Your Dependents’ Eligibility

Your Eligible Dependents become Participants in the Fund on the later of:

• The day you begin participation; or
  
  
• The date you enroll them with the Fund Office.

Your newborn Child, adopted Child, or Child placed with you for adoption will automatically become covered as a Dependent under the Fund on the date the Child is born, adopted, or placed for adoption.

Example: Your Dependent’s Eligibility

In the previous example, John becomes eligible for coverage on June 1, 2011. John’s spouse and his unmarried Dependent Children become eligible on the same date.

Eligible Dependents are defined as follows:

In general, your Dependents include your legal spouse and your unmarried Dependent Children.

• Your legal spouse; and
  
• Your unmarried Children who depend on you for more than one-half of their support during the calendar year, maintain a principal residence with you for more than one-half of the calendar year, are younger than you (except for dependents who are physically or mentally disabled), and are:
  
• Under age 19;
  
  
• Under age 23 if they are full-time students; or
  
  
• Any age if mentally or physically disabled, as long as the mental or physical handicap began before the Child reached age 19 or age 23 if the Child was a full-time student.

Children include:

• Natural born Children as of the date of birth;
  
  
• Adopted Children (determined as of the time of placement with you for adoption); and
  
  
• Stepchildren who depend on you for more than one-half of their support during the calendar year, live with you in a regular parent-child relationship, and maintain a principal residence with you for more than one-half of the calendar year.
  

To enroll your newborn or newly acquired Child, you must provide the Fund Office with a copy of the birth certificate or adoption papers. Dependent status may continue until each Child’s 19th birthday or until each Child’s 23rd birthday if the Child is a full-time student attending an accredited educational institution. You must provide proof to the Fund Office, at the beginning of each school year (September) and again in February, that the Child is taking at least 12 credit hours per semester to maintain coverage for the Child. The Dependent’s benefits terminate when the Child reaches age 19, unless the Fund Office receives proof of student status from an accredited educational institution. If such proof is received, coverage will continue each year until graduation or age 23, whichever comes first.

You must consult the Fund Office within 31 days before Plan benefits might otherwise terminate (at age 19 or 23, if a full-time student) to apply for continued coverage for your disabled or handicapped Dependent Child.

If your Dependent Child is mentally or physically disabled or handicapped and is chiefly dependent on you, Plan benefits will continue as long as your Dependent is disabled or handicapped. To be eligible, your Child must be unable to engage in the normal activities of a person of like gender and age in good health due to disability or handicap. You must consult the Fund Office within 31 days before Plan benefits might otherwise terminate (at age 19 or 23, if a full-time student) to apply for continued coverage for your disabled or handicapped Dependent Child.

The Plan will provide benefits for your Dependent Child who is named as an alternate recipient in a Qualified Medical Child Support Order (QMCSO).

If your 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:

• For parents who are divorced, separated or who never married:
  
• The Child’s parents are: 1) divorced or legally separated under a decree of divorce or separate maintenance; 2) separated under a written separation agreement; or 3) 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;
  
  
• 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
  
  
• You provide over one-half the Child's support and the Child is not a "qualifying child" of any other person.

Effective on and after July 1, 2010, your covered Dependent Child may be eligible for medical leave under Michelle’s Law. If your Dependent has full-time student status immediately before the first day of leave, Plan coverage will not terminate for that Dependent Child due to a medically necessary leave of absence before the date that is the earlier of:

The date that is one year after the first day of the medically necessary leave of absence; or

The date on which such coverage would otherwise terminate under the terms of the Plan.

For purposes of this provision, a medically necessary leave of absence means a leave of absence of such Child from a postsecondary educational institution (including an institution of higher education as defined in Section 102 of the Higher Education Act of 1965), or any other change in enrollment of the Child at such an institution, that:

Begins while the Child is suffering from a serious illness or injury;

Is medically necessary; and

Causes the Child to lose student status as a full-time student for purposes of coverage under the terms of the Plan.

For coverage to continue during such a medically necessary leave described above, the Dependent’s treating Physician must provide a written certification to the Plan that the Dependent Child is suffering from a serious illness or injury and that the leave of absence (or other change of enrollment) described above is medically necessary.

You will receive notice of this provision from the Plan with any notice regarding the Plan’s requirement for certification of student status for coverage under the Plan.

If your Dependent Child’s benefits are continued under this provision, the Dependent Child will be entitled to the same benefits as if (during the medically necessary leave of absence) the Child continued to have full-time student status at the institution of higher education and was not on a medically necessary leave of absence.

If coverage under the Plan changes, e.g., from self-insured to insured, while your Dependent Child is being covered pursuant to a medically necessary leave of absence, then the leave provisions will apply to the changed coverage of the Dependent Child for the remainder of the period of the medically necessary leave of absence in the same manner as it would have applied to the previous coverage, provided the Plan continues to provide Dependent coverage.

Your Dependents’ benefits are subject to the rules outlined in the Coordination of Benefits.