2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 6
Dependent Eligibility
Your Dependents are eligible for participation in this Health Care Plan provided he/she is:
(1)
Your Spouse.
(2)
Your Child until the end of the month in which he/she attains age 26.
(3)
Your Child age 26 or older, who is unable to be self-supporting by reason of mental or physical handicap and
is incapacitated, provided the child suffered such incapacity prior to the end of the month in which he/she
attained age 26. Your Child must be unmarried, primarily dependent upon you for support, and have the same
principal residence as the Employee. The Health Care Plan Sponsor may require subsequent proof of your
Child’s disability and dependency, including a Physician’s statement certifying your Child’s physical or mental
incapacity.
(4)
A child for whom you are required to provide health coverage due to a Qualified Medical Child Support Order
(QMCSO). Procedures for determining a QMCSO may be obtained from the Employer at no cost.
The below terms have the following meanings:
“Spouse” means a person of the opposite sex recognized as the Covered Employee's husband or wife under the
laws of the state where you live. Specifically excluded from this definition is a Spouse by reason of common law
marriage or a Spouse of the same gender, whether or not permitted in your State. The Employer may require
documentation proving a legal marital relationship. Your Spouse is only eligible for coverage if his or her employer
does not offer a group health plan for which the Spouse is eligible (this also includes coverage under a group health
plan sponsored by a governmental or educational institution, a medical care program of the Indian Health Service
or of a tribal organization).
“Child” means your natural born son, daughter, stepson, stepdaughter, legally adopted child (or a child placed with
you in anticipation of adoption), or a child for whom you are the Legal Guardian. Coverage for a child for whom you
are the Legal Guardian will remain in effect until such child no longer meets the age requirements of an eligible
Dependent under the terms of the Health Care Plan, regardless of whether or not such child has attained age 18
(or any other applicable age of emancipation of minors). The term “Child” does not include a child of any “samesex” or “opposite-sex” domestic partner, or a child of any “same-sex” Spouse.
"Child placed with you in anticipation of adoption" means a child that you intend to adopt, whether or not the adoption
has become final, who has not attained the age of 18 as of the date of such placement for adoption. The term
"placed" means the assumption and retention by you of a legal obligation for total or partial support of the child in
anticipation of adoption of the child. The child must be available for adoption and the legal process must have
commenced.
“Legal Guardian” means a person recognized by a court of law as having the duty of taking care of the person and
managing the property and rights of an individual that is placed with such person by judgment, decree or other
order of any court of competent jurisdiction.
To establish an individual’s status as an eligible Dependent it is necessary to provide the documentation of the
relationship to the Employer. For a Spouse to be eligible for coverage, you must provide proof that your Spouse
does not have access to employer-provided health coverage. Acceptable proof includes a copy of the employer’s
plan document detailing eligibility requirements for that plan, or a certification from that employer. Except as
regarding Medicaid or a state Children’s Health Insurance Program (CHIP), all documents must be received within
31 days of whichever of the following occurs first: an Employee’s eligibility date if the Employee has any eligible
Dependents at that time, or the date the Employee acquires an eligible Dependent. For example, to add a natural
born son or daughter to the Health Care Plan, acceptable proof would be a copy of the birth certificate. For more
information on the acceptable documents, contact the Employer.
The Plan Administrator, in its sole discretion, shall have the right to require documentation necessary to establish
an individual’s status as an eligible Dependent.
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