91 Eligibility and Enrollment – Adding Members In this section you will find information on who is eligible for coverage under this Plan and when Members can be added to your coverage. Eligibility requirements are described in general terms below. For more specific information, please see your Human Resources or Benefits Department. Who is Eligible for Coverage The Subscriber To be eligible to enroll as a Subscriber, the individual must: • Be an employee member, or retiree of the Employer, and: • Be entitled to participate in the benefit Plan arranged by the Employer; • Have satisfied any probationary or waiting period established by the Employer and (for non-retirees) and perform the duties of your principal occupation for the Employer; Dependents To be eligible to enroll as a Dependent, you must be listed on the enrollment form completed by the Subscriber, meet all Dependent eligibility criteria established by the Employer, and be one of the following: • The Subscriber's spouse. For information on spousal eligibility please contact the Employer. • The Subscriber’s Domestic Partner, if Domestic Partner coverage is allowed under the Group’s Plan. Please contact the Group to determine if Domestic Partners are eligible under this Plan. Domestic Partner, or Domestic Partnership means a person of the same or opposite sex who has signed the Domestic Partner Affidavit certifying that he or she is the Subscriber’s sole Domestic Partner and has been for 12 months or more; he or she is mentally competent; he or she is not related to the Subscriber by blood closer than permitted by state law for marriage; he or she is not married to anyone else; and he or she is financially interdependent with the Subscriber. For purposes of this Plan, a Domestic Partner shall be treated the same as a spouse, and a Domestic Partner’s child, adopted child, or child for whom a Domestic Partner has legal guardianship shall be treated the same as any other child. Any federal or state law that applies to a Member who is a spouse or child under this Plan shall also apply to a Domestic Partner or a Domestic Partner’s child who is a Member under this Plan. This includes but is not limited to, COBRA, FMLA, and COB. A Domestic Partner’s or a Domestic Partner’s child’s coverage ends on the date of dissolution of the Domestic Partnership. To apply for coverage as Domestic Partners, both the Subscriber and the Domestic Partner must complete and sign the Affidavit of Domestic Partnership in addition to the Enrollment Application, and must meet all criteria stated in the Affidavit. Signatures must be witnessed and notarized by a notary public. The Employer reserves the right to make the ultimate decision in determining eligibility of the Domestic Partner. • The Subscriber’s or the Subscriber’s spouse’s children, including natural children, stepchildren, newborn and legally adopted children and children who the Employer has determined are covered under a Qualified Medical Child Support Order as defined by ERISA or any applicable state law. • Children for whom the Subscriber or the Subscriber’s spouse is a legal guardian or as otherwise required by law.
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