Initial Cobra Notification
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Eligibility
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Medical
Dental
Vision
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Coverage Levels
 
For each health plan (medical, dental, vision) in which you enroll, you will also select a coverage level from the following categories:

    Employee only
    Employee + Spouse
    Employee + Child(ren)
    Employee + Spouse + Child(ren)
    Employee + Domestic Partner
    Employee + Domestic Partner + Child(ren)

Default Plan
If you do not enroll or do not waive your coverage options when you are first eligible for benefits, you will be enrolled in the Default Plan. Once enrolled in this plan, you will not be able to elect dependent coverage unless you experience a
qualifying event or until the next Open Enrollment period.