Spouse/Domestic Partner Surcharge

New for 2012 Enrollment

If you cover a spouse/domestic partner in a First Data medical plan, you will automatically be assigned to "spousal surcharge applies" and the $900 annual surcharge will be assessed. If you do not qualify for the surcharge, you must complete your enrollment and select "spousal surcharge does not apply" for 2012. The surcharge will automatically be deducted beginning with your first 2012 paycheck, and deductions will not be refunded.

The spousal surcharge is an additional amount you pay for medical coverage if you choose to enroll your spouse/domestic partner in coverage in a First Data medical plan and he/she is eligible for coverage through his/her employer. The additional surcharge amount is $900 per year deducted on a per-pay-period basis.

The spousal surcharge does not apply if:

• You do not enroll your spouse/domestic partner in medical coverage.
• Your spouse/domestic partner is not employed
• Your spouse/domestic partner is employed but is not eligible for medical coverage through his/her employer.
• Your spouse/domestic partner is eligible for and/or is enrolled in Medicare/Medicaid.
• You and your spouse/domestic partner both work at First Data.