Enrollment documentation. The following documents are required prior to enrolling the following Dependents: 5.4.1 Overage child. For a Dependent child over the limiting age: 5.4.1.1 Eligible Dependent Children residing outside the Service Area are eligible for coverage up to but not including their twenty-sixth (26th) birthday, provided proof of eligibility such as but not limited to a legal birth certificate being submitted to the Company, The Eligible Dependent Children must select a Participating Provider as provided in §2.1.1 of this Certificate. To obtain coverage, all care must be provided or coordinated with the Participating Primary Care Provider and Prior Authorization must be obtained from the Company for Specialty and Hospital Services excluding Emergency and covered Primary Care Services. 5.4.1.2 Proof of incapacity. For continuing dependency resulting from incapacity, satisfactory proof of such continuing incapacity and dependency, within thirty-one (31) days of such child attaining the limiting age and annually thereafter. 5.4.1.3 Child under court order. For a Dependent child under court order requiring the Subscriber to provide health coverage for such child, a certified copy of the court order requiring such coverage.
Appears in 5 contracts
Samples: Group Health Insurance Agreement, Group Health Insurance Agreement, Group Health Insurance Agreement
Enrollment documentation. The following documents are required prior to enrolling the following Dependents:
5.4.1 Overage child. For a Dependent child over the limiting age:
5.4.1.1 Eligible Dependent Children residing outside the Service Area are eligible for coverage up to but not including their twenty-sixth (26th) birthday, provided proof of eligibility such as but not limited to a legal birth certificate being submitted to the Company, The Eligible Dependent Children must select a Participating Provider as provided in §2.1.1 of this Certificate. To obtain coverage, all care must be provided or coordinated with the Participating Primary Care Provider and Prior Authorization must be obtained from the Company for Specialty and Hospital Services excluding Emergency and covered Primary Care Services.
5.4.1.2 Proof of incapacity. For continuing dependency resulting from incapacity, satisfactory proof of such continuing incapacity and dependency, within thirty-thirty- one (31) days of such child attaining the limiting age and annually thereafter.
5.4.1.3 Child under court order. For a Dependent child under court order requiring the Subscriber to provide health coverage for such child, a certified copy of the court order requiring such coverage.
Appears in 2 contracts
Samples: Group Health Insurance Agreement, Group Health Insurance Agreement