An Employee’s unmarried child who meets the following requirements: 1. A newborn child from the moment of birth to 26 years old; 2. A child who is 26 or more years old, primarily dependent on the Employee for support and maintenance and incapable of self-sustaining employment by reason of mental or physical impairment.
A child, for purposes of this provision, includes an Employee’s: 1. natural child;
2. adopted child, beginning from the moment of birth, if placement for adoption occurs within 30 days of the child’s birth, or beginning from the date of placement, if placement for adoption occurs more than 30 days after the child’s birth. “Placement for adoption” means the assumption and retention by a person of a legal obligation or total or partial support of a child in anticipation of the adoption of the child. It also means the legally adopted child of the Employee’s Spouse or Domestic Partner/Par tner to a Civil Union; 3. Child for whom the Employee is required by a court order or administrative order to provide health insurance coverage for a child regardless of whether it is the custodial or non-custodial parent; 4. stepchild;
5. child for whom the Employee is the court-appointed legal guardian; 6. a child of the Employee’s domestic partner /Partner to a Civil Union.
c) The definition of Nurse is revised:
A licensed graduate registered Nurse (R.N.), a licensed practical Nurse (L.P.N.), or a licensed vocational Nurse (L.V.N.) who is not:
1. employed or retained by the Policyholder/Subscriber; 2. a parent, sibling, spouse or child of the Covered Person.
d) The definition of Physician is revised:
A licensed medical, healthcare provider who is practicing within the scope of his license issued within the United States who is not:
1. employed or retained by the Policyholder/Subscriber; 2. a parent, sibling, spouse or child of the Covered Person.
e) The definition of Spouse is revised:
The Employee’s current lawful spouse who is at least Age 18 but under Age 100 on the coverage effective date. Except for purposes of determining initial eligibility, the term includes a Spouse who is widowed, divorced, legally separated from, or annulled from an Employee. The term includes a common-law Spouse who is recognized as a common-law Spouse under the laws of the jurisdiction where the common-law marriage was formed.
f) The definition of Complications of Pregnancy is revised to add pre-eclampsia as an example.
g) The 1 st sentence of the definition of Hospital is revised as follows: “A facility that is licensed and operating within the scope of such license” and the following is added:
The term Hospital shall include a Veteran’s Administration Hospital or Federal Government Hospital, and the requirement that a patient must incur an expense as an Inpatient at such a facility shall be waived.
6) The Termination of Insurance section is revised as follows:
a) The following does not apply: • for a Spouse, the date the Spouse reaches age 100;
49
Made with FlippingBook - PDF hosting