Eligibility

Eligible Employees

You are eligible to participate in Xerox’s benefits program if you are a U.S. employee regularly scheduled to work at least 30 hours per week.

Certain temporary and part-time employees (except for certain cases in Hawaii), independent contractors, leased employees, supplemental contract workers, consultants, agents, other third party personnel, or employees covered by a collective bargaining agreement not expressly providing for eligibility, are not eligible to be covered by the Xerox plans and programs, unless they are eligible dependents.

Eligible Dependents

You may enroll your eligible dependents for medical, dental, vision, optional insurance benefits, dependent life insurance, and/ or dependent accidental death and dismemberment (AD&D) coverage.

Your eligible dependents include:

• Spouse or domestic partner* (same or opposite gender), who does not have access to medical coverage through their employer’s plan
• Biological and legally adopted child(ren)
• Covered spouse’s or domestic partner’s child(ren)* (as long as you cover your domestic partner too)
• Children who have been placed with you for adoption
• Stepchildren
• Foster children
• Children for whom you are the court-appointed legal guardian
• Disabled children who became disabled on or before age 26 or are covered as a result of a qualified medical child support order (QMCSO)

Note: Children are eligible up to age 26 regardless of student status, marital status, financial support, or whether they live with you.

*You may be required to complete a Domestic Partner Declaration (Affidavit) and submit it to the Xerox Benefits Center for your domestic partner and/or your domestic partner’s eligible dependent children, if you enroll them in Xerox benefit plans.

No other individuals are eligible for coverage, including parents, grandchildren, your child’s spouse, or other relatives.

You are responsible for ensuring that all covered dependents are eligible, and you must be prepared to submit documentation of your relationship with any dependent you elect to cover. If you enroll someone as a dependent who is not an eligible dependent under the terms of the plan, such as a child over the age limit, child’s spouse, former spouse, or anyone else not eligible under the plan, the ineligible individual will not be covered by the plan for any expenses or benefits, and you will be required to repay all applicable costs to the plan. If you don’t notify the plan that an individual is or has become ineligible in a timely manner, the individual could lose his or her ability to continue coverage under COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended). Additionally, consequences of continuing to cover an ineligible dependent is considered fraud. Intentional misrepresentation of you and your dependents' coverage may be terminated, including retroactively, and could result in disciplinary action, up to and including termination of employment.