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TABLE OF CONTENTS |
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1.1.4 Eligibility of Dependents – Medical, Dental, Prescription Drug and Wellness |
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Eligible Dependents include:
1. The Employee's spouse;
2.The employee’s unmarried children until attainment of age 19 including children adopted by or placed for adoption with the Employee and other children of the Employee to the extent required by a qualified Medical Child Support Order.
3. The Employee's unmarried stepchildren and foster children provided such children live with the Employee for more than half the year and the Employee provides at least half the child's financial support. Foster children are those who reside in the Employee's household, for whom the Employee provides parental care, guidance and responsibility, including health care and for whom the Employee has legal custody.
4. An unmarried Child between the ages of 19 and 23 as long as (1) the child otherwise meets this definition of dependent; (2) is enrolled as a full-time student at an Educational Institution; (3) lives with the Employee more than half the year (a student residing in a dorm or other temporary housing for the purposes of attending school will be deemed to be living with the Employee); and (4) receives at least half his or her financial support from the Employee.
a) Full-time enrollment means a minimum of twelve semester or quarter hours, unless the school’s definition of full-time attendance is different in which case the school’s definition will control.
b) For purposes of this Plan, an “Educational Institution” includes accredited high schools, colleges, universities, and vocational schools; as well as licensed technical, beautician, automotive and similar technical schools. On the job training courses, correspondence schools, and night schools not attended as part of a full-time degree program do not satisfy this definition.
c) For purposes of this Plan there are two coverage periods: the Spring coverage period is January 1 through August 31 and the Fall coverage period is September 1 through December 31.
d) It is the responsibility of the Employee or student to provide proof of full-time student status for each coverage period. In order to assure no break in coverage, verification must be submitted to Benefit Consultants prior to the start of the coverage period. Full-time student verification forms which include pre-enrollment verification may be obtained from the Fund office or the Participant or student may furnish a standard document issued by the school for the purpose of confirming full-time student enrollment, provided the school’s document includes the following information: Identification of the student by name, address and date of birth; the school’s definition of full-time student; verification that the student is currently enrolled or pre-enrolled as a full-time student; the period for which the student is enrolled; and whether the student will be graduating at the end of the school term.
e) A dependent who has provided proof of enrollment prior to the start of the coverage period and meets the requirements of a full-time student for any part of a Plan coverage period will be covered for that full coverage period. Except that if a dependent graduates or drops out and is not enrolled or pre-enrolled in another Educational Institution then coverage ends at the actual end of the school term and does not continue until the end of the coverage period. For example, a student is enrolled full-time as a junior in an Educational Institution. Coverage will continue until August 31 of that year. The next year the student graduates on May 20, which is the end of the school’s semester, and is not enrolled in graduate school. That year coverage ends on May 20. The child no longer meets the definition of dependent for this Plan but may be eligible for COBRA.
f) If verification is not furnished prior to the coverage period but is furnished within thirty (30) days after the beginning of the school’s term or the coverage period then eligibility will be reinstated retroactively to the beginning of the applicable school term or coverage period. For example, if a dependent age 20 who has been out of school since age 18 enrolls in a program beginning March 1, that child will again be an eligible dependent effective January 1 (the start of the coverage period) if the enrollment information is provided before February 1. If the enrollment information is not provided prior to February 1, but is provided prior to April 1 (30 days after the start of the school term), then eligibility will begin March 1 (the start of the school term). In either case coverage continues through August 31.
g) Full-time student status as defined in this section need not be continuous. Eligibility is based on student status and verification for each coverage period.
h) It is the responsibility of the student and the Employee to inform Benefit Consultants of the student’s graduation or other termination of enrollment. If Benefit Consultants is not informed and benefits are paid after graduation or termination of enrollment then the student and Employee are both responsible for reimbursing the Fund for any amounts paid on claims incurred after graduation or termination of enrollment. If necessary, the Fund has a right to recoup improperly paid benefits by withholding future benefits.
5. The following Dependents are excluded from coverage:
a) Any Dependent while that Dependent is engaged in a period of full-time active duty in the Armed Forces of any country; and
b) Any Dependent while that Dependent does not satisfy the definition of a Dependent under the Working Families Tax Relief Act of 2004 (WFTRA). Any conflict between this definition and the WFTRA or any other applicable provision of the law shall be reconciled in favor of compliance with the WFTRA or other applicable law. To the extent the law provides for a more restrictive definition of Dependent Child than contained in the Plan, the Plan's definition of Dependent Child shall be the definition provided by WFTRA as written and periodically amended.
6. It is the responsibility of the Employee to notify the Fund Office of any changes in dependent status and all requests for coverage changes and/or additions of dependents must be in writing. If an Employer is paying contributions on the Employee as a single individual and the Employee adds dependents, coverage for the dependents does not begin until the Employer begins contributing for family coverage.
7. If both husband and wife are covered under the Plan as Employees, each may be covered as a Dependent of the other; children may be covered as Dependents of both the husband and wife; these situations are subject to coordination of benefits (See Part IX, beginning on page 107).
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TABLE OF CONTENTS |
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St. Louis Graphic Arts Joint Health & Welfare Fund
14323 South Outer Forty Rd. - Suite S106
Chesterfield, Missouri 63017 |
Fund Office: (314) 878-1579
twesthues@slgahw.org
Fax: (314) 275-2640 |
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