2024-BenefitsGuide-V16-Final

Reliance Rewards Dependent Verification

To enroll your eligible dependents, you must submit proof of eligibility for each dependent. The table below gives some examples of acceptable documentation for dependent eligibility verification. Failure to verify will result in termination of benefits retroactive to your dependent’s initial enrollment date.

ELIGIBLE DEPENDENT

REQUIRED DOCUMENTATION

Spouse Includes same gender

Marriage certificate AND Proof of Joint Ownership; OR Prior year state or federal tax return (Extension Form 4868 for current year) Reliance Rewards Affidavit for Domestic Partnership, Common Law Marriage and Civil Unions (Notarized) AND Proof of Joint Ownership AND , where applicable by law a Certification of Tax Status Reliance Rewards Affidavit for Domestic Partnership, Common Law Marriage and Civil Unions (Notarized) AND Proof of Joint Ownership AND , where applicable by law a Certification of Tax Status

Common Law Spouse Where allowed by law

Domestic or Civil Union Partner The employer cost of the benefits for domestic or civil union partners and the children of domestic or civil union partners or other covered dependents may be considered taxable income. Children Under age 26 (covered through the end of their birth month). Natural children, stepchildren, legally adopted children, children who are placed in your home for adoption, and children of your domestic or civil union partner. For the children of your domestic or civil union partner to be eligible, your domestic or civil union partner must also be enrolled in Reliance Rewards

Proof of parent/child relationship, such as:

• Birth certificate showing the child’s parents • Official hospital record showing the child’s parents • Court-approved adoption papers (with signature or seal) • Qualified Medical Child Support Order (QMCSO)

Children Under Legal Guardianship Eligible to age of majority

Legal Guardianship papers (with signature or seal) AND proof of financial support

Disabled Adult Children Age 26 and older andwas disabled prior to age 26. Themedical carrier determines the disabled status under the Plan.

Proof of parent/child relationship AND Proof of financial support AND Proof of residency

Working Spouse Provision

The WSP APPLIES if your spouse/domestic partner: • is employed full-time, AND • is eligible to participate in their employer’s group medical plan, AND • elects not to participate in their employer’s group medical plan, AND • chooses to enroll in the Reliance Rewards medical plan The WSP DOES NOT APPLY if your spouse/domestic partner: • is not employed, OR • is employed part-time, OR • is not eligible to participate in their employer’s group medical plan, OR • is enrolled in their employer’s plan, OR • alsoworks for Reliance or another participating employer under the plan

On average, Reliance pays over 91% of the claims costs for our medical/pharmacy plans, this is significantly above the industry average for our size of company. Your payroll contributions are also well below the industry average. Your low cost, rich plan is a great value and is there when you need it. To keep our costs down, the Working Spouse Provision (WSP) rate is an additional $200 per month. IF YOU ARE ENROLLING YOUR SPOUSE/ DOMESTIC PARTNER IN MEDICAL COVERAGE, REVIEWWHETHER OR NOT THE WSP APPLIES TO YOU. IF YOU DO NOTHING, THEN THE WSP RATE WILL BE ADDED TO YOUR PAYROLL CONTRIBUTIONS.

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