Enrollment Documentation

When you and your dependents satisfy the eligibility requirements described above, you and your dependents are eligible under this plan. However, before any claims can be processed, an Enrollment Form and the required documents must be on file at the Trust Office.

If you need to add or remove a dependent from the plan, the following documentation is required.

Marriage

To enroll a spouse, you must provide the following documentation:

• A new Enrollment Form.
• A copy of the certified marriage certificate.

Coverage for your spouse will begin retroactive to the date of marriage if enrollment documents are received within 60 days of marriage. If documentation is received after 60 days from date of marriage, coverage will begin on the first of the month following receipt of documentation.

Domestic Partner

To enroll a domestic partner, you must provide the following documentation:

• A new Enrollment Form.
• A copy of the Affidavit of Domestic Partnership.
• An Affidavit of Dependent Status (If you are able to claim your partner as a dependent)
• Two separate documents verifying joint financial responsibility

To obtain forms needed for enrollment of your domestic partner please contact Participant Services at the Trust Office to request an enrollment packet.  Please note that under current law, the Internal Revenue Service does not consider domestic partners as dependents. As such, the value of the Health and Security Plan coverage may be taxed as supplemental wages.

Coverage for your domestic partner will begin once enrollment is complete, retroactive to the date all paperwork was received.

Newborn, Adopted, Legally Placed, or Stepchildren

To enroll a newborn or other dependent child, you must provide the following documentation within 60 days of the birth, marriage, establishment of the domestic partnership, adoption, or the date the child was legally placed in your care:

• For a newborn, a new Enrollment Form and a copy of the birth certificate that was certified by the Department of Vital Statistics. For natural children born out of wedlock, a Child Enrollee Questionnaire, a copy of the birth certificate that was certified by the Department of Vital Statistics, and the paternity affidavit or a copy of the judgment or decree establishing paternity are also required. Other documents may be required to determine the effective date of coverage for a child born out of wedlock (please see the definition of children).
• For stepchildren, a new Enrollment Form, a copy of the certified marriage certificate, a Child Enrollee Questionnaire, and a complete copy of the appropriate divorce decree, parenting plan, and child support order.
• For a child who is placed for adoption, a new Enrollment Form and a certified copy of the placement report and petition for adoption that were filed with the court, or other documents confirming that the child was legally placed for adoption.
• For legally placed children, a new Enrollment Form and a copy of the court order specifying legal custody.

Your newborn child will be eligible for coverage on the date of birth. If a child is placed with you for adoption, he or she will be eligible for coverage on the date of the placement for adoption as long as the child satisfies the eligibility requirements of this plan. If a child is legally placed with you by virtue of a court order, he or she will be eligible for coverage on the date of the court order. Stepchildren who live in your home are eligible for coverage on the date the parent was enrolled in the plan. Please see Eligible Dependents for additional details about eligibility.

Legal Separation or Divorce

If you are divorced or legally separated, you must provide the following documentation:

• A new Enrollment Form.
• A complete copy of the divorce decree.
• If there are children, a complete copy of the parenting plan and child support order.

Eligibility for your former or legally separated spouse and stepchildren ends on the last day of the month in which the legal separation or dissolution of marriage becomes final. However, your former or legally separated spouse and stepchildren may elect to continue coverage under COBRA Continuation Coverage for up to 36 months (please see COBRA Continuation Coverage).

If, following a divorce, you want your former spouse to remain your life insurance beneficiary, you must designate your former spouse as your life insurance beneficiary on a new Enrollment Form.

A Qualified Medical Child Support Order (QMCSO) could have an effect on benefit coverage. Please notify the Trust Office if a QMCSO is part of a divorce proceeding (please see Eligible Dependents).

End of Domestic Partnership

If you no longer satisfy the requirements of a domestic partnership, you must provide the following documentation:

• A new Enrollment Form.
• A Domestic Partnership Termination Form.

Eligibility for your former domestic partner and his or her children ends on the last day of the month in which the termination of the domestic partnership becomes final. COBRA Continuation Coverage is not available to your former domestic partner or the children of a former domestic partner.

If, following the end of a domestic partnership, you want your domestic partner to remain your life insurance beneficiary, you must designate your former domestic partner as your life insurance beneficiary on the new Enrollment Form.

Child's Loss of Eligibility

No documentation is required when a dependent child loses eligibility because he or she attained a limiting age. However, you should contact the Trust Office if your child leaves school or marries. Your dependent children's eligibility also ends on the last day of the month in which you, your spouse, your domestic partner, or your dependent child no longer satisfies the eligibility requirements of the plan (please see Eligible Dependents, Suspension of Eligibility For Noncovered Employment and Termination of Coverage).

Your dependent children may elect to continue coverage under COBRA Continuation Coverage for up to 36 months (please see COBRA Continuation Coverage). COBRA Continuation Coverage is not available to the children of a domestic partner.

Death of A Dependent

You should notify the Trust Office if a spouse, domestic partner or a dependent child dies. The Trust Office will provide you with the information necessary to submit a life insurance claim (please see Life Insurance Benefits).

Death of Participant

If you die, someone in your family should notify the Trust Office. Your surviving dependents are covered under this plan until your earned eligibility is exhausted if they continue to meet the eligibility requirements of this plan. When your earned eligibility is exhausted, COBRA Continuation Coverage may be available to your dependents. Domestic partners are not eligible for COBRA. In certain circumstances, your dependents may qualify for the Carpenters Health and Security Plan—For Retired Carpenters (please see Carpenters Health and Security Plan—For Retired Carpenters). When the Trust Office is notified of your death, your life insurance beneficiary will receive the information necessary to submit a life insurance claim (please see Life Insurance Benefits). A surviving spouse or domestic partner who remains enrolled under this plan must also complete a Life Insurance Beneficiary Designation—Surviving Dependent form naming a new life insurance beneficiary.

Documentation

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.