d) The Dependent Child definition is replaced with the following: An Employee’s child who meets the following requirements: 1. A child from live birth to 26 years old;
2. A child who is 26 or more years old, who is chiefly dependent upon the Employee for support and maintenance and incapable of self-sustaining employment by reason of intellectual disability or physical disability. A child, for purposes of this provision, includes an Employee’s: 1. natural child; 2. adopted child, beginning on the date of the child’s birth if Placement occurs within 60 days after the child’s birth, or otherwise on the date of Placement for the purpose of adoption. As used in this paragraph, ''Placement'' means physical placement in the Employee’s care. If physical placement is prevented due to the medical needs of the child, Placement means the date the Employee signs an agreement for adoption of such child and assumes financial responsibility for such child; 3. stepchild who resides with the Employee and is financially dependent upon the Employee; 4. child, grandchild for whom the Employee is the court-appointed legal guardian, as long as the child resides with the Employee and primarily depends on the Employee for financial support. Financial support means that the Employee is eligible to claim the dependent for purposes of Federal and State income tax returns; 5. a child of the Employee’s domestic partner/Partner to a Civil Union , provided the child is living with, and is financially dependent upon the Employee . e) The definition of Spouse is replaced with the following: The Employee’s current lawful Spouse who is at least Age 18 for any coverage requiring Proof of Good Health but not yet Age 100. Except for purposes of determining initial eligibility, the term includes a Spouse who is widowed or divorced or legally separated from an Employee. f) The definition of Totally Disabled or Total Disability is replaced with the following: Either: 1. the inability of the Covered Person who is currently employed to do any type of work for which he is or may become qualified by reason of education, training or experience; or 2. the inability of the Covered Person who is not currently employed to perform the normal activities of like age and sex without human supervision or assistance. 3) Under the Effective Date Provisions, the following changes are made: a. Under Effective Date for Individuals, add the following: If the Dependent Child other than a newborn Dependent Child or a newly adopted Dependent Child, is eligible for Guaranteed Issue coverage, and the Employee applies for coverage and agrees to make required contributions within 31 days after the date the Dependent Child becomes eligible and, subject to the Deferred Effective Date Provisions section below, coverage becomes effective on the later of: 1. the effective date of the Policyholder's participation under this Policy; 2. the date the Employee becomes eligible at the end of the Eligibility Waiting Period; 3. the date the Employee’s coverage becomes effective; 4. the date the dependent meets the definition of Dependent Child as applicable; 5. the first of the month following the date We or the Employer receive the completed enrollment form for Dependent Child coverage. If the Dependent Child who is a newborn Dependent Child or a newly adopted Dependent Child, is eligible for Guaranteed Issue coverage, and the Employee applies for coverage and agrees to make required contributions within 31 days after the date the Dependent Child becomes eligible and, subject to the Deferred Effective Date
Provisions section below, coverage becomes effective on the later of: 1. the effective date of the Policyholder's participation under this Policy;
40
Made with FlippingBook. PDF to flipbook with ease