Eligible
Spouse And Dependent Children
If a retiree is
eligible for this plan, the following dependents are also eligible if they
satisfy the eligibility requirements specified below:
- A
lawful spouse, unless legally separated.
- 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 the retiree for support
and maintenance, and for whom the retiree is entitled to a federal income tax
exemption. The following children qualify as eligible
dependents:
- Natural
children and legally adopted children.
- A
child placed with the retiree for adoption before the adoption is
finalized.
- Stepchildren
who live with the retiree.
- Legally
placed children meaning any child dependent by virtue of a court order
specifying that the retiree has legal custody.
- Natural
children born out of wedlock to the male retiree 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, the retiree must officially acknowledge
paternity in writing and submit such acknowledgement on the form required by the
Department of Vital Statistics to establish himself as the natural father on the
original or a substitute birth certificate. The effective date shall be the date
the acknowledgement of paternity was submitted to the Department of Vital
Statistics for this purpose provided the retiree is named as the child’s
father on the child’s birth
certificate.
Without
Paternal
Acknowledgement
If
the retiree does not acknowledge paternity, a court of jurisdiction must enter a
judgment or decree in an action brought to establish paternity, finding that the
retiree is, as a matter of law, the natural father of the child. The effective
date shall be the date of entry of the decree of judgement.
- A
noncustodial child the retiree is 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 the retiree 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 the retiree’s dependent.
The Medical Child Support Order must show the name and last known address for
the 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 the retiree 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 disability or physical handicap provided the child primarily
depends on the retiree 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 incapacity as long
as the retiree continues to be eligible under this plan. If coverage for a child
with a disability is needed, the retiree 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 the retiree continuously provides more than 50 percent of
the child’s financial support and is entitled to claim the child as a
dependent on his or her federal income tax return. If the retiree is unable to
claim the child as a dependent for tax purposes because of a divorce settlement,
the retiree is considered to be providing principle support if the child resides
with the retiree or the retiree has 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
or eligibility and the dependent’s right to enroll will be
denied. For other
circumstances which will result in a loss of eligibility for the spouse and
dependent children, please see Suspension Of Coverage and Termination Of Coverage.
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