Eligible Employees

You may enroll in the benefits program if you are:

• A regular employee working 30 hours or more
• Employed Nidec Motor Corporation dba The Imperial Electric Company
• A member of the Local Union 1587 of the International Brotherhood of Electrical Workers, AFL-CIO henceforth referenced as Middleport Union

Eligible Dependents

Eligible dependents generally include your legally married spouse and children up to age 26. Children may include natural, adopted, step-children, or children obtained through court-appointed legal guardianship.

Social Security Number Required

You must provide a valid Social Security number for yourself and each enrolled dependent. Employers are required to provide names and SSNs to the federal government for each individual enrolled for medical coverage.

Dependent Eligibility Verification is Required

As an employee covering dependents on the Nidec medical plan, you are required to provide proof of eligibility for all dependents you choose to enroll in benefits. We understand that this process requires both time and effort on your part and want you to know that we are here to help you through this process.

As part of our continued efforts to manage health and welfare costs, we are verifying eligibility for coverage for each of your dependents listed on the enclosed Cover Sheet. Instructions on verification requirements and how to submit documentation are also enclosed. To determine who is considered an eligible dependent, refer to the “Dependent Classification and Document Requirements” section.

To help ensure there are no delays in your dependent(s) benefit coverage, you must submit the proper documentation to verify your dependent’s eligibility within 30 days of enrolling your dependents in Nidec benefits.

You must load your documents in Workday and then send an email to [email protected] letting us know that the documents have been uploaded for review and approval.  Please provide an email address where we can reach you regarding the status of your submission.

Please note: if you do not submit the proper documentation to verify your dependent(s) eligibility by the deadline listed above, your dependent(s) will be removed from the Plan. Please ensure you comply by submitting your documentation in a timely manner.

How Do I Certify My Dependents?

STEP 1: Review the list of the dependents you have enrolled and match each of them to a dependent type listed in the “Dependent Classification and Documents Required” section.

STEP 2: For each dependent type you will find the eligibility requirements and a list of document options required to verify that particular dependent type.

DOCUMENTATION REQUIREMENTS AND THINGS TO REMEMBER

• Black out the first 5 numbers of any social security numbers appearing on any documents
• Documents providing joint ownership are: Mortgage Statements, Credit Card Statements, Bank Statements, and Residential Leasing Agreement listing both party’s names as co-owners. The joint ownership may be established prior to the current year, however the statement provided must be issued within the last 6
• Proof of Marriage must be a government issued marriage license or marriage certificate (not a church issued marriage certificate) including the date of your
• Birth Certificates must be a government issued birth certificate (not hospital issued certificate). A hospital issued birth certificate will ONLY be accepted if the child’s birth occurred within the last 60 days. Please note: You will be required to provide a government issued birth certificate upon request at a later

• Qualified Medical Child Support Orders will suffice in lieu of any other

STEP 3: Once you have matched your dependents to types, gather all the necessary documents and load them to your Workday portal and send an email to [email protected].

Dependent Classification and Document Requirements

You are required to provide:

1. Cover Sheet
2. Certification of Dependent Eligibility for Covered Dependents
3. Items listed in the relevant dependent category listed below