• Spousal Coverage Eligibility

    Important Notice Regarding Your Medical Insurance

  • In order to determine whether your spouse can be covered as your dependent, under the ATOMIC Design, Inc. Health plan, please provide answers to the following questions.

  • Is your spouse employed elsewhere?*
  • Does your spouse's employer offer medical insurance?*
  • Is your spouse eligible to participate in the medical insurance offered?*

  • Since you indicated that your spouse’s employer offers medical insurance, your spouse is not eligible for coverage under the ATOMIC Design, Inc. plan. Your spouse will need to secure coverage in their company’s medical plan. Your spouse should contact their employer’s HR/Benefits department to enroll in that company’s medical plan during the proper enrollment period.

  • Your spouse is eligible to be enrolled in the ATOMIC Design, Inc. Plan.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: