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Summary Plan Description (SPD)
Eligible Dependents
The legal wife, or husband (California law and this Health Plan do not recognize a common law spouse), of the Employee and the Employee's unmarried children (including a step child or a legally adopted child) under 19 years of age are eligible dependents under the terms of this Plan. As required by law, an eligible dependent will include a child under age 18, when placed with an Employee for adoption. Coverage for an Employee's unmarried children will terminate at the end of the month in which the child reaches age 19, unless otherwise extended under the provisions of this Plan. When a child reaches his 19th birthday and continues to be unmarried and dependent upon the Employee, he will continue to be covered for hospital/medical, dental, prescription drug, and vision benefits through age 25 if he/she is attending an accredited school on a full-time basis (8 or more units). Legal guardianship will qualify a child for coverage under the Self-Funded Hospital/Medical Indemnity Plan. An eligible dependent includes any stepchild of the Employee who depends upon the Employee for support and lives with the Employee in a regular parent-child relationship and is claimed as a dependent of the Employee within the meaning of IRS Revenue Code Section 105 and/or 106. Refer to individual HMO definitions of dependent.
Employees must provide written proof to the Administrative Office of their legal dependents in order for dependents to be eligible for the benefits of this Plan. For example, a copy of your marriage certificate for a spouse, a copy of a birth certificate for a child and a copy of a decree of adoption for an adopted child. Once enrolled, coverage for the Participant's unmarried children under age 19 and the lawful spouse under this Plan is not optional. There is no ability to subsequently terminate coverage under this Plan for enrolled eligible dependents of any eligible Participant so long as the dependent continues to be an eligible dependent. Nothing in this Section is intended to modify the Plan's coordination of benefit provisions.
Student continuation coverage must be supported by the return of a Verification Form from the academic institution to the Administrative Office. Verification Forms may be obtained from and submitted to the Administrative Office upon completion.
At the time of the initial presentation of a valid Student Verification Form, dependent eligibility will be afforded for a rolling 6-month period. The subsequent presentation of a valid Student Verification Form to the Administrative Office will afford dependent coverage for a subsequent rolling 6-month period.
Student continuation coverage terminates at the end of the month in which the first of the following events occurs:
- The student ceases to be enrolled in an academic institution;
- The student graduates from an academic institution;
- The rolling 6 month period expires and has not been extended; or
- The student attains age 25. Eligible dependent will maintain coverage through the end of the month in which their 25th birthday occurs (i.e. DOB 6/21/79; coverage ends June 30, 2004).
Dependent children are covered for life insurance benefits from birth to age 21.
If a child covered by this Plan becomes totally and permanently disabled prior to reaching his/her 19th birthday, or between his/her 19th and 25th birthday while dependent upon his/her parents for support and a full-time student, his/her eligibility shall be continued for the duration of his/her disability, under the member's eligibility.
If a child covered by this Plan becomes temporarily disabled, while between the ages of 19 and up to his/her 25th birthday, and while dependent upon his/her parents for support and is a full time student, his/her eligibility shall be continued for the duration of his/her temporary disability, under the employee’s eligibility, for a maximum of twelve months. Upon expiration of one period of temporary disability, a student covered under this Plan will not be eligible for another period of temporary disability until he/she returns to school as a full time student for six months, provided the student was continuously covered under the employee’s eligibility during this six-month period.
DOMESTIC PARTNERS
Certain collective Bargaining Agreements and Subscriber Agreements requiring contributions to the Fund include provisions calling for the domestic partner of an eligible employee working under the Collective Bargaining Agreement or Subscriber Agreement to be treated as an eligible dependent of the eligible employee. To the extent required by such a Collective Bargaining Agreement or Subscriber Agreement an individual will be treated as a dependent domestic partner of the eligible employee only if all of the following conditions are met:
- The eligible employee and domestic partner must be eighteen (18) years of age or older.
- The eligible employee and domestic partner must share a close personal relationship and be responsible for each other’s common welfare.
- The eligible employee and domestic partner must be each other’s sole domestic partner.
- The eligible employee and domestic partner may not be married to anyone or have had another domestic partner within the prior six (6) calendar months.
- The eligible employee and domestic partner may not be related by blood to an extent that would bar their marriage in the State of California.
- The eligible employee and domestic partner must share the same regular permanent residence with the intent to do so indefinitely.
- The eligible employee and domestic partner must agree to be responsible for each other’s basic living expenses which are the cost of basic food, shelter and any other expenses of a domestic partner.
- The eligible employee and domestic partner must be mentally competent to consent to a contract of domestic partnership when the domestic partnership commenced.
- The eligible employee and domestic partner must have submitted a signed and notarized Affidavit of Domestic Partnership to the Fund Manager.
An eligible employee must submit completed domestic partner enrollment forms and a notarized Affidavit of Domestic Partnership to commence the enrollment process. The required Affidavit and enrollment forms are available from the Fund Offices.
The enrollment of a domestic partner by an eligible employee will create taxable income on the fair market value of coverage to the eligible employee. The eligible employee must agree to pay the employee’s share of any and all applicable payroll taxes and any and all income taxes.
The domestic partner of an eligible employee shall be eligible for benefits on the first day of the month following the month in which the Fund Offices have received the notarized Affidavit of Domestic Partnership and the fully completed domestic partner enrollment forms.
In no event shall the dependents of an eligible dependent domestic partner be deemed eligible dependents under the Plan.
The Trustees reserve the right to require additional proof at any time of ongoing eligible dependent domestic partner status.
A domestic partner losing eligibility shall not be entitled to elect coverage under federal COBRA law. A domestic partner losing eligibility who had been enrolled in an HMO or insured program is entitled to elect California COBRA coverage and/or conversion coverage in accord with the provisions contained within the HMO contract or insurance policy. An eligible dependent domestic partner’s eligibility will terminate on the earlier of the following dates: (1) when the Collective Bargaining Agreement or Subscriber Agreement under which the employee works no longer provides for domestic partner coverage; or (2) when the employee ceases to be eligible; or (3) the date the dependent domestic partner no longer qualifies as an eligible domestic partner; or (4) the date the eligible domestic partner enters into full-time military service.”