General
| Field | Description |
|---|
| First Name
|
This field displays the first name of the dependent/beneficiary.
|
| Middle Name
|
This field displays the middle name of the dependent/beneficiary.
|
| Last Name
|
This field displays the last name of the dependent/beneficiary.
|
| SSN / Government ID
|
This field displays the dependent/beneficiary's social security number or government ID number.
|
| Relationship
|
Use this drop-down list to select the relationship of the dependent/beneficiary to you.
|
| Other Relationship
|
In this field, you can enter the other relationship of the dependent/beneficiary to you. This field will be enabled if you select
Other in the
Relationship drop-down list.
Note:
If you select
Other in the
Relationship drop-down list, the
Other Relationship field will be required. If you do not enter a value, the system will display the following message: "Other Relationship is required when "Other" is selected as the Relationship."
|
| Gender
|
Use this drop-down list to select the gender of the dependent/beneficiary.
|
Type
Select the applicable option: Dependent & Beneficiary,
Beneficiary Only, or
Dependent Only.
Status
Select the
Student and
Handicapped check boxes, if applicable, for the dependent/beneficiary.
| Field | Description |
|---|
| Date of Birth / Agreement
|
This field displays the date of birth (or date of legal agreement/document) of the dependent/beneficiary.
|
Address
| Field | Description |
|---|
| Same Address as Employee
|
Select this check box when the dependent/beneficiary's mailing address is the same as yours.
Note:
Changes to employee address should be made from Address/Telephone information
|
| 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 a 25-character, alphanumeric city for the dependent/beneficiary.
|
| State/Province
|
|
Telephone
| Field | Description |
|---|
| Home
|
Enter up to 25 alphanumeric characters for the dependent/beneficiary’s home telephone information.
|
| Office
|
Enter up to 25 alphanumeric characters for the dependent/beneficiary’s business telephone information.
|
| Reset
|
Select this button to reset any changes made and return to what was in the system when you first entered the screen (before making any changes).
|
