The following table summarizes who may be enrolled in the Plan as an eligible dependent and the documentation required by the Administrative 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. A detailed explanation of the eligibility requirements under the Plan follows this table.
| Eligible Plan Participants | Required Documentation |
|---|---|
| Spouse | Copy of Marriage Certificate |
| Domestic Partner | Enrollment Affidavit/ State Tax Attestation |
| Biological Children to age 26 | Birth Certificate/Paternity Test/QMSCO |
| Step Children to age 26 | Birth Certificate |
| Adopted Children to age 26 | Adoption Affidavit |
| Permanently Disabled Children | Birth Certificate/Paternity Test/ Adoption or Guardianship Affidavit |
| Child (Temporary or Permanent) | Legal Guardianship/State or Federal Tax Forms |
| Temporarily Disabled Child | Disability Application/Birth Certificate – Child subject to Temporary or Permanent Guardianship |
Under this Plan, eligible Dependents are the legal wife or husband (this Trust Fund does not recognize a common law spouse unless the common law marriage was established in a jurisdiction which permits the creation of common law marriages) 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 18, 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.
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 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 carrier's coordination of benefits provisions.
Dependent children are covered for life insurance benefits from birth to age 26.
If a child covered by this Trust Fund 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 Trust Fund if COBRA continuation coverage is timely elected, as more fully set forth in the COBRA section of this Trust Fund. In order to avoid liability for benefit expenses of ineligible dependents, which amounts will have to be repaid, you should notify the Administrative Office of a dissolution, divorce, or annulment as soon as it occurs.