email this page   printer friendly

View Previous Language

Eligible Dependents

The following table summarizes who may be enrolled in the Plan as an eligible dependent and the documentation required by the Administrative Trust Funds Office to process the enrollment.  An eligible dependent may be covered under all benefits available to the Member.  Eligibility for benefits will continue in the case of dependent children up to the limiting age shown in the table below; eligible dependent children will continue to be covered for dependent life insurance benefits to age 26.   An explanation of the eligibility requirements under the Plan follows this table.

Eligible Plan Participants	Required Documentation
Spouse	Copy of Marriage Certificate
Domestic Partner	Notarized Enrollment Affidavit/ State Tax Attestation
Dependents	Birth Certificate/Paternity Test/QMSCO/Adoption or Guardianship Affidavit Overage Dependent Certification

Under this Plan, eligible Dependents are the legal wife or husband (this Health Plan does not recognize a common law spouse unless the jurisdiction in which the parties were common law spouses was in a state which recognizes common law spouses) of the Employee or a domestic partner as described in the following section and the Employee's children (including a step child or a legally adopted child) under 26 years of age. As required by law, an eligible Dependent will include a child under age 26, when placed with an Employee for adoption. Coverage for an Employee's children will terminate at the end of the month in which the child reaches age 26, unless otherwise extended under the provisions of this 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 a dependent of the Employee within the meaning of Internal Revenue Code Section 105 and/or 106. Refer to individual PPO and HMO definitions of dependent.

Employees must provide written proof to the Administrative Trust Funds 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 children under age 26 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 benefits provisions.

Dependent children are covered for life insurance benefits from birth to age 26.

If a child covered by this Plan becomes totally and permanently disabled prior to reaching his 26th birthday while dependent upon his parents for support, his eligibility shall be continued for the duration of his disability, under the member's eligibility.

Upon dissolution, divorce, legal separation, or annulment, a spouse ceases to be an eligible Dependent on the first day of the month following the month in which the final decree terminating the marital relationship is issued. However, a spouse may continue to be eligible as a qualified beneficiary under this Plan if COBRA continuation coverage is timely elected, as more fully set forth in the COBRA section of this Plan.  In order to avoid payment of claims for ineligible dependents, which amounts will have to be repaid, you should notify the Administrative Trust Funds Office of a dissolution, divorce, or annulment as soon as it occurs.

Domestic Partners

Certain Collective Bargaining Agreements and Subscription Agreements requiring Contributions to the Fund include provisions calling for the domestic partner of an eligible Employee working under the Collective Bargaining Agreement or Subscription Agreement to be treated as an eligible Dependent of the eligible Employee.  To the extent required by such a Collective Bargaining Agreement or Subscription Agreement an individual will be treated as a dependent domestic partner of the eligible Employee only if all of the following conditions are met:

1. The eligible Employee and domestic partner must be eighteen (18) years of age; or
2. The eligible Employee and domestic partner must share a close personal relationship and be responsible for each other's common welfare;
3. The eligible Employee and domestic partner must be each other's sole domestic partner.
4. 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;
5. 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;
6. The eligible Employee and domestic partner must share the same regular permanent residence with the intent to do so indefinitely;
7. 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;
8. The eligible Employee and domestic partner must be mentally competent to consent to a contract of domestic partnership when the domestic partnership commenced;
9. The eligible Employee and domestic partner must have submitted a signed and notarized Affidavit of Domestic Partnership to the Administrative Trust Funds Office;

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 Administrative Trust Funds Office.

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 report the value of such taxable income on their Federal and state income tax returns based upon the Form 1099 issued by the Administrative Trust Funds Office and to pay the Employee's share of any and all Federal and state taxes attributable to the amount reported on the Form 1099, including but not limited to the Employee's share of Social Security and Medicare 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 Administrative Trust Funds Office has 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 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 isentitled to elect California COBRA coverage and/or conversion coverage in accord with the provisions contained within the HMO contract or insurance policy.  An eligible domestic partner's eligibility will terminate on the earlier of the following dates: (1) when the Collective Bargaining Agreement or Subscription 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.