Contents of the Dependents/Beneficiaries Screen

Use the fields and options to configure the Dependents/Beneficiaries Screen.

Identification

This group box displays the employee's name.

Field	Description
View Inactive Individuals/Hide Inactive Individuals	Click this button to display/hide inactive dependents/beneficiaries.
Active	Select this check box if the dependent/beneficiary record is in "Active" status.
First Name	Enter the first name of the individual.
Middle Name	Enter the middle name of the individual. This field is optional.
Last Name	Enter the last name of the individual.
SSN / Government ID	Enter the Social Security Number or government ID of the individual.
Relationship	From the drop-down list, select individual's relationship to you.
Other Relationship	If "Other" was selected from the Relationship drop-down list, this field displays information entered about the nature of the relationship. Note: This field is editable only from the Dependents/Beneficiaries tab in either the Perform Benefit Enrollment or Perform Life Events application.
Type	Options under Type indicate whether the individual is a dependent and a beneficiary, a beneficiary only, or a dependent only. Note: This field is editable only from the Dependents/Beneficiaries tab in either the Perform Benefit Enrollment or Perform Life Events application.
Gender	This field displays the gender of the dependent/beneficiary. Note: This field is editable only from the Dependents/Beneficiaries tab in either the Perform Benefit Enrollment or Perform Life Events application.
Date of Birth / Agreement	This field displays the date of birth (or date of legal agreement/document) of the dependent/beneficiary.
Student	This check box indicates if the dependent/beneficiary is a student and may be eligible for coverage.
Handicapped	This check box indicates if the dependent/beneficiary is handicapped and may be eligible for coverage.
Same Address as Employee	Select this check box when the dependent/beneficiary's mailing address is the same as yours.
Street 1	Enter up to a 30-character, alphanumeric street address, line 1, for the dependent/beneficiary.
Street 2	Enter up to a 30-character, alphanumeric street address, line 2, for the dependent/beneficiary.
Street 3	Enter up to a 30-character, alphanumeric street address, line 3, for the dependent/beneficiary.
City	Enter up to 25 alphanumeric characters for the dependent/beneficiary's address city.
State/Province	Click to select the state/province for the address entered/displayed on the screen. The valid values the states/provinces set up in Costpoint for the selected country.
Postal Code	Enter up to a 10-character, alphanumeric postal code for the dependent/beneficiary.
Postal Code Format	This field shows acceptable format of the value that you enter in the Postal Code field. This is based on the Postal Format option selected on the Configure Self Service Settings screen.
Country	Click to select the country for the address entered/displayed on the screen. The valid values are the countries set up in Costpoint. If you make a different selection in the Country field, the State/Province drop-down box will repopulate with valid values based on the country selected.
Home Telephone	Enter up to 25 alphanumeric characters for the dependent/beneficiary's home telephone information.
Home Format	This field displays the acceptable format for the value that you enter in the Home Telephone field. This is based on the Phone Format option selected on the Configure Self Service Settings screen.
Office Telephone	Enter up to 25 alphanumeric characters for the dependent/beneficiary's business telephone information.
Office Format	This field displays the acceptable format for the value that you enter in the Office Telephone field. This is based on the Phone Format option selected on the Configure Self Service Settings screen.