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ELIGIBILITY FOR BENEFITS  
 

Eligible Members and Eligible Dependents receive Benefits as soon as they are enrolled in the Program. Subject to cancellation as provided under this Program, enrollment of Eligible Members and Eligible Dependents is for a minimum period of one year.

You are eligible to enroll as an Eligible Member if you meet the eligibility requirements defined by the Client.

Eligible Dependents become eligible on:

  1. the date you are eligible for coverage;
  2. 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.

Eligible Dependents include:

  1. spouse (unless legally separated or divorced) or Domestic Partner (until such partnership is terminated by either or both parties);
  2. unmarried children from birth up to the limiting age as defined by the Client;
  3. unmarried children beyond the limiting age if they are wholly dependent on you for support and are Full-Time Students.

Children include natural children, stepchildren, adopted children, foster children and children of a Domestic Partner provided all such children 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. Legally adopted children (other than newborns) are eligible from and after the moment the child is placed in the physical custody of the Eligible Member for adoption.

An unmarried dependent child may continue eligibility if:

  1. he or she is incapable of self-support because of a physical disability or mental incapacity that began prior to reaching the limiting age;
  2. he or she is chiefly dependent on you for support; and
  3. proof of dependent's disability is provided within 31 days of request. Such requests will not be made more than once a year after this dependent reaches the limiting age. Eligibility will continue as long as the dependent relies on you for support because of a physical disability or mental incapacity that began before he or she reached the limiting age.

Dependents in active military service are not eligible. Medicare eligibility shall not affect the eligibility of an Eligible Member or an Eligible Dependent.

 
 
 
 
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