| Dependents Who Are Eligible for Coverage from This Fund Include
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- Your lawful spouse
- Each unmarried lawful child under the age of 19
- Each unmarried child between the ages of 19 and 23, who are full-time students
- Unmarried children over the age of 19 who are incapable of self-sustaining
employment.
- Same Sex Domestic Partners
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| Dependent Premium
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Due to ever increasing health care costs, changes have been made to improve
the financial security of the Health Fund. One of those changes, effective July
1st, 2003 was a $50 per month dependent premium. Dependent premiums are payable
quarterly and must be paid in advance. Dependents are: your spouse or same-sex
domestic partner, your children and/or other eligible dependents (please refer
to your SPD for a description of eligible dependents under the Health Fund).
This premium covers all your dependents regardless of number.
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| When Will You Receive A Bill? |
You will receive an invoice about 30 days prior to the due date. Please review
your invoice carefully, only the dependents listed on the invoice will be covered.
If your dependent information is incorrect, please contact the Fund immediately.
If, in the future, you gain or lose a dependent through birth, adoption, marriage,
divorce, age ineligibility, or death, please notify the Fund within 30 days
of the event. Please refer to the chart below for an example of dependent premium
due dates for.
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| Premium Due Date |
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Eligibility Quarter
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Due Date
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January 1 through March 30
April 1 through June 30
July 1 through September 30
October 1 through December 31
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December 20
March 20
June 20
September 20
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You may pay premiums for more than one quarter at a time,
if you wish. If payments are not received by the due date indicated on your
invoice, dependent coverage will be terminated. |
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| If You Are A Certified Retiree |
With Dependents If you have been deemed a Certified Retiree by the Fund and
are between the ages of 60 and 64, you are required to pay the dependent premium
regardless of the type of coverage you have (retiree or earned). Once you turn
65 the following rules apply: If you are on earned coverage - you will be required
to pay the dependent premium If you are on Certified Retiree coverage - you
will be exempt from the dependent premium
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| If You Choose Not To Cover Your Dependents |
Should you decide not to continue coverage for your dependents, please let us
know by completing and returning the declination form included with your premium
invoice. Please note: By declining dependent coverage you will not be able to
reinstate your dependent(s) coverage until the Fund's annual open enrollment
period in the fall for coverage changes effective January 1st of the following
year.
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| Special Enrollment |
If you decline enrollment for your dependents (including your spouse) because
of other insurance coverage, you may in the future be able to enroll your dependents
in the Health Fund, without waiting until the next Open Enrollment, provided
that you request enrollment within 30 days after the other coverage ends. In
addition, if you have a new dependent as a result of marriage, birth, adoption,
placement for adoption, or guardianship, you may be able to enroll your dependents
provided that you request enrollment within 30 days after the marriage, birth,
adoption, placement for adoption or guardianship.
Please contact the Health Fund with questions regarding the dependent premium.
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| To enroll dependents please provide the following documentation:
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| Relation/Event | Documentation Required
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| Spouse | A certified copy of your marriage certificate. | |
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| Divorce or Legal Separation | A copy of the final divorce decree or legal separation documents. | |
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| Child | A copy of the birth certificate. | |
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| Step-Child | A copy of the birth certificate and the divorce decree, custody information
or statement of financial responsibility. | |
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| Adoption/Guardianship | A copy of the adoption/release or guardianship or placement documents. | |
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| Students 19-23 | A student verification form completed by the Registrar’s office of the institution
of higher learning.
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| Mental Retardation and Physically Handicapped Dependents | Completed attending physicians statement along with any other proof of incapacity
including medical records and a statement of financial support.
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| Same Sex Domestic Partner | A signed Affidavit of Domestic Partnership and any additional documents requested
by the Administrative Office. If you are considering adding your partner, please
contact the Eligibility Department and request a Same Sex Domestic Partner Packet
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| Disclaimer
| NOTE: This is only a brief summary of your benefits. All benefit descriptions contained herein are governed by the limitations and other information contained in your SPD.
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