How to Add or Remove Coverage for Family Members If your plan offers family coverage, you must notify your employer if you want to add or remove family members according to the Special Enrollment provisions described above. When adding or removing a family member, inform your employer in advance of the requested effective date and your employer will notify us. All requests must be made through your employer. We cannot directly add or remove coverage for you or your family members.
Optional Coverages If chosen by You, and shown as applicable on the Declarations Page, the following optional coverages apply separately to each Pet per Policy year. Some coverage options may be restricted by Pets age at time of sign-up. Defender/DefenderPlus We will reimburse You, if shown on the Declarations Page, for the Preventive Care listed below that Your Pet(s) receives from a licensed Veterinarian during the Policy period. Benefits will not exceed the Maximum Allowable Limits shown below. Coinsurance and Deductible requirements do not apply to Preventive Benefits. Our total liability of each Pet for each Policy Year is shown in the Maximum Allowable Limits. Benefit Schedule Maximum Allowable Limits Preventive Benefit Defender DefenderPlus Spay/Neuter or Teeth Cleaning $0 $150 Rabies Vaccine $15 $15 Flea/Tick/Heartworm Prevention $80 $95 Vaccination/Titer $30 $40 Wellness Exam $50 $50 Heartworm test or FELV (Feline Leukemia Virus) screen $25 $30 Blood, fecal, parasite exam $50 $70 Microchip $20 $40 Urinalysis or ERD Test (Early Renal Disease Test) $15 $25 Deworming $20 $20 *Benefits may be combined or separate up to the maximum allowable limit. SupportPlus Coverage We will reimburse You, if shown on the Declarations Page, for the cost of final expenses for necropsy, cremation and urns upon the death of each Pet covered for such costs incurred after the Waiting Period and during the Coverage Period up to a maximum benefit of three hundred dollars ($300) subject to the Annual Limit amount. Coinsurance and Deductible provisions do not apply to SupportPlus Coverage. ExamPlus Coverage We will reimburse You, if shown on the Declarations Page, for the Covered Expenses that occur during the Coverage Period subject to Policy limits and exclusion including, but not limited to, Coinsurance, Deductible and Annual Limit for physical examination; including costs and/or fees for telephone consultation; to diagnose a current covered Injury. This endorsement does not provide coverage for annual wellness office exams.
Dental Coverage 206. Each employee covered by this agreement shall be eligible to participate in the City's dental program.
Child Coverage Limited to Coverage Under One Employee If both spouses work for the State or another organization participating in the State’s Group Insurance Program, either spouse, but not both, may cover the eligible dependent children or grandchildren. This restriction also applies to two divorced, legally separated, or unmarried employees who share legal responsibility for their eligible dependent children or grandchildren.
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:
The General Liability and Property Damage coverages required for performance of this Agreement shall include the State of Vermont and its agencies, departments, officers and employees as Additional Insureds. If performance of this Agreement involves construction, or the transport of persons or hazardous materials, then the required Automotive Liability coverage shall include the State of Vermont and its agencies, departments, officers and employees as Additional Insureds. Coverage shall be primary and non-contributory with any other insurance and self-insurance.
Insurance or Other Medical Coverage Patient acknowledges and understands that this Agreement is not an insurance plan, and not a substitute for health insurance or other health plan coverage (such as membership in an HMO). It will not cover hospital services, or any services not personally provided by Direct Doctors. Patient acknowledges that Direct Doctors has advised that patient obtain or keep in full force such health insurance policy(s) or plans that will cover Patient for general healthcare costs. Patient acknowledges that this Agreement is not a contract that provides health insurance, and this Agreement is not intended to replace any existing or future health insurance or health plan coverage that Patient may carry.
ADDITIONAL COVERAGES We cover the following in addition to the limits of liability:
