Eligibility Rules

MDLZ offers health and welfare coverages to Part-Time Sales Service Representatives (PT SSRs) who meet the hours-service requirement.*

As an eligible PT SSR, you may enroll the following eligible dependents for medical coverage:

Your legal spouse
Your same- or opposite-sex domestic partner
Your children

NOTE: If your domestic partner or domestic partner’s child isn't your tax dependent, the full cost of his or her medical coverage is taxable income to you. This amount is “imputed income” and will be included in the income amount shown on your pay statement and W-2 form. Applicable taxes on imputed income will be withheld each pay period.

*An hours-service requirement (i.e., average hours worked during a specified measurement period) applies for PT SSRs. See Newly Eligible for more details. For more information regarding the specific coverages for which you’re eligible and/or enrolled, go to MyBenefits Online.

ELIGIBLE CHILDREN

Your child is eligible for coverage, up to age 26, provided he or she is your (or your spouse's or domestic partner's):

Biological child
Stepchild
Foster child
Legally adopted child, or child placed in your and your spouse's (or your and your domestic partner's) home for legal adoption
Child for whom adoption procedures have started
Child for whom a court has appointed you (or your spouse or domestic partner) as the legal guardian
Child for whom you (or your spouse or domestic partner) have been ordered to cover through a Qualified Medical Child Support Order (QMCSO)

To be eligible for coverage, your spouse's or domestic partner’s child also must be primarily dependent on you (or your spouse or domestic partner) for more than one-half of his or her support and live with you (or your spouse or domestic partner) for more than one-half of the calendar year.

VERIFY YOUR DEPENDENTS

You're responsible for ensuring that each individual you enroll for coverage under the Mondelēz Global Medical Plan (Medical Plan) meets the Medical Plan's eligibility requirements at all times. See the "Your Guide to the Mondelēz Global LLC Group Benefits Plan" and the SPDs for specific eligibility requirements (access these in the Reference Center on MyBenefits Online).

Proof of eligibility, including a Social Security Number if you’re enrolling your dependent via MyBenefits Online, will be required within 90 days after enrollment. If your dependent doesn’t have a Social Security Number, you’ll need to call the Mondelēz International Benefits Center at 1-800-887-8807 (Option 1 – Benefits; Option 1 – Health & Welfare Benefits) to add your dependent.

Any misrepresentations or inaccurate information you provide could result in loss of coverage. And, if you cover an individual who isn’t eligible, you may be required to reimburse the Medical Plan for any expense incurred as a result of covering the ineligible individual.

	2025	NEW for 2026
When the Medical Plan Begins to Pay:	$500 Deductible: Immediately $2,000 and $3,500 Deductible: After you satisfy your deductible	All Coverage Options: After you satisfy your deductible
Retail Pharmacy (up to a 30-day supply)
Non-Preventive Drugs	You Pay	You Pay
Generic Drugs	$10 copay	$15 copay
Preferred Brand Drugs	30% (after $25 min/$75 max copay)	30% (after $35 min/$85 max copay)
Non-Preferred Brand Drugs	40% (after $50 min/$100 max copay)	40% (after $60 min/$110 max copay)
Mail Order or CVS Retail Pharmacy (up to a 90-day supply)
Non-Preventive Drugs	You Pay	You Pay
Generic Drugs	$25 copay	$37.50 copay
Preferred Brand Drugs	30% (after $62.50 min/$187.50 max copay)	30% (after $87.50 min/$212.50 max copay)
Non-Preferred Brand Drugs	40% (after $125 min/$250 max copay)	40% (after $150 min/$275 max copay)
Note: Out-of-network prescription drug services aren’t covered

	2025		NEW for 2026
Out-of-Pocket Maximums*	$500 Deductible Option		$750 Deductible Option
Out-of-Pocket Maximums*	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	$3,000	$6,000	$3,250	$6,500
Family	$6,000	$12,000	$6,500	$13,000
* Includes deductible

	2025		NEW for 2026
Out-of-Pocket Maximums*	$2,000 Deductible Option		$2,250 Deductible Option
Out-of-Pocket Maximums*	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	$4,000	$8,000	$4,250	$8,500
Family	$8,000	$16,000	$8,500	$17,000
* Includes deductible

	2025		SAME for 2026
Out-of-Pocket Maximums*	$3,500 Deductible Option		$3,500 Deductible Option
Out-of-Pocket Maximums*	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	$7,000	$14,000	$7,000	$14,000
Family	$14,000	$28,000	$14,000	$28,000
* Includes deductible

	2025		NEW for 2026
Deductibles	$500 Deductible Option		$750 Deductible Option
Deductibles	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	$500	$1,000	$750	$1,500
Family	$1,000	$2,000	$1,500	$3,000