3) Under the Description of Coverage and Benefits the Substance Abuse Facility Care Benefit Exclusions are revised as follows:
The exclusions that apply to this benefit are in the Common Exclusions Section.
Exclusions
4) Under the General Definitions section the following changes are made:
a) Active Service is revised as follows:
An Employee will be considered in Active Service with His Employer on any day that is either: 1. one of the Employer’s scheduled work days on which the Employee is performing His regular duties on a Full- time basis, either at one of the Employer’s usual places of business or at some other location to which the Employer’s business requires the Employee to travel; or 2. a scheduled holiday, vacation day or period of Employer-approved paid leave of absence, other than disability or sick leave after 7 days, only if the Employee was in Active Service on the preceding scheduled workday. A Covered Person is not considered in Active Service if He is: 1. Inpatient in a Hospital, receiving Hospice Care or confined in a rehabilitation or convalescence center; 2. confined at home under the care of a Physician for Illness or Injury.
b) The definition of Dependent Child is revised as follows:
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, primarily supported by the Employee and incapable of self-sustaining employment by reason of developmental disability.
A child, for purposes of this provision, includes an Employee’s: 1. natural child; 2.
adopted child, beginning with any waiting period pending finalization of the child’s adoption. It also means the legally adopted child of the Employee’s Spouse or Domestic Partner/Partner to a Civil Union provided there is a legal obligation for total or partial support from the Employee; 3. stepchild who resides with the Employee; 4. child for whom the Employee is the court-appointed legal guardian 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.
5) Under the Eligibility section the following Newborn and Adopted Children provision is added:
Newborn and Adopted Child(ren) Coverage for a newly born or adopted child shall be provided from the moment of birth or placement for adoption. Coverage for a newly born child shall include coverage for any congenital anomaly. If payment of an additional premium is required to provide coverage for such child, notification of the birth or placement of such child and the payment of the required premium must be furnished to Us within 60 days from the date of birth or placement.
6) Under the Common Exclusions and Limitations section the following exclusions do not apply:
• voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; • operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. ''Under the influence of alcohol'', for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Injury or Covered Illness occurred.
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