Dependent Eligibility. For all programs covered in this article, eligible dependents are an employee’s lawful spouse or domestic partner (as defined by Section 297 of the California Family Code), and unmarried children (natural, step, adopted, legal guardianship, and/or xxxxxx) of the employee or domestic partner, who are qualified IRS dependents of the employee or domestic partner, up to twenty-three (23) years of age. Disabled dependents may be able to continue coverage beyond the limiting age if the disability occurred while the dependent was covered under a County-sponsored medical plan or prior to the dependent’s 19th birthday, and is certified by a licensed physician.
Dependent Eligibility. A dependent claiming eligibility hereunder as a spouse must be legally married to a Qualified Employee.
Dependent Eligibility. To be eligible to enroll as a Dependent, a person must:
Dependent Eligibility. To be eligible to enroll as a Covered Dependent, a person must be:
a. the spouse of a Subscriber under a legally valid existing marriage;
b. the Domestic Partner of a Subscriber; or
c. the child of a Subscriber, or the Subscriber’s covered Domestic Partner, provided that the following conditions apply:
i. the child is under the age of 26; and
ii. the natural child or stepchild of the Subscriber or the Subscriber’s covered Domestic Partner;
iii. a legally adopted child in the custody of the Subscriber or the Subscriber’s covered Domestic Partner;
iv. a child for whom the Subscriber, the Subscriber’s covered spouse, or covered Domestic Partner, has been appointed legal guardian pursuant to a valid court order; or
v. the newborn child of a Covered Dependent child of the Subscriber (such coverage terminates 18 months after the birth of the newborn child).
Dependent Eligibility. To be eligible to enroll as a Covered Dependent, an individual must be determined by AvMed, or the Marketplace if applicable, to meet the following requirements:
a. Maintain continuous primary residence in the Service Area;
b. Not be entitled to Medicare or eligible for Medicaid/CHIP as of the effective date of coverage;
c. Be named on the initial Application for this Contract, or properly enrolled thereafter;
d. Be the Contractholder’s spouse under a legally valid existing marriage; or
e. Be the natural, adopted, step child, or xxxxxx child of the Contractholder or the Contractholder’s Covered Dependent spouse, until the end of the month in which the child reaches age 26;
f. Be a child for whom the Contractholder or the Contractholder’s Covered Dependent spouse has been appointed legal guardian or legal custodian pursuant to a valid court order, until the end of the month in which the child reaches age 26;
g. Be a child for whom the Contractholder or the Contractholder’s Covered Dependent spouse is obligated by a Qualified Medical Child Support Order (QMCSO) to provide medical coverage, until the end of the month in which the child reaches age 26. An order may not require a plan to provide any type or form of benefit or option not otherwise provided under the plan, except to the extent required by law (you may obtain copies of the Plan’s procedures governing QMCSOs and a sample QMCSO without charge by contacting AvMed);
h. Be the newborn child of a Covered Dependent child of the Contractholder (such coverage terminates 18 months after the birth of the newborn child); and
i. Pay the required Premiums.
Dependent Eligibility. For all programs covered in this article, eligible dependents are an employee’s lawful spouse or domestic partner (as defined by Section 297 of the California Family Code), and unmarried children (natural, step, adopted, legal guardianship, and/or xxxxxx) of the employee or domestic partner, who are qualified IRS dependents of the employee or domestic partner, up to twenty-six (26) years of age.
Dependent Eligibility. For medical, dental, Flexible Spending Account (Medical Reimbursement) and EAP programs covered in this article, eligible dependents are an employee’s lawful spouse or domestic partner (as defined by Section 297 of the California Family Code), and children (natural, step, adopted, legal guardianship, and/or xxxxxx) of the employee or domestic partner, who are qualified IRS dependents for purposes of pre tax payment of health insurance premiums of the employee or domestic partner, up to twenty-six (26) years of age. Appropriate documentation verifying the relationship to the employee is required. The County medical plans qualify as a “grandfathered” plan under the Patient Protection and Affordable Care Act and other related legislation and regulations until December 31, 2013. Until that time, qualified dependents that are not eligible as an adult dependent defined by federal legislation may be eligible to participate in the program as a full time student. Disabled dependents are able to continue coverage beyond the limiting age if the disability occurred while the dependent was covered under a County-sponsored medical plan or prior to the dependent’s19th birthday, and is certified by a licensed physician. For life insurance programs covered in this article, eligible dependents are an employee’s lawful spouse or domestic partner (as defined by Section 297 of the California Family Code), and unmarried children (natural, step, adopted, legal guardianship, and/or xxxxxx) of the employee or domestic partner, who are qualified IRS dependents of the employee or domestic partner, up to age nineteen (19) or up to twenty-four (24) years of age if they are a full time student. Disabled dependents are able to continue coverage beyond the limiting age if the disability occurred while the dependent was covered under a County-sponsored plan or prior to the dependent’s 19th birthday, and is certified by a licensed physician.
Dependent Eligibility. Employee Only Employees and dependent children Employees, spouse and dependent children Employees, spouses, domestic partners and dependent children
Dependent Eligibility. In order to be a Dependent, a Member must be:
a. The Subscriber’s legal spouse or legal domestic partner as recognized under applicable state law.
b. A child, who is under age 26, of the Subscriber or the Subscriber’s spouse or domestic partner, including newborn children, biological children, adopted children or children Placed for Adoption, stepchildren, children placed in xxxxxx care, and children for whom the Subscriber or the Subscriber’s spouse/domestic partner is a legal guardian. NOTE: A Dependent who turns 26 years of age will remain covered for the remainder of the Calendar Year unless coverage terminates. The Dependent will not be renewed into the Plan for the following Calendar Year unless documentation is provided to the Marketplace and Health Options that shows the Dependent meets other requirement described below.
c. An unmarried child of the Subscriber or the Subscriber’s spouse/domestic partner who, as of the date the child turns age 26 or older, is mentally or physically unable to earn his or her own living and is chiefly financially dependent on the Subscriber.
d. A child who is eligible as a Dependent because of a Qualified Medical Support Order (“QMSO”) or other court or administrative order requiring medical coverage for a child of a Subscriber or spouse/domestic partner of the Subscriber. Such child will be eligible for medical coverage as stated in the QMSO or other court or administrative order. A QMSO is a judgment, decree, or order issued by a court or administrative agency that meets certain federal law requirements.
Dependent Eligibility. A Dependent claiming eligibility hereunder as a spouse must be legally married to an Eligible Employee. A Dependent claiming eligibility hereunder as a domestic partner must be personally related to an Eligible Employee by a domestic partnership as defined below. Eligible Employee agrees to notify CaliforniaChoice Benefit Administrators immediately upon termination of the marriage or domestic partnership. A Dependent child claiming eligibility hereunder must be born to, a step-child or legal xxxx of, adopted by the Eligible Employee or the Eligible Employee’s spouse or domestic partner or is a child for whom the Eligible Employee has assumed a parent-child relationship, as indicated by intentional assumption of parental status or assumption of parental duties by the Eligible Employee, as certified by the Eligible Employee at the time of enrollment of the child and annually thereafter (but not to include xxxxxx children), subject to the following condition: • Under age 26 (unless disabled, disability diagnosed prior to age 26) • This “child” profile describes herein an “eligible dependent child.” A Dependent child who exceeds the age limit for Dependent children and is disabled, that is, who is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition diagnosed as such by competent health care professionals prior to such Dependent’s 26th birthday, and has remained continuously dependent on the Employee for at least 50% of his/her economic support since he/she became disabled, shall be eligible for coverage hereunder until such disability ceases. Proof of Dependent’s disability must be received within 60 days after CaliforniaChoice Benefit Administrators requests it. CaliforniaChoice Benefit Administrators will provide you a 90-day notice that a dependent is about to reach the age limit for dependent children and will lose coverage unless you provide written certification from a competent health care professional, within 60 days of receiving this 90-day warning notice, that the dependent meets the above conditions of being disabled. Formal proof of the required eligibility and existence of the relationship of any Dependent to the Employee may be requested at the time of enrollment, time of service authorization request or claim submission, but not more frequently than annually after the two-year period following a child’s attainment of the limiting age.
