Eligible Dependents
An Eligible Dependent means a person who is the Eligible Participant’s:
- spouse; civil union partner, or domestic partner;
- natural child, stepchild or legally adopted child who has not yet reached age 26;
- own or spouse’s, civil union partner’s or domestic partner’s own child, of any age, enrolled prior to age 26, who is incapable of self support due to continuing mental retardation or physical disability and who is chiefly dependent on the Eligible Participant. The Insurer requires written proof from a Physician of such disability and dependency within 31 days of the child’s 26th birthday and annually thereafter;
- For a person who becomes an Eligible Dependent (as described below) after the date the Eligible Participant’s coverage begins, coverage for the Eligible Dependent will become effective in accordance with the following provisions:
- Newborn Children: Coverage will be automatic for the first 31 days following the birth of an Insured Participant’s Newborn Child. To continue coverage beyond 31 days, the Newborn child must be enrolled within 31 days of birth.
- Adopted Children: An Insured Participant’s adopted child is automatically covered for Illness or Injury for 31 days from either date of placement of the child in the home, or the date of the final decree of adoption, whichever is earlier. To continue coverage beyond 31 days, as Insured Participant must enroll the adopted child within 31 days either from the date of placement or the final decree of adoption.
- Court Ordered Coverage for a Dependent: If a court has ordered an Insured Participant to provide coverage for an Eligible Dependent who is spouse, civil union partner, domestic partner or minor child, coverage will be automatic for the first 31 days following the date which the court order is issued. To continue coverage beyond 31 days, and Insured Participant must enroll the Eligible Dependent within that 31 day period;
- grandchild, niece or nephew who otherwise qualifies as a dependent child, if: (i) the child is under the primary care of the Insured Participant; and (ii) the legal guardian of the child, if other than the Insured Participant, is not covered by an accident or sickness policy.
The term “primary care” means that the Insured Participant provides food, clothing and shelter on a regular and continuous basis.
A person may not be an Insured Dependent for more than one Insured Participant.