NAF BENEFIT ORIENTATION CHECKLIST

03/2019

*Failure to make opt out of the defined benefit plan will result in an automatic enrollment in the Plan. Employee contributions will not be refunded until

employment is terminated or changed to flexible status.*

Important Affordable Care Act (ACA) information such as healthcare Marketplace coverage options and Individual Mandate requirements can be

found at www.nafhealthplans.com or at www.healthcare.gov to view the Department of Labor notice on the requirements of the ACA Individual Mandate.

□ I understand I only have 31 days from my date of hire/status change to enroll in the medical, dental, life, FSA and/or short term disability plans. □ I understand I can enroll or opt out of enrollment in 401k by contacting/notifying Fidelity the Wednesday following my 1st paycheck. □ I understand I only have 90 days from my enrollment date in the Group Retirement Plan to exercise my military service credit buy back opportunity. □ I understand I only have 31 days from my enrollment date in the Group Retirement Plan to exercise refunded service credit buy back opportunity. I have been advised of the benefits in which I am eligible to enroll: ____________________________________________________ ______________20___ Signature Date

Employee Eligibility Full-Time/Part- Time Non-Appropriated Fund Civilian Employees

Dependent Eligibility Who can be covered under medical, dental and life

Dependent Coverage Qualifications – age limits- required documentation and what documentation is required

Medical Plans Aetna or HMO

Aetna Medical Plan Aetna Choice POS II or Aetna International (Available at Japan commands only)

Health Maintenance Organization (HMO) Medial Plans

Coverage is available in specific locations (Hawaii, California and Mid-Atlantic) Kaiser and HMSA

JELLYVISON An interactive tool which explains all plans

Medical Premiums Medical premiums based on coverage and paid on bi-weekly basis

Dental Plans Aetna or HMO

Aetna Dental Plans Aetna PPO Dental or SAD

Health Maintenance Organization (HMO) Dental Plans

Coverage is available in specific locations (Hawaii) Kaiser and HMSA

Dental Premiums Dental premiums based on coverage and paid on biweekly basis

Premium Conversion (Section 125) Qualifying Life Events; Opting out of Section 125

Life Insurance Standard Life Insurance and Accidental Death & Dismemberment (AD&D)

Life Insurance Premiums Life premiums are based on salary. If unsure ask your HR representative for your premium

Optional Life Plans Optional life plans Opt 1 or Opt 2

Optional Dependent Life Plans Dependent Life 1, Dependent Life 2, Dependent Life 3 or Dependent Life 4

Optional and Dependent Life Premiums Optional Life is based on Age. Dependent life is a flat rate.

Flexible Spending Accounts (FSA) Healthcare FSA and Dependentcare FSA

Short Term Disability Disability Income replacement protection (AFLAC)

Long Term Care Plan Federal Long Term Care plan

Employee Assistance Program Magellan

*Retirement Plan NAF Retirement Plan. I elect to enroll in the NAF Retirement Plan on my date of hire ___Y___N

NAF Retirement Refund Buyback I received a refund for my prior Marine Corps NAF Retirement contributions. If yes let your HR rep know you may be eligible for a Retirement Refund Buy Back

___Y___N

NAF Military Buy Back I am interested in a former military Contributory, Military Purchased and Campaign (USERRA creditable service buy back.

___y___N

FERS Military Buy Back I am interested in a former military Contributory, Military Purchased and Campaign (USERRA creditable service buy back.

___y___N

401k Savings Plan Enrollment Options

401k & Pension Plan Comparison Retirement and Savings plans contribution and vesting information

Retirement Portability APF - NAF I Moved From Civil Service – NOTIFY YOUR HR REP KNOW IMMEDIATELY ___Y___N

Retirement Portability NAF – NAF Previous enrollment in other NAFI retirement plans (Air Force, Army, CNIC, AAFES or NEXCOM) prior refund? IF so NOTIFY YOUR HR REP KNOW IMMEDIATELY

___y___N

Benefit enrollment options 499 form or Peoplesoft Self Service

                                                                                                                                                                   

BENEFITS PARTICIPATION ACKNOWLEDGEMENT

This acknowledges that you were made aware that you have:

31 days from the start of your employment/eligibility date to elect participation in the MCCS

Medical Dental Life Insurance

30 days from the start of your employment/eligibility date to elect participation in the MCCS

Disability Protection (AFLAC)

60 days from date of employment/eligibility date to apply for participation in the Federal Long Term Care Insurance Plan (FLTCIP)

Failure to enroll in Medical or Dental within the 31 day eligibility period will result in no opportunity to enroll until the next designated open enrollment period. The only exception to this will be if/when you experience an eligible qualifying event (i.e., involuntary loss of coverage, divorce, etc). Qualifying events are determined by the Internal Revenue Service (IRS).

Failure to enroll in the Disability Income Protection Group plan during your 30 day eligibility period will require that you complete a short Health Care Application Form and be approved by applicable carrier prior to enrollment.

Failure to enroll in the Group Life Insurance plans during your 31 day eligibility period will require that you complete a short Health Care Application Form and be approved by applicable carrier prior to enrollment.

Enrollment in the FLTCIP requires eligible employees apply for enrollment within 60 days of attaining eligibility. Underwriting approval required prior to enrollment. Premiums are paid via direct bill to the FLCIP carrier.

________________________________________________________________________________ 

Signature Date

________________________________________________________________________________ 

Print Name

________________________________________________________________________________ 

HR Representative Date

REQUIREMENTS FOR ADDING DEPENDENTS TO MEDICAL/DENTAL/LIFE PLANS FOR 2012 

  Appropriate documentation must be presented when enrolling dependents into the NAF Benefit Programs.  This applies to dependents of new hires, employees enrolling dependents during the Open Enrollment period and employees with status changes to a benefits eligible position.  Children may be covered under an employee’s medical/dental plan up to age 26 regardless of whether they have access to other employer‐sponsored health care coverage.  Documentation requirements are as follows: 

 

HEALTH PLANS DEPENDENT CHECKLIST Listed below is the information required to add dependents to medical coverage.  Employees are required to 

provide evidence of that dependent’s relationship to the employee. 

DEPENDENT  DOCUMENTATION  DATE RECEIVED  To Add a Spouse  Most Recent 1040 reflecting spouse as a 

dependent  

  If newly married and 1040 is not available a marriage certificate is required 

 

To Add children under age 26  Birth Certificate naming parent  OR    Adoption papers naming parents OR    Official Court documentation naming 

guardianship designation OR  

  1040 showing reflecting child as dependent   

DEPENDENT LIFE PLANS CHECKLIST Listed below is the information required to add dependents to life coverage.  Employees are required to provide evidence of that dependent’s relationship to the employee. 

DEPENDENT  DOCUMENTATION  DATE RECEIVED  To Add a Spouse  Most Recent 1040 reflecting spouse as a 

dependent  

  If newly married and 1040 is not available a marriage certificate is required 

 

To Add children under age 19  Birth Certificate naming parent OR    Adoption papers naming parents OR    Official Court documentation naming 

guardianship designation OR  

  1040 showing reflecting child as dependent  To add children over age 19 ‐ 23  Birth Certificate naming parent OR    Adoption papers naming parents OR    Official Court documentation naming 

guardianship designation OR  

  1040 showing reflecting child as dependent OR     And Full‐time student status   

DISSOLUTION OF RELATIONSHIP Listed below is information required to remove dependents from any type of benefits.   

DEPENDENT  DOCUMENTATION  DATE RECEIVED Spouse  Divorce Decree  Children  Divorce Decree    Court Documents cancelling any 

coverage obligations  

 

 

  REQUIREMENTS FOR ADDING DEPENDENTS TO MEDICAL/DENTAL/LIFE PLANS 

SAME SEX DOMESTIC PARTNER HEALTH PLANS DEPENDENT CHECKLIST Listed below is the information required to add dependents to medical coverage.  Employees are required to 

provide evidence of that dependent’s relationship to the employee. 

DEPENDENT DOCUMENTATION DATE RECEIVED

 To Add a Same Sex Domestic Partner (SSDP) 

Approved affidavit declaring Domestic Partnership or Marriage certificate for states that recognize same sex marriages 

 

  And proof of shared residence (utility bill or 1040) 

 

To Add SSDP children under age 26  Birth Certificate naming parent  OR  

  Adoption papers naming parent OR  

  Official Court documentation naming guardianship designation OR 

 

  1040 showing reflecting child as dependent 

 

 

SAME SEX DOMETIC PARTNER DEPENDENT LIFE PLANS CHECKLIST Listed below is the information required to add dependents to life coverage.  Employees are required to provide 

evidence of that dependent’s relationship to the employee. 

 

DISSOLUTION OF RELATIONSHIP Listed below is information required to remove dependents from any type of benefits.   

DEPENDENT  DOCUMENTATION DATE RECEIVED

SSPD  Dissolution Affidavit or Divorce Decree(for states that recognize same sex marriages) 

Children  Dissolution Affidavit or Divorce Decree (for states that recognize same sex marriages) 

  Court Documents cancelling any coverage obligations 

 

Dependents must be added within 31 days of a qualifying event; otherwise, they must wait for an open enrollment 

period and submit supporting documentation. 

DEPENDENT DOCUMENTATION DATE RECEIVED

 To Add a Same Sex Domestic Partner (SSDP) 

Approved affidavit declaring Domestic Partnership or Marriage certificate for states that recognize same sex marriages 

 

  And proof of shared residence (utility bill or 1040) 

 

To Add SSDP children under age 19  Birth Certificate naming parent OR  

  Adoption papers naming parents OR  

  Official Court documentation naming guardianship designation OR 

 

  1040 showing reflecting child as dependent  OR 

 

To add SSDP children over age 19 ‐ 23  Birth Certificate naming parent  OR  

  Adoption papers naming parents  OR  

  Official Court documentation naming guardianship designation  OR 

 

  1040 showing reflecting child as dependent  OR 

 

  Birth Certificate naming parent   

  And Full‐time student status  

LOG IN LANDING PAGE – CLICK THE BENEFITS TILE

IT WILL TAKE YOU THE BENEFITS SUMMARY PAGE

On this Page click on the Review/Update Your Benefits Link to the left.

The Benefits Information page will open and you can make your benefit elections

Click on the Edit My____ buttons to begin the enrollment process. Health Plan Elections:

Life Plans:

FSA Plans: