DELTA VISION

1. DELTA VISION Complete Dental/Vision form. If they want vision, complete vision section. If they don’t want it, leave it blank. Make sure they sign and date the bottom of the form. On Date of hire you will enter their hire date, or if they are a category change put full time start date.

2. DELTA DENTAL • Complete Dental/Vision form. If they want dental, complete dental section. If they don’t want it, leave it blank. Make sure they sign and date the bottom of the form. On Date of Hire you will enter their hire date, or if they are a category change put full time start date.

3. LINCOLN FINANCIAL • Everyone is automatically signed up for $20,000 Life, Short & Long Term insurance. Have them complete the beneficiary formfor life. • You have to offer them Voluntary Life during benefit time. They complete the Lincoln enrollment form check YES by the type of coverage if they want it.Complete the amount they want, on the back have them list their beneficiary, check request coverage, then print, sign and date. • If they do not want to pick up the voluntary life insurance, have them complete the top with their name and address, check NO by type of coverage, on the back have them check NOT ENROLL then print, sign and date.

4. 5 STAR TERM LIFE • During their benefit time tell them about 5 Star, if they want it have them complete the from. If they don’t ,they don’t have to complete anything. • They will not be able to pick up 5 Star again till open enrollment in March.

5. HEALTH ADVANTAGE • Category 1E receive Health Advantage. If they want coverage have them complete section 1,2,3,4, & 5 then print, sign and date. Section 5. if they check YES they need to get a creditable coverage letter form there old insurance. company. • If they are waiving cover have them complete sections1, 4 & 7 then print, sign and date. • If they are making any changes complete a change form.

6. ARKANSAS HEALTH NETWORK • We need a copy of their Driver license and birth certificate. Also, on spouses if they add them. • If they don’t have their birth certificate have them complete the vital records form for HR to order them one. • They have to order their spouses birth certificate if they don’t have one. • An income chart is listed so you can let them know what it will cost to cover their spouse. • If they don’t have health insurance they can’t waive coverage. • Category 1I receive ARH. Go over the information packet of what benefits are covered. Have them complete an enrollment form. If they are taking insurance have them select the coverage they want, complete the first page, for household list spouse and everyone under 19, on the second page they will list all income including spouse, sign the two authorization sections. • If they already have insurance have them check waived, complete employee information on the front page complete waiver section check why and sign. • If they want to add their spouse they can, children are not covered.

7. FIDELITY • Category 1E and 3E are eligible for 401K. • Have them complete an enrollment form and beneficiary form. • They can start contributing after 30 days, Pathfinder will not start contributing their 5% till after 6 month of employment, either Jan 1 or July 1. • They have to list their spouse as primary if they are married and NO ONE under 18.

8. 5% SAVINGS • Category 1I, 2I and 3I are eligible for the 5%. • Patricia Walker will send out an election form to all eligible persons. • After working 6 month as a 1I, 2I, or 3I your 5% will kick in to how you selected it. • 5% will go into effect Jan 1 or July 1.