97 Newborn children coverage will be for injury or sickness, including: • The necessary care and treatment of medically diagnosed congenital defects and birth abnormalities; and • Medical and dental treatment (including orthodontic and oral surgery treatment) involved in the management of birth defects for cleft lip and cleft palate. Adopted Children A child will be considered adopted from the earlier of: (1) the moment of placement in your home; or (2) the date of an entry of an order granting custody of the child to you. The child will continue to be considered adopted unless the child is removed fr om your home prior to issuance of a legal decree of adoption. Your Dependent’s Effective Date will be the date of the adoption or placement for adoption if you send the Employer the completed application / change form within 31 days of the event. To continue coverage beyond the 31 day period you should submit an application / change form to the Employer, within 31 days following the adoption or placement for adoption. Adding a Child due to Award of Legal Custody or Guardianship If you or your spouse is awarded legal custody or guardianship for a child, an application must be submitted within 31 days of the date legal custody or guardianship is awarded by the court. Coverage will be effective on the date the court granted legal c ustody or guardianship. Qualified Medical Child Support Order If you are required by a qualified medical child support order or court order, as defined by ERISA and/or applicable state or federal law, to enroll your child in this Plan, we will permit the child to enroll at any time without regard to any Open Enrollme nt limits and will provide the benefits of this Plan according to the applicable requirements of such order. However, a child's coverage will not extend beyond any Dependent Age Limit listed in the Schedule of Benefits. Updating Coverage and/or Removing Dependents You are required to notify the Employer of any changes that affect your eligibility or the eligibility of your Dependents for this Plan. When any of the following occurs, contact the Employer and complete the appropriate forms: • Changes in address; • Marriage or divorce; • Death of an enrolled family member (a different type of coverage may be necessary); • Enrollment in another health plan or in Medicare; • Eligibility for Medicare; • Dependent child reaching the Dependent Age Limit (see “ Termination and Continuation of Coverage ”); • Enrolled Dependent child either becomes totally or permanently disabled, or is no longer disabled. Failure to notify the Employer of individuals no longer eligible for services will not obligate the Plan to cover such services, even if F ees are received for those individuals. All notifications must be in writing and on approved forms.
Benefit Booklet: Plan 1 Page 97 Page 99