Benefit Plan Eligibility

You are eligible to participate in the Dog Tag Bakery (DTB) Employee Benefits Program if you are classified as a full-time employee regularly scheduled to work at least 30 hours a week.

You are not eligible for the employee benefit plans if you are:

• An employee who is not regularly scheduled to work 30 or more hours per week

• An individual who has signed an agreement, or has otherwise agreed, to provide services to the Company as an independent contractor, regardless of the tax or other legal consequences of such an arrangement

• A leased employee compensated through a leasing entity, whether or not you fall within the definition of leased employee as defined in Section 414(n) of the Internal Revenue Code

Certain plans also permit you to cover your eligible dependents, which include your:

• Legal spouse (unless legally separated) or same/opposite sex domestic partner

• Your child, including:

  • Biological child
  • Stepchild
  • Legally adopted child
  • A child who has been placed with you in anticipation of adoption

Children listed above must be under 26* years of age, regardless of whether that child qualifies as your dependent for federal income tax purposes.

In addition, you can also cover the following dependents if they are claimed as your dependent for federal income tax purposes:

• Your domestic partner’s child**

• A child for whom you are the legal guardian/legal custodian

* Dependent children can have medical coverage until the end of the calendar year they attain age 26.
** Special guidelines apply when covering a domestic partner or the child of a domestic partner. Contact Human Resources for additional information.

Your dependent children who are age 26 or over and physically or mentally incapable of self-support may continue coverage beyond age 26 if they remain totally incapacitated and dependent on you for support.

If your spouse/domestic partner works for the Company, either you or your spouse/domestic partner can elect to cover your dependent children, but not both of you. Your dependent (spouse/domestic partner or child) is not eligible if they are covered as an employee, on active duty in the military service of any country or if you are not enrolled for coverage.

Initial Eligibility Period

You have a certain time frame to enroll yourself and your eligible dependents for coverage. This initial eligibility period begins on your employment date and ends 30 days after that date. If your enrollment is not completed on or before the end of your initial eligibility period, you will have to wait until the next Open Enrollment period to change your benefit elections (except as summarized in the section below titled Making Changes During the Year).

Special enrollment rules apply if you terminate employment and are then rehired. Contact Human Resources for additional information.

How to Enroll

Enrolling into the benefit programs is easy! Shortly after you are hired, you will receive an enrollment package from Human Resources providing detailed enrollment instructions:

• Medical: Activate your account on DC Health Link at www.dchealthlink.com and then make your coverage elections, even if you are waiving coverage.
• Dental and/or Vision: Complete the CareFirst Enrollment Form and submit it to Human Resources.
• Life and Accident: Complete the RSLI Enrollment Form and submit it to Human Resources. Under certain circumstances, you may also have to provide evidence of insurability. You should also fill out a Beneficiary Form and return it to Human Resources.

If you enroll any dependents, you need their name, Social Security number and date of birth. You must also provide supporting documentation (e.g., birth certificate, marriage license, etc.).

If you need assistance enrolling for benefits, contact Human Resources.

When Coverage Begins

Effective Date of Coverage For Selected Events

Plans	New Hire Enrollment	Qualifying Event (Reported within 30 days)	Open Enrollment
Medical	First of the month following or coinciding with date of hire	First of the month following qualifying event (birth or adoption is date of qualifying event)	February 1 following Open Enrollment
Dental, Vision	First of the month following date of hire	First of the month following qualifying event (birth or adoption is date of qualifying event)	February 1 following Open Enrollment
Life and Accident	First of the month following or coinciding with date of hire	First of the month following qualifying event (birth or adoption is date of qualifying event)	February 1 following Open Enrollment

Making Changes During the Year

Generally, after you have made your benefit plan elections, you may change those elections only during the next Open Enrollment period. However, if you experience a qualifying event or other allowable event during the year, you may change certain benefit plan elections before the next Open Enrollment period by contacting Human Resources and providing the required supporting documentation.

Your new election must be on account of the event and must correspond with that gain or loss of coverage. A qualifying event is defined as an event that results in the gain or loss of eligibility by you or your dependents. For example:

• A change in legal marital status

• A change in number of dependents

• A change in employment status

• Your dependent satisfies or ceases to satisfy the requirements for dependents, including a domestic partner or domestic partner’s child

• A change in residence or worksite by you or your dependent that causes a loss or gain of coverage

The rules regarding changes after your new hire enrollment and the Open Enrollment period are very specific; therefore, you should contact Human Resources if you require assistance.

Special Enrollment Rules

If you originally declined health coverage because you had other health coverage, you may be eligible to change your elections under the following circumstances:

• If the other coverage was COBRA and it is now exhausted; or

• The other coverage was not COBRA and either the coverage terminated due to loss of eligibility or employer contributions toward such coverage terminated. Loss of eligibility includes legal separation, divorce, death or termination of employment

• The other coverage was Medicaid or state Child Health Insurance Program (CHIP) and coverage terminated due to loss of eligibility

• You or your dependent becomes eligible for state premium assistance under a Medicaid or CHIP plan (This is an optional state program under Medicaid or CHIP that pays the employee’s share of the premium for group health plan coverage)

If your dependents also had other health coverage and lost that coverage in the above situations, they may be added to your coverage. However, you will not be able to add yourself or your dependents to this coverage if the other coverage was terminated for cause (including failure to timely pay the required premiums).

In addition to the changes described above, you may enroll yourself and your spouse (with or without the new dependent) in a health plan following marriage or the adoption, placement for adoption or birth of a child. You must be enrolled in order to cover your dependents.

Special Enrollment Procedure

You must enroll for coverage within 30 days of the special enrollment event (60 days for CHIP). Supporting documentation must be provided to Human Resources.

If you enroll and provide the required documentation within this period, the effective date of coverage will be the date of the special enrollment event. Your paycheck contributions will be deducted retroactive to the date of the special enrollment event.

If you do not enroll and provide supporting documentation within 30 days of the special enrollment event (60 days for CHIP), you may not enroll until the next Open Enrollment period.

For more information on how your benefits are affected by these life changes, contact Human Resources.

When Coverage Ends

The following table shows the dates your coverage ends under the various employee benefit plans:

Benefit Plans	Last Day of Coverage
Medical, Dental, Vision	On the last day of the month in which your employment or benefits eligibility ends
Life and Accident	On the last day in which your employment or benefits eligibility ends

• Medical, Dental and Vision coverage for your dependent spouse will end on the earlier of the end of the month:
- Your coverage ends; or
- Your dependent spouse no longer meets the definition of an eligible dependent.
• Medical coverage for your dependent child will end on the earlier of the end of the month:
- Your coverage ends; or
- Your dependent child no longer meets the definition of an eligible dependent.*
• Dental and Vision coverage for your dependent child will end on the earlier of the end of the month:
- Your coverage ends;
- Your dependent child no longer meets the definition of an eligible dependent; or
- The end of the month in which your child attains age 26.
* A dependent child who no longer meets the definition of an eligible dependent due to attaining age 26 will be permitted to continue Medical coverage until the end of the calendar year (i.e., December 31). This extension of coverage until the end of the year does not apply to Dental or Vision coverage.

Under certain circumstances, you may be able to continue certain benefit coverage for yourself and your dependents through COBRA.

The life and accident insurance policies contain both conversion and portability provisions that may allow you to continue coverage – you must request it from Human Resources and apply within 31 days of your benefits termination date.