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GGFM-ER-8514 Maxwell Health Employer Information Form 02/24 <br /> Contract and administrative options for Sun Life benefits, continued <br />C.If an employee who is not initially eligible (part-time, not in a benefits eligible class, etc.), but laterbecomes eligible for Sun Life benefits, do you want their time already spent as an employee tocount towards their waiting period? ...................................................................................................... Yes No <br />If “Yes,” service time always includes full time: <br />Will time spent as part-time employee also be included? ..................................................................... Yes No <br />If any other time counts, please explain: ____________________________________________________________ <br />(May require Home Office approval.) <br />D.Rehire provision: <br />An employee rehired during this time does not have to complete a new waiting period in order to be eligible <br />for Sun Life benefits. The rehire provision must be the same for all benefits. <br /> 3 months 6 months (standard) 9 months 12 months None Other: __________________ <br />E.Age changes take effect as follows for Sun Life benefits: (select one within each category) <br />Age reductions apply ........................ Yes No <br />If “Yes,” when does the age reduction changes for Life <br />insurance and Critical Illness take effect: <br /> Immediately <br /> Annually on policy anniversary <br />Age band rates apply ......................... Yes No <br />If “Yes”, when does the age banded premium (step- <br />rate) changes take effect: <br /> Immediately <br /> Annually on policy anniversary <br />Changes in age that trigger a new premium rate for age-band rated Voluntary products typically occur on the <br />policy anniversary. <br />F.Section 125 Plan: <br />Do you have a Section 125 Plan? ........................................................................................................ Yes No <br />If “No,” proceed to next section. <br />If “Yes,” please indicate which coverages are included: _____________________________________________ <br />G.Annual enrollment for Sun Life benefits: <br />Note: Annual Enrollment is required for Sun Life Dental, Vision, Critical Illness, Cancer Indemnity, Accident <br />and Hospital Indemnity. <br />Do you allow changes only during your annual enrollment period (excluding qualifying event)? ........ Yes No <br />If “Yes,” please specify when you administer your annual enrollment period. <br /> The calendar month prior to the policy anniversary (standard) <br /> Other (not to exceed 30 days) Start Date _____________ End Date _____________ <br />When do annual enrollment changes take effect? <br /> Policy anniversary <br /> Other: __________________________________ <br />Decreases in insurance take effect: ............................................................ Immediately At annual enrollment <br />If “No,” please specify when changes to elections should take effect: <br /> Immediately (standard) <br /> First of the month following <br /> First of the month coincident with or next following <br />Docusign Envelope ID: BA987120-63B9-40BD-A4CA-C6E248AD9B65 <br />X <br />X <br />X <br />10/15 <br />X <br />X <br />X <br />X <br />X <br />X <br />90 days <br />11/15 <br />X X