Spousal Coverage Limitations Sample Clauses

Spousal Coverage Limitations. The spouse of any employee who is eligible to 29 participate or becomes eligible to participate, as a current employee or retiree, in a group health 30 insurance plan sponsored by his/her employer or retirement plan, must enroll with that Employer 31 or retirement plan for sponsored group insurance coverage. The spouse’s plan will be considered 32 as primary coverage for the spouse. The spouse may opt to additionally enroll in Medina County 33 employee health plan, but the County’s plan will only provide secondary coverage, and spousal 34 enrollment will require the employee to contribute to the monthly cost based upon the full 35 funding rates established on an annual basis by Medina County. 36 37 This requirement does not apply to any spouse who must pay more than fifty (50%) 38 percent of the single premium amount to participate in his/her employer or retirement group 39 health insurance plan. 40 41 The Employer will distribute a request for written certification verifying the spouse’s 42 eligibility to participate in another group health plan. An employee’s spouse will be removed 43 from the Medina County health plan if documentation is not provided within fourteen (14) days 44 of distribution. 45 1 It is the employee’s responsibility to immediately notify Medina County of any 2 subsequent change in a spouse’s eligibility to participate in his/her employer or retirement health 3 plan. If a spouse accepts a new job where coverage is available, he/she must immediately enroll 4 in that plan and the employee must notify Medina County within fourteen (14) days of any 5 change in their spouse’s eligibility. 6
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Spousal Coverage Limitations. The spouse of any employee who is eligible to 2 participate or becomes eligible to participate, as a current employee or retiree, in a group health 3 insurance plan sponsored by his/her employer or retirement plan, must enroll with that Employer 4 or retirement plan for sponsored group insurance coverage. The spouse’s plan will be considered 5 as primary coverage for the spouse. The spouse may opt to additionally enroll in Medina County 6 employee health plan, but the County’s plan will only provide secondary coverage, and spousal 7 enrollment will require the employee to contribute to the monthly cost based upon the full 8 funding rates established on an annual basis by Medina County. 9 10 This requirement does not apply to any spouse who must pay more than fifty (50%) 11 percent of the single premium amount to participate in his/her employer or retirement group 12 health insurance plan. 14 The Employer will distribute a request for written certification verifying the spouse’s 15 eligibility to participate in another group health plan. An employee’s spouse will be removed 16 from the Medina County health plan if documentation is not provided within fourteen (14) days 17 of distribution. 19 It is the employee’s responsibility to immediately notify Medina County of any 20 subsequent change in a spouse’s eligibility to participate in his/her employer or retirement health 21 plan. If a spouse accepts a new job where coverage is available, he/she must immediately enroll 22 in that plan and the employee must notify Medina County within fourteen (14) days of any 23 change in their spouse’s eligibility. 24 26 ARTICLE 24 SENIORITY‌
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Spousal Coverage Limitations. The spouse of any employee who is eligible to participate or becomes eligible to participate, as a current employee or retiree, in a group health insurance plan sponsored by his/her employer or retirement plan, must enroll with that Employer or retirement plan for sponsored group insurance coverage. The spouse’s plan will be considered as primary coverage for the spouse. The spouse may opt to additionally enroll in Medina County employee health plan, but the County’s plan will only provide secondary coverage, and spousal enrollment will require the employee to contribute to the monthly cost based upon the full funding rates established on an annual basis by Medina County. This requirement does not apply to any spouse who must pay more than twenty-five (25%) percent of the single premium amount to participate in his/her employer or retirement group health insurance plan. The Employer will distribute a request for written certification verifying the spouse’s eligibility to participate in another group health plan. An employee’s spouse will be removed from the Medina County health plan if documentation is not provided within fourteen (14) days of distribution. It is the employee’s responsibility to immediately notify Medina County of any subsequent change in a spouse’s eligibility to participate in his/her employer or retirement health plan. If a spouse accepts a new job where coverage is available, he/she must immediately enroll in that plan and the employee must notify Medina County within fourteen (14) days of any change in their spouse’s eligibility.
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Related to Spousal Coverage Limitations

  • Spousal Coverage Any new Participants to the COG, after June 30, 2015, with working spouses who have the ability to be covered under an insurance plan through his/her place of employment, will be required to take his/her plan as their primary plan. This provision does not apply to a participant who had insurance with one COG employer and immediately thereafter, moved to another COG employer. If the spouse is required to pay forty (40%) percent or more of the premium with his/her employer, the requirements of this section shall not apply.

  • Individual Coverage If you have Individual Coverage, only your own health care expenses are cov­ ered, not the health care expenses of other members of your family. FAMILY COVERAGE Under Family Coverage, your health care expenses and those of your enrolled spouse and your (and/or your spouse's) enrolled children who are under the limit­ ing age specified in the BENEFIT HIGHLIGHTS section of this Certificate will be covered. All of the provisions of this Certificate that pertain to a spouse also apply to a party of a Civil Union unless specifically noted otherwise. “Child(ren)” used hereafter in this Certificate, means a natural child(ren), a step­ child(xxx), adopted child(xxx), xxxxxx child(xxx), a child(ren) for whom you are the legal guardian or a child(xxx) for whom you have received a court order requiring that you are financially responsible for providing coverage under 26 years of age. a child(xxx) who is in your custody under an interim court order prior to finaliza­ tion of adoption or placement of adoption vesting temporary care, whichever comes first, child(xxx) for whom you are the legal guardian under 26 years of age, regardless of presence or absence of a child's financial dependency, residency, student status, employment status, marital status, eligibility for other coverage or any combination of those factors. In addition, enrolled unmarried children will be covered up to the age of 30 if they: • Live within the service area of the Plan network for this Certificate; and • Have served as an active or reserve member of any branch of the Armed Forces of the United States; and • Have received a release or discharge other than a dishonorable discharge. Coverage for children will end on the last day of the calendar month in which the limiting age birthday falls. If you have Family Coverage, newborn children will be covered from the moment of birth. Please notify the Plan within 31 days of the birth so that your member­ ship records can be adjusted. Your Group Administrator can tell you how to submit the proper notice through the Plan. Children who are under your legal guardianship or who are in your custody under an interim court order prior to finalization of adoption or placement of adoption vesting temporary care, whichever comes first, and xxxxxx children will be cov­ ered. In addition, if you have children for whom you are required by court order to provide health care coverage, those children will be covered. Any children who are incapable of self‐sustaining employment and are dependent upon you or other care providers for lifetime care and supervision because of a disabled condition occurring prior to reaching the limiting age will be covered regardless of age as long as they were covered prior to reaching the limiting age specified in the BENEFIT HIGHLIGHTS section. This coverage does not include benefits for grandchildren (unless such children have been legally adopted or are under your legal guardianship). Coverage under this Certificate is contingent upon timely receipt by the Plan of necessary information and initial premium. MEDICARE ELIGIBLE COVERED PERSONS A series of federal laws collectively referred to as the ``Medicare Secondary Payer'' (MSP) laws regulate the manner in which certain employers may offer group health care coverage to Medicare eligible employees, spouses, and in some cases, dependent children. Reference to spouse under this section do not include a party to a Civil Union with the Eligible Person or their children. The statutory requirements and rules for MSP coverage vary depending on the basis for Medicare and employer group health plan (“GHP”) coverage, as well as certain other factors, including the size of the employers sponsoring the GHP. In general, Medicare pays secondary to the following:

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