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DEPENDENT ELIGIBILITY PROVISIONS

For eligibility purposes, “dependent” includes only an Employee’s:

  1. legal spouse, if not legally separated; and
  2. Dependent child, (includes a legally adopted child or a child placed in your care in anticipation of adoption where the adoption is being actively pursued, foster child, child for whom the Employee is a legal guardian, a step-child, a child who is the subject of a Qualified Medical Child Support Order under age 26.
  3. Additionally, while the employee is eligible, coverage shall continue for any child who is incapacitated beyond age 26. Proof of such incapacity and dependency must be furnished within 31 days after reaching the age limit or becoming initially eligible for Plan benefits and annually thereafter.An incapacitated child is one:

a.)who is dependent on the Employee for support and maintenance;

b.) who has a developmental disability or physical handicap; and

c.) is diagnosed by a Physician as having a permanent or long term disability condition.

Developmental disability means substantial handicap which results from mental retardation, cerebral palsy, epilepsy, or other neurological disorder.

While the employee is eligible, coverage shall continue for any child who is and continues to be both incapable of self-sustaining employment by reason of mental retardation or physical handicap and chiefly dependent upon the employee for support and maintenance.   If dependent is older than 26 as of the commencement date of employee’s eligibility, the employee must submit a doctor’s note that the dependent has been disabled since before his/her 26th birthday.

 A dependent does not include any person:

  1. who is eligible for coverage as an Employee under this Plan, other than your spouse.

 

  1. who is on active duty in the armed forces.

 

To determine eligibility, proof is required as follows:

 

  1. Dependent lawful spouse – a certified copy of a marriage certificate.

 

  1. Natural unmarried children – a certified copy of a birth certificate.

 

  1. Stepchildren – submission of a certified copy of certification of marriage and a copy of the Court Order showing that the spouse has legal custody of the child.
  2. Adopted child – submission of a certified copy of a birth certificate and adoption Decree or court documents reflecting placement for adoption.

 

  1. A child under legal guardianship of the Employee.

 

  1. A child upon submission of a Qualified Medical Child Support Order (QMCSO) that contains the following information:

a.) the name and last known mailing address of the participant and each alternate recipient covered by the Medical Child Support Order

b.) a reasonable description of the type of coverage to be by the plan

c.) the date through which the health benefits are provided

d.) the social security number of the participant and each Alternate Recipient covered by the order.

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