Eligible
Spouse and Dependent Children
Once
you have satisfied the eligibility requirements discussed above, the following
family members qualify as eligible dependents (also referred to as
“dependent” or “dependents”):
- A
lawful spouse, unless legally separated. A lawful spouse means only a
legal union between one man and one woman, as husband and wife.
- A domestic partner subject to satisfaction of certain enrollment and tax prepayment requirements. Please contact the Enrollment Department at the Trust Office for appropriate documents.
- Unmarried
children who are under age 19 and primarily dependent on you for support and
maintenance, and for whom you are entitled to a federal income tax exemption.
The following children qualify as eligible
dependents:
- Natural
children and legally adopted children.
- A
child placed with you for adoption before the adoption is finalized.
- Stepchildren
who live with you.
- Legally
placed children meaning any child dependent by virtue of a court order
specifying that you have legal custody.
- Natural
children born out of wedlock to the male participant if paternity is
established. If paternity is established, the following criteria are used to
establish the effective date of
coverage:
With
Paternal
Acknowledgement
If
the acknowledgement is made jointly with the consent of the natural mother
immediately after birth in connection with the application for the original
birth certificate, the effective date shall be the date of birth. If paternity
is not acknowledged at that time, you must officially acknowledge paternity in
writing and submit such acknowledgement on the form required by the Department
of Vital Statistics to establish yourself as the natural father on the original
or a substitute birth certificate. The effective date shall be the date you
submit the acknowledgement of paternity to the Department of Vital Statistics
for this purpose provided you are named as the child’s father on the
child’s birth
certificate
Without
Paternal
Acknowledgement
If
you do not acknowledge paternity, a court of jurisdiction must enter a judgment
or decree in an action brought to establish paternity, finding that you are, as
a matter of law, the natural father of the child. The effective date shall be
the date of entry of the decree judgement.
A
noncustodial child you are required to cover by virtue of a court or
administrative agency’s issuance of a Qualified Medical Child Support
Order
(QMCSO).
If
a Medical Child Support Order requires you to cover a noncustodial child, the
child’s other parent, legal guardian or a state Medicaid agency may also
have the right to enroll that child as your dependent. The Medical Child Support
Order must show the name and last known address for the enrolled parent and
child, give a reasonable description of the coverage to be provided by the plan,
state the period for which the order applies and specifically state that the
child must be covered under this plan. The plan has procedures for determining
whether a medical child support order is “qualified” within the
meaning of the plan. A copy of these procedures can be obtained, without charge,
from the Trust Office. The request for enrollment must be received within 60
days of the date of the order for a child covered under a Medical Child Support
Order. Coverage for an otherwise eligible child that is required under the order
will become effective on the date of the order if all the eligibility
requirements are met.
-
Unmarried
children ages 19 through 23 if they are full-time students (as determined by the
school) attending an accredited college, university, technical trade, or
mechanical school (this does not include on-the-job training courses,
correspondence schools or night schools) provided the student primarily depends
on you for support and maintenance. Students are eligible during the summer
months as long as they attend school full time before and after the summer.
Proof of student status is required each quarter or semester.
-
Unmarried
children over the age of 19 incapable of self-sustaining employment because of a
developmental or physical disability provided the child primarily depends on you
for support and maintenance, is entitled to a Social Security benefit on the
date his or her eligibility for benefits under this plan would otherwise end,
and is covered under this plan immediately prior to attainment of the limiting
ages above (age 19 or age 24 if a full-time student). Coverage may continue
under this plan for the duration of the disability as long as you continue to be
an eligible participant under this plan. If you need to provide coverage for a
child with a disability, you must submit a copy of the most recent Report of
Confidential Social Security Benefit Information to the Trust Office before that
child reaches the appropriate limiting age. This extension of eligibility does
not include life insurance benefits.
“Primarily
dependent” means you continuously provide more than 50 percent of the
child’s financial support and are entitled to claim the child as a
dependent on your federal income tax return. If you are unable to claim the
child as a dependent for tax purposes because of a divorce settlement, you are
considered to be providing principle support if the child resides with you or
you have been issued a court order to provide substantial support.
The Board of Trustees
reserves the right to request documented proof of dependency at any time.
Whenever documented proof of dependency or any other documentation is requested
by the Trust Office, it must be received within 60 days of the
request.
For circumstances which will
result in a loss of eligibility for a spouse or a dependent child, please see Suspension of
Eligibility For Noncovered Employment
and Termination of
Coverage.
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