Common use of Coverage of the Over Clause in Contracts

Coverage of the Over. Age Dependent may continue after age 26 for the duration of incapacity if, prior to or within thirty-one days of the Dependent Child reaching age 26, an application for continued coverage with current medical information from the Dependent Child’s attending Physician is submitted to Company. Company may require additional or periodic medical documentation regarding the Dependent Child’s intellectual or physical disability as often as it deems necessary, but not more frequently than once per year after the two year period following the child’s 26th birthday. Company may terminate coverage of the Over-Age Dependent if Company determines the Dependent Child is no longer reliant on Subscriber for support or is no longer intellectually or physically disabled to the extent, he is incapable of sustaining employment. Pharmacy Benefit Manager (PBM) – A third party administrator of Prescription Drug programs. Physical Therapy – Treating disease or injury by using therapeutic exercise and other interventions that focus on improving posture, locomotion, strength, endurance, balance, coordination, joint mobility, flexibility, and alleviating pain. Physician – A Doctor of Medicine or a Doctor of Osteopathy who is legally qualified and licensed to practice medicine and is practicing within the scope of that license at the time and place service is given. Plan – See Contract.

Coverage of the Over. Age Dependent may continue after age 26 for the duration of incapacity if, prior to or within thirty-one (31) days of the Dependent Child reaching age 26, an application for continued coverage with current medical information from the Dependent Child’s attending Physician is submitted to Company. Company may require additional or periodic medical documentation regarding the Dependent Child’s intellectual or physical disability as often as it deems necessary, but not more frequently than once per year after the two year period following the child’s 26th birthday. Company may terminate coverage of the Over-Age Dependent if Company determines the Dependent Child is no longer reliant on Subscriber for support or is no longer intellectually or physically disabled to the extent, he is incapable of sustaining employment. Pharmacy Benefit Manager (PBM) – A third party administrator of Prescription Drug programs. Physical Therapy – Treating disease or injury by using therapeutic exercise and other interventions that focus on improving posture, locomotion, strength, endurance, balance, coordination, joint mobility, flexibility, and alleviating pain. Physician – A Doctor of Medicine or a Doctor of Osteopathy who is legally qualified and licensed to practice medicine and is practicing within the scope of that license at the time and place service is given. Plan – See Contract.