information - lists coverages, previous and current number of lives, current premium, premium adjustments, and premium by class information. o Advanced Notice of Change - view member/dependent changes prior to the effective date of the change. o Bill Premium Detail - lists the premium type, member name, class, location, effective date, reason, and total amount. 49

The Payment Summary screen is displayed. Click on the Download Bill, Print Bill, or Print Page buttons if needed. Please note that it does take a few moments for the billing statement to be converted to Excel or the PDF format. o Download Bill - allows Excel upload format to provide more detailed information from the bill. Including volumes, class, location codes, family indicators, and premiums. o Print Bill - allows the bill in a printable invoice format. Including notices section, coverages for each employee, and continued coverage section for COBRA. o Print Page - allows you to print the Payment Summary, Summary Notice, Advanced Notice of Change or Bill Premium detail on an individual basis. Click on List of Bills to return to the View Billing Statements listing. 50

BILLING HOW TO RECALCULATE YOUR BILLING STATEMENT You can click the Recalculate Bill button to request a revised billing statement for the most current unpaid due date only. Once the bill has been recalculated a message will appear on the Employer s Home Page advising them to view the estimated bill. 52

The revised statement appears on the View Estimated Bill link to review. It may take up to 24-48 hours to recalculate your bill. You must view and accept this bill before it will be used as a replacement for your current bill. The revised bill will appear on the Current Bill tab. 53

BILLING HOW TO MAKE A PAYMENT On the Employer portal home page, click the Billing tab, and then click Make a Payment. Enter the Bank Account Information (Account Name, Bank Name, Transit Number, Account Number). Enter Payment Information (the date of withdrawal is automatically displayed and cannot be changed, select the due date to pay or select to pay another amount and enter the amount, select to receive email notification). 54

Click Continue. Verify the payment information, and then click Submit. Please note: if you need to cancel a premium payment that was submitted via Guardian Anytime, please contact us at 1-800-627-4200 the same business day (or the following business day if the payment was submitted over the weekend or on a holiday). 55

BILLING HOW TO MAKE A PAYMENT ALTERNATE FUNDED On the Employer portal home page, click the Billing tab, and then click Make a Payment. Enter the Bank Account Information (Account Name, Bank Name, Transit Number, Account Number). Enter Payment Information (the date of withdrawal is automatically displayed and cannot be changed, select the due date to pay or select to pay another amount and enter the amount, select to receive email notification). 56

Please note: Guardian's Unique Identifiers for electronic banking and payments through Guardian Anytime are below. These numbers are for security protection when handling electronic bank transactions, and may be requested by your bank. o Guardian Anytime Online Payment 9555837002 o Guardian Anytime Online Payment Alternate Funded Claims Invoice 1135123390 Click Continue. Verify the payment information, and then click Submit. Please note: if you need to cancel a premium payment that was submitted via Guardian Anytime, please contact us at 1-800-627-4200 the same business day (or the following business day if the payment was submitted over the weekend or on a holiday). 57

BILLING HOW TO ESTABLISH AUTOMATIC EFT PAYMENTS On the Employer portal home page, click the Billing tab, and then click Make a Payment. Enter the Bank Account Information (Account Name, Bank Name, Transit Number, and Account Number). Enter Payment Information (the date of withdrawal is automatically displayed and cannot be changed, select the due date to pay or select to pay another amount and enter the amount, select to receive email notification). 58

Please note: Guardian's Unique Identifier for electronic banking and payments through Guardian Anytime is below. This number is for security protection when handling electronic bank transactions, and may be requested by your bank. o Guardian Anytime Online Payment 9555837002 Click Continue. Verify the payment information, and then click Submit. Please note: if you need to cancel a premium payment that was submitted via Guardian Anytime, please contact us at 1-800-627-4200 the same business day (or the following business day if the payment was submitted over the weekend or on a holiday). 59

BILLING HOW TO VIEW YOUR PAYMENT HISTORY On the Employer portal home page, click the Billing tab, and then click View Payment History. The Payment History screen is displayed and includes the payment due date, check number, amount billed, amount paid, posting date, and any outstanding amount. The Payment History can be emailed or printed by clicking on the appropriate button. 60

BILLING HOW TO CHANGE YOUR BILLING OPTION On the Employer portal home page, click the Billing tab, and then click Change Billing Option. Select Yes or No to receive a paper copy of the billing statement, and then click Update Paper Bill Option. Select the option for volumes to appear or not to appear on billing materials, then click Update Volume Option. 61

GROUP INFORMATION OR PLAN CHANGES HOW TO MAKE GROUP INFORMATION OR PLAN CHANGES On the Employer portal home page, click the Group Information/Plan Changes From the Request Plan Changes Tab, select the type of change that apply and complete the required fields. 62

Hovering over each option will provide you with an overview of what that type of change involves Select from the list or if you don t find exactly what you need, select Other Change for more options 63

GROUP INFORMATION OR PLAN CHANGES DEPENDENT AGE LIMITS CHANGES On the Employer portal home page, click the Group Information/Plan Changes Review the current plan information and then click on Request Plan Changes Select Dependent Age Limit Change and click Continue 65

Complete the additional fields that apply to the change If you have dependent whose eligibility will be impacted by the change, you may enter them at this time Click Continue 66

Complete the Additional Information section and add any attachments such as proof of student status if applicable and click Continue. 67

Review the requested changes. You can expand the boxes for more information. Edit if needed You can Pend, Cancel or Submit the change Your transaction will not be completed until you click on Submit If you need to Pend the transaction the following instruction will appear 68

GROUP INFORMATION OR PLAN CHANGES PLAN NAME, ADDRESS, OR CORRESPONDENT CHANGES Select Request Plan Changes and the requested effective date of the change. Complete required fields and click Continue 69

Complete the additional fields that apply to the change and click Continue 70

Complete the Additional Information section and add any attachments if applicable and click Continue. 72

GROUP INFORMATION OR PLAN CHANGES OPEN ENROLLMENT CHANGES Select Request Plan Changes and the requested effective date of the change. Complete required fields and click Continue 74

Select the type of change and enter the dates that apply Complete required fields and click Continue 75

Complete the Additional Information section and add any attachments such as enrollment forms and click Continue 76

GROUP INFORMATION OR PLAN CHANGES HOW TO TERMINATE COVERAGE Select Request Plan Changes and the requested effective date of the change Complete required fields and click Continue 78

Select the type of coverage to terminate You can terminate a benefit for the entire group or just for a particular class of employees. Click Continue 79

Complete the Additional Information section and add any attachments such as a new carrier acceptance letter. 80

GROUP INFORMATION OR PLAN CHANGES WAITING PERIOD CHANGES Select Request Plan Changes and the requested effective date of the change Complete required fields and click Continue 82

Select the group of employees and benefits Select New Waiting Period using the See Example link for additional information Click Continue 83

Complete the Additional Information section and add any attachments if applicable and click Continue 84

GROUP INFORMATION OR PLAN CHANGES OTHER PLAN CHANGES On the Employer portal home page, click the Group Information/Plan Changes Review the current plan information and then click on Request Plan Changes Select Other Change and click Continue 86

This brings up a list of change options. Hovering over each option will provide you with an overview of what that type of change involves Select from the list or if you don t find exactly what you need, select Other Not Listed Above Enter details about the change as needed and click Continue 87

GROUP INFORMATION OR PLAN CHANGES AFFILIATE CHANGES Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 88

From the selection list click on Affiliate and select the type of change that fits your need. You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 89

Complete the Additional Information section and add any attachments if applicable and click Continue 90

GROUP INFORMATION OR PLAN CHANGES ANNIVERSARY OR RENEWAL DATE CHANGES Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 92

From the selection list click on Anniversary and/or Renewal date You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 93

Complete the Additional Information section and add any attachments if applicable and click Continue 94

GROUP INFORMATION OR PLAN CHANGES CLASSIFICATION CHANGES Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 96

From the selection list click on Classifications You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 97

Complete the Additional Information section and add any attachments if applicable and click Continue 98

GROUP INFORMATION OR PLAN CHANGES DOMESTIC PARTNERSHIP CHANGES Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 100

From the selection list click on Domestic Partnership You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 101

Complete the Additional Information section and add any attachments if applicable and click Continue 102

GROUP INFORMATION OR PLAN CHANGES EARNINGS DEFINITION FOR SALARY BASED COVERAGE(S) Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 104

From the selection list click on Earnings Definition for Salary Based Coverage(s) You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 105

Complete the Additional Information section and add any attachments if applicable and click Continue 106

GROUP INFORMATION OR PLAN CHANGES CHANGING HOURLY WORK REQUIREMENTS Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 108

From the selection list click on Hourly Work Requirements You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 109

GROUP INFORMATION OR PLAN CHANGES CHANGES TO ID CARDS Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 110

From the selection list click on ID Cards and select the type of change that fits your need. You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 111

Complete the Additional Information section and add any attachments if applicable and click Continue 112

GROUP INFORMATION OR PLAN CHANGES CHANGING REDETERMINATION DATE FOR SALARY BASED COVERAGE(S) Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 114

From the selection list click on Redetermination Date for Salary Based Coverage(s) You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 115

Complete the Additional Information section and add any attachments if applicable and click Continue 116

GROUP INFORMATION OR PLAN CHANGES CHANGING REHIRE PROVISIONS Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 118

From the selection list click on Rehire Provision You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 119

Complete the Additional Information section and add any attachments if applicable and click Continue 120

GROUP INFORMATION OR PLAN CHANGES TPA (THIRD PARTY ADMINISTATOR) Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 122

From the selection list click on TPA (Third Party Administrator) You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 123

Complete the Additional Information section and add any attachments if applicable and click Continue 124

GROUP INFORMATION OR PLAN CHANGES CHANGES TO TAX IDENTIFICATION NUMBERS Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 126

From the selection list click on Tax ID You can hover over the selections to view a pop up box with additional information regarding the options available Enter details about the change as needed and click Continue 127

Complete the Additional Information section and add any attachments if applicable and click Continue 128

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GROUP INFORMATION OR PLAN CHANGES ALL OTHER CHANGES Use this option when none of the other options meet your needs Select Request Plan Changes and the requested effective date of the change. Select Other Changes and click Continue 131

From the selection list click on Other Not Listed Above Enter a detailed description of the changes needed and click Continue Please note that some changes such may require a rate change 132

Complete the Additional Information section and add any attachments if applicable and click Continue 133