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| WHO IS ELIGIBLE FOR COVERAGE? |
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You and your Eligible Dependents, as defined below, are eligible provided you live or work in the DeltaCare USA service area. You and your Eligible Dependents become eligible:
- on the first day of the month following our receipt of timely* Premium and complete enrollment information;
- as soon as an Eligible Dependent becomes your dependent, or at any time subject to a change in legal custody or lawful order to provide Benefits.
*Delta must receive the enrollment materials by the 21st day of the month for coverage to be effective the first day of the following month. If Delta Dental receives the enrollment materials after the 21st day of the month, coverage will become effective the first day of the second month.
Your Eligible Dependents include your:
- spouse (unless legally divorced);
- unmarried children from birth up to age 19;
- dependent children up to age 23 if they are Full-Time Students.
Full-Time Students who are covered under this program, and are unable to attend school because of an illness, are eligible to continue coverage for one year following the last day they attended school. The need for this medical leave of absence must be certified by a medical practitioner licensed to practice in the state of New York. In order to continue coverage, the Enrollee must submit this documentation to Delta Dental.
Children include natural children, stepchildren, adopted children and foster children if they are dependent on you for support. Newborn children (including newborn adopted children) are covered from and after the moment of birth. Notice of birth must be received within 31 days after the date of birth for coverage to continue beyond 31 days. Foster children are eligible from and after the moment they are placed in your physical custody. Dependents in military service are not eligible.
A newborn adopted infant is eligible from and after the moment of birth as long as
- you take physical custody upon the infant's release from the hospital;
- a petition pursuant to Section 115c of the Domestic Relations Law is filed within 30 days of birth;
- you do not file a notice of revocation of the adoption pursuant to Section 115b; and
- consent to the adoption has not been revoked.
Other legally adopted children are eligible during and after the period of probation.
An unmarried child over the age of 19 may remain eligible if that child is incapable of self-support or self-sustaining employment by reason of mental illness, developmental disability or mental retardation, as defined in the mental hygiene law, or physical handicap. The child must also be chiefly dependent on you for support and maintenance. See Renewal, Cancellation and Termination of Benefits.
Any person covered by this Contract, who is also a member of a reserve component of the armed forces of the United States, including the National Guard, is entitled to have their coverage suspended during a period of active duty. We will refund any unearned Premium for the period of suspension. Please contact the Customer Service department at 800- 422-4234 for additional information.
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