Eligibility, Enrollment and Effective Date. Eligible Individuals. An individual is eligible for coverage as a subscriber under this contract if, at the time of application, the subscriber is a resident in the service area for which this contract is issued, and has been determined by PIC to be an eligible individual. Note: Coverage will be rescinded or terminated in the event of fraud, intentional misrepresentation of material fact (including a misleading omission of material fact) or failure to pay, when due, any required premium. Eligible Dependents. A subscriber is permitted to enroll only eligible dependents. Eligible dependents of the subscriber include those individuals whom XXX has determined to be eligible individuals and who meet the requirements of any of the following:
1. Lawful spouse whose marriage to the subscriber is valid under Minnesota law.
2. Children, through end of the month in which the child reaches age 26, including:
a. Natural children of a covered subscriber from birth.
b. Legally adopted children or children placed with the subscriber for legal adoption (date of placement means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of adoption of the child. The child’s placement with a person terminates upon the termination of the legal obligation of total or partial support).
c. Children for whom the subscriber or the subscriber’s covered lawful spouse has been appointed legal guardian by a court of law, up to the age stated in the court appointment if less than age 26.
d. Stepchildren of the subscriber.
e. Grandchildren of the subscriber or the subscriber’s covered lawful spouse who have resided in the covered grandparent’s home continuously since the date of the initial discharge from the hospital due to birth and are dependent on the covered grandparent for their financial support.
3. Dependent children who are disabled. Application for extended coverage and proof of incapacity must be furnished to PIC within 31 calendar days after the dependent child reaches age 26. After this initial proof, XXX may request proof again at any time during the two-year period following the child’s attainment of the limiting age but not more frequently than annually after such two-year period. A dependent child may be eligible for coverage if coverage has not otherwise terminated by PIC and if the dependent child meets all of the following criteria:
a. Is incapable of self-sustaining employment, because of a physical disabili...
Eligibility, Enrollment and Effective Date. Subscribers and Dependents who meet the following criteria are eligible for coverage under this Plan.
1.1 Who Is Eligible Subscriber. To be eligible to enroll as a Subscriber, an Individual must: Dependent. To be eligible to enroll as a Dependent, an individual must be one of the following:
a. The child must be covered as a Dependent under this Plan before reaching the limiting age, and proof of incapacity and dependency must be given to HPN by the Subscriber within thirty-one (31) days of the child reaching the limiting age; or
b. The handicap started before the child reached the limiting age, but the Subscriber was covered by another health insurance carrier that covered the child as a handicapped Dependent prior to the Subscriber applying for coverage with HPN. HPN may require proof of continuing incapacity and dependency when the child reaches the limiting age. HPNs determination of eligibility is final. Evidence of any court order needed to prove eligibility must be given to HPN.
1.2 Who Is Not Eligible
Eligibility, Enrollment and Effective Date. Subscribers and Dependents who meet the following criteria are eligible for coverage under this Certificate.
Eligibility, Enrollment and Effective Date. Subscribers and Eligible Family Members who meet the following criteria are eligible for healthcare coverage under this Plan.
1.1 Who Is Eligible Subscriber. To be eligible to enroll as a Subscriber, an Individual must:
Eligibility, Enrollment and Effective Date. Subscribers and Eligible Family Members who meet the following criteria are eligible for healthcare coverage under this Plan.
1.1 Who Is Eligible Subscriber. To be eligible to enroll as a Subscriber, an Individual must: Dependent. To be eligible to enroll as a Dependent, an individual must be one of the following:
a. The child must be covered as a Dependent under this Plan before reaching the limiting age, and proof of incapacity and dependency must be given to SHL by the Subscriber within thirty-one (31) days of the child reaching the limiting age; or
b. The handicap started before the child reached the limiting age, but the Subscriber was covered by another health insurance carrier that covered the child as a handicapped Dependent prior to the Subscriber applying for coverage with SHL. SHL may require proof of continuing incapacity and dependency, but not more often than once a year after the first two (2) years beyond the date when the child reaches the limiting age. Evidence of any Court Order needed to prove eligibility must be given to SHL.
1.2 Who Is Not Eligible
Eligibility, Enrollment and Effective Date. Subscribers and Dependents who meet the following criteria are eligible for coverage under this EOC.
1.1 Who Is Eligible Subscriber. To be eligible to enroll as a Subscriber, an employee must:
A. Be a bona fide employee of the Group; and
B. Meet the following criteria: • Be employed full-time. An employee is considered full-time if the employee works at least twenty (20) hours per week and is on the regular payroll of the Group; • Be in an active employment status; • Meet the applicable waiting period indicated by the Group in its Attachment A to the GEA; • Enroll during an enrollment period; • Live or work in HPN’s Service Area; • Be a Retired Employee of the Group; or • Be a Surviving Spouse of a Retired Employee, provided such spouse was covered under the Plan at the time of the Retired Employee’s death. The active employment status requirement will not apply to individuals covered under Group’s prior welfare benefit plan on the date of that plan’s discontinuance, provided that this EOC is initially effective no more than sixty (60) days after the prior plan’s discontinuance. All other requirements will apply to such individuals. • A Subscriber's legal spouse or a legal spouse for whom a court has ordered coverage. • A child by birth. Stepchild. Adopted child or Child being Placed for Adoption with the Subscriber. A child for whom a court has awarded legal guardian/custody to the Subscriber or the Subscriber’s spouse, and is chiefly dependent upon the Subscriber for support. Child must be claimed as a Dependent on the most recent tax return of the Subscriber. Coverage is only available to those guardianship children for whom the Subscriber covered as a Dependent on December 31, 2010. • A child for whom a court has ordered coverage through a National Qualified Medical Child Support Order (QMCSO). The definition of Dependent is subject to the following conditions and limitations: • A Dependent includes any child listed above under the limiting age of 26 with the exception of court appointed guardianship to age 18. • A Dependent includes a Dependent child who is incapable of self-sustaining employment due to mental or physical handicap, chiefly dependent upon the Subscriber for economic support and maintenance, and who has satisfied all of the requirements of (a) or (b) below:
a. The child must be covered as a Dependent under this Plan before reaching the limiting age, and proof of incapacity and dependency must be given to HPN by the Subscriber within thi...
Eligibility, Enrollment and Effective Date
