Common use of Dependent Eligibility Clause in Contracts

Dependent Eligibility. A Dependent claiming eligibility hereunder as a spouse must be legally married to an Eligible Employee. A Dependent claiming eligibility hereunder as a domestic partner must be personally related to an Eligible Employee by a domestic partnership as defined below. Eligible Employee agrees to notify CaliforniaChoice Benefit Administrators immediately upon termination of the marriage or domestic partnership. A Dependent child claiming eligibility hereunder must be born to, a step-child or legal xxxx of, adopted by the Eligible Employee or the Eligible Employee’s spouse or domestic partner or is a child for whom the Eligible Employee has assumed a parent-child relationship, as indicated by intentional assumption of parental status or assumption of parental duties by the Eligible Employee, as certified by the Eligible Employee at the time of enrollment of the child and annually thereafter (but not to include xxxxxx children), subject to the following condition: • Under age 26 (unless disabled, disability diagnosed prior to age 26) • This “child” profile describes herein an “eligible dependent child.” A Dependent child who exceeds the age limit for Dependent children and is disabled, that is, who is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition diagnosed as such by competent health care professionals prior to such Dependent’s 26th birthday, and has remained continuously dependent on the Employee for at least 50% of his/her economic support since he/she became disabled, shall be eligible for coverage hereunder until such disability ceases. Proof of Dependent’s disability must be received within 60 days after CaliforniaChoice Benefit Administrators requests it. CaliforniaChoice Benefit Administrators will provide you a 90-day notice that a dependent is about to reach the age limit for dependent children and will lose coverage unless you provide written certification from a competent health care professional, within 60 days of receiving this 90-day warning notice, that the dependent meets the above conditions of being disabled. Formal proof of the required eligibility and existence of the relationship of any Dependent to the Employee may be requested at the time of enrollment, time of service authorization request or claim submission, but not more frequently than annually after the two-year period following a child’s attainment of the limiting age.

Dependent Eligibility. A Dependent claiming eligibility hereunder as a spouse Your Eligible Dependents become eligible for coverage on the same date you become eligible, or if later, on the date you acquire an Eligible Dependent. For all Inside Xxxxxxx and CW/CE Employees, Employer contributions must be made on your Eligible Dependents’ behalf in order for your Eligible Dependents to be covered. For MRA Employees to cover Eligible Dependents, you must elect family coverage and pay the required monthly self-payment amount. The self-payment amount is due to the Fund Office by the 15th of each month. Whenever you acquire a new Eligible Dependent, you should contact the Fund Office to update your personal information on file. In addition, you should notify the Fund Office of any change in your address. Your Eligible Dependents are eligible for the same coverage you are, with the exception of the Weekly Disability, Death, and AD&D Benefits. Your Eligible Dependents are your legally married to an Eligible Employee. A Dependent claiming eligibility hereunder as a domestic partner must be personally related to an Eligible Employee by a domestic partnership as defined below. Eligible Employee agrees to notify CaliforniaChoice Benefit Administrators immediately upon termination of the marriage or domestic partnership. A Dependent child claiming eligibility hereunder must be born to, a step-child or legal xxxx of, adopted by the Eligible Employee or the Eligible Employee’s spouse or domestic partner or is a child for whom the Eligible Employee has assumed a parent-child relationship, as indicated by intentional assumption of parental status or assumption of parental duties by the Eligible Employee, as certified by the Eligible Employee at the time of enrollment of the child and annually thereafter (but not to include xxxxxx children), subject to the following condition: • Under age 26 (unless disabled, disability diagnosed prior unmarried children up to age 26) • This “. You must submit written proof of your child” profile describes herein an “eligible dependent child.” A Dependent ’s dependency status to the Fund Office, if requested. You may also extend coverage for your unmarried child who exceeds the after age limit for Dependent children and is disabled, that is, who 26 if your child is incapable of self-sustaining employment by reason due to mental impairment or a physical handicap that existed before age 26, provided your child remains dependent on you for support. Your child will be considered dependent on you if your child resides with you for more than one half of a physically or mentally disabling injury, illness, or condition diagnosed the calendar year and is dependent on you for more than one half of the child’s support and maintenance. Such coverage will continue as such by competent health care professionals prior long as your child remains eligible. You must provide satisfactory written proof of your child’s incapacity and dependency to such Dependentthe Fund Office within 31 days of your dependent’s 26th birthday, and has remained continuously periodically thereafter upon request. Children include your natural children, stepchildren, xxxxxx children and legally adopted children (including children placed with you for adoption). You must provide satisfactory proof of dependency, if requested. If your disabled child’s principal place of residence is not with you, eligibility depends on his or her ability to meet the other non-residence-related requirements above (support and relationship tests) and to meet either of the following conditions: • The Child’s parents are divorced or legally separated under a decree of divorce or separate maintenance, separated under a written separation agreement, or live apart at all times during the last six months of the calendar year; • The Child’s parents provide over one-half of the Child’s support; and • The Child is in the custody of one or both of his or her parents for more than one-half of the calendar year; and • The Child is the qualifying child or qualifying relative, as defined in the Tax Code, of one of the parents; or • Not the dependent on of any other person during the Employee for at least 50% of his/her economic support since he/she became disabledcalendar year. When Eligibility Ends When your coverage or your Eligible Dependent’s coverage ends, shall you or they may be eligible to continue coverage by making monthly payments for COBRA Continuation Coverage (see page 17). FOR YOU Your eligibility for coverage hereunder until such disability ceases. Proof of Dependent’s disability must be received within 60 days after CaliforniaChoice Benefit Administrators requests it. CaliforniaChoice Benefit Administrators under the Plan will provide you a 90-end on the: • First day notice that a dependent is about to reach the age limit for dependent children and will lose coverage unless you provide written certification from a competent health care professional, within 60 days of receiving this 90-day warning notice, that the dependent meets the above conditions of being disabled. Formal proof of the month in which you do not meet the Plan’s continuing eligibility requirements; • First day of a Benefit Month for which you do not make the required eligibility and existence self-payment contribution by the due date; • Date you do not timely elect COBRA Continuation Coverage; • Date of the relationship of any Dependent to the Employee may be requested at the time of enrollment, time of service authorization request your death; or claim submission, but not more frequently than annually after the two-year period following a child’s attainment of the limiting age• Date this Plan ends.