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Eligibility / Dependent Coverage

Dependent Child Eligibility

For purposes of eligibility in this Plan, your dependent child is any of the following, provided that the child is your “child” or “dependent” as defined in Section 105(b) of the Internal Revenue Code:
  • A natural child; 
  • A child adopted by judicial decree;
  • A child legally placed for adoption in your home; 
  • A child for whom the Plan is required to provide coverage pursuant to a Qualified Medical Child Support Order (QMSCO); or 
  • Your stepchild, as long as the child’s natural parent is your spouse. If your stepchild is covered under a health plan of either natural parent, this Plan’s coverage of the stepchild will be secondary to the natural parent’s plan. 
Your child is eligible for dependent coverage until the last day of the calendar month in which the child’s 26th birthday occurs.

Your child may remain eligible for dependent coverage past the child’s 26th birthday if the child is totally disabled and you rightfully claim a deduction for the child on your federal income tax return.

For continued coverage of a totally disabled child age 26 and over, substantiation of the child’s disability will be required by the Plan no later than 31 days after the child’s 26th birthday and periodically thereafter as requested by the Plan.

Opting Out of Dependent Coverage

Any dependent eligible for coverage may opt out of coverage by signed written notice to the Trustees, specifying the date on which coverage may terminate. Any dependent who has voluntarily terminated dependent coverage may reinstate coverage by written notice to the Trustees, provided that the dependent qualifies for coverage at the time of reinstatement. The parent of a child under the age of 18 may request to opt out of coverage on behalf of the minor child. A dependent child age 18 or older or a spouse must request to opt out of the Plan individually.

Termination of Dependent Eligibility

Except as provided for a dependent who has elected COBRA, eligibility of a member’s dependent will automatically end on the last day of the month in which the earliest of the following dates occurs:
  • The date the member’s eligibility ends, except as follows: 
    • Eligibility of dependents of a member in the non-active classification will not terminate solely because the member becomes entitled to Medicare, so long as the member is enrolled in the UHC Medicare Advantage Program. 
    • In the event of a member’s death while covered in the Outside or Inside Eligibility class, the member’s dependents will remain covered until the end of the third month after the month in which the death occurred, or if later, until the end of the eligibility period earned by the member’s credit hours as of the date of death.
  • The date the individual no longer qualifies as an eligible dependent under the terms of the Plan. 
  • The date the dependent falsifies any information in connection with a claim for benefits or commits any action with the intent to defraud the Plan.
  • The date the Plan terminates.

When Dependent Coverage Ends

You have options for continuing coverage when your coverage under the Plan is about to end. Under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), you and your dependents have the right to continue coverage under the Plan in lieu of minimum/difference payments if you (or your enrolled dependents) would otherwise lose coverage due to certain qualifying events such as termination of employment, death, or certain other qualifying events. For details, see COBRA Continuation Coverage