Common use of Eligible Dependents Clause in Contracts

Eligible Dependents. If you are covered, your eligible dependents include: ● your spouse; ● your unmarried children (including stepchildren, adopted children, and children for whom you are a legal guardian; however, xxxxxx children are not included) until the end of the calendar year of the 19th birthday; ● your unmarried children beyond the end of the calendar year of their 19 th birthday to the end of the calendar year of their 25th birthday who are dependent on you for a majority of their support (dependency for tax purposes, as determined by the Internal Revenue Service, is not required); ● your unmarried children beyond the end of the calendar year of the 25th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter) who are mentally retarded or physically disabled, dependent upon you for a majority of their support and who are incapable of self-sustaining employment by reason of their mental retardation or physical disability. (Under no circumstances will mental illness be considered a cause of incapacity nor will it be considered as a basis for continued coverage.) Please contact BC/BS to obtain the appropriate form to continue coverage; ● your unmarried children beyond the end of the calendar year of their 25th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter), who are full-time students and dependent on you for a majority of their support; ● your sponsored dependents who are members of your family, either by blood or marriage, who qualify as your dependents under the Internal Revenue Code, were declared as dependents on your federal tax return for the preceding tax year and are continuing in that status for the current tax year. (Children who are no longer eligible for coverage as dependent children cannot be covered as sponsored dependents). It is your responsibility to notify BC/BS and your employer: ● of any change in your employment status; ● when you wish to add a spouse or dependent(s); ● of any change to a dependent’s eligibility for coverage; ● when a spouse or dependent is no longer eligible as defined above. Special health care coverage guidelines apply to you and your spouse at age 65 during your active school employment. You should contact your school business office or BC/BS for complete details. The Social Security Administration should be contacted regarding Medicare enrollment 120 days prior to attaining age 65.

Eligible Dependents. If you are covered, your eligible dependents include: ● • your spouse; ● • your unmarried children (including stepchildren, adopted children, and children for whom you are a legal guardian; however, xxxxxx children are not included) until the end of the calendar year of the 19th birthday; ● • your unmarried children beyond the end of the calendar year of their 19 th 19th birthday to the end of the calendar year of their 25th birthday who are dependent on you for a majority of their support (dependency for tax purposes, as determined by the Internal Revenue Service, is not required); ● • your unmarried children beyond the end of the calendar year of the 25th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter) who are mentally retarded or physically disabled, dependent upon you for a majority of their support and who are incapable of self-sustaining employment by reason of their mental retardation or physical disability. (Under no circumstances will mental illness be considered a cause of incapacity nor will it be considered as a basis for continued coverage.) Please contact BC/BS to obtain the appropriate form to continue coverage; ● • your unmarried children beyond the end of the calendar year of their 25th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter), who are full-time students and dependent on you for a majority of their support; ● • your sponsored dependents who are members of your family, either by blood or marriage, who qualify as your dependents under the Internal Revenue Code, were declared as dependents on your federal tax return for the preceding tax year and are continuing in that status for the current tax year. (Children who are no longer eligible for coverage as dependent children cannot be covered as sponsored dependents). It is your responsibility to notify BC/BS and your employer: ● • of any change in your employment status; ● • when you wish to add a spouse or dependent(s); ● • of any change to a dependent’s eligibility for coverage; ● • when a spouse or dependent is no longer eligible as defined above. Special health care coverage guidelines apply to you and your spouse at age 65 during your active school employment. You should contact your school business office or BC/BS for complete details. The Social Security Administration should be contacted regarding Medicare enrollment 120 days prior to attaining age 65.

Eligible Dependents. If you are covered, your eligible dependents include: ● your spouse; ● your unmarried children (including stepchildren, adopted children, and children for whom you are a legal guardian; however, xxxxxx children are not included) until the end of the calendar year of the 19th birthday; ● your unmarried children beyond the end of the calendar year of their 19 th birthday to the end of the calendar year of their 25th birthday who are dependent on you for a majority of their support (dependency for tax purposes, as determined by the Internal Revenue Service, is not required); ● your unmarried children beyond the end of the calendar year of the 25th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter) who are mentally retarded or physically disabled, dependent upon you for a majority of their support and who are incapable of self-sustaining employment by reason of their mental retardation or physical disability. (Under no circumstances will mental illness be considered a cause of incapacity nor will it be considered as a basis for continued coverage.) Please contact BC/BS to obtain the appropriate form to continue coverage; ● your unmarried children beyond the end of the calendar year of their 25th 25 th birthday (if covered under this plan at the end of the calendar year of their 25th birthday and continuously thereafter), who are full-time students and dependent on you for a majority of their support; ● ●your sponsored dependents who are members of your family, either by blood or marriage, who qualify as your dependents under the Internal Revenue Code, were declared as dependents on your federal tax return for the preceding tax year and are continuing in that status for the current tax year. (Children who are no longer eligible for coverage as dependent children cannot be covered as sponsored dependents). It is your responsibility to notify BC/BS and your employer: ● of any change in your employment status; ● when you wish to add a spouse or dependent(s); ● of any change to a dependent’s eligibility for coverage; ● when a spouse or dependent is no longer eligible as defined above. Special health care coverage guidelines apply to you and your spouse at age 65 during your active school employment. You should contact your school business office or BC/BS for complete details. The Social Security Administration should be contacted regarding Medicare enrollment 120 days prior to attaining age 65.