Eligible Employee: An active full-time employee, including an owner, sole proprietor or partner who works a minimum of 30 hours on average per week for the Policyholder and has completed any probationary period for employees and for whom the Policyholder deducts FICA taxes from your pay.
The following are eligible as a dependent:
- The legal spouse of an enrolled employee
- Coverage for Dependent Children is extended up to age 26 regardless of marital
status, dependency status, residency with the Member or any other person, employment of the Dependent Child, or student status:
- A Dependent Child will remain eligible for coverage until he or she has attained twenty-six (26) years of age, regardless of financial dependency, residency with the Member or any other person, student status, employment, or eligibility for any other coverage.
- This Plan will cover the child regardless of whether or not the Dependent Child is married. However, no coverage is provided for a child of a dependent child (grandchildren are not covered).
- The term "Dependent Child" as used herein shall include any stepchild, legally adopted child or child placed in the Subscriber's home prior to adoption, or a child for whom the Subscriber is legal guardian.
- Coverage for a Dependent Child shall end on the last day of the month in which the Dependent Child attains the age of 26 years unless the Dependent Child is incapable of self-support because of mental illness, mental retardation, developmental disability, or physical handicap. See the definition of "Dependent Child" in the Evidence of Coverage.
Newborns are automatically covered for thirty-one (31) days after birth. To continue coverage beyond thirty-one 31 days, (unless the subscriber is already enrolled under the family membership plan), the subscriber must apply for coverage for the newborn by submitting an enrollment/change form to the Policyholder within the thirty-one (31) day period. Any subscriber who is already enrolled under the family membership plan must complete an enrollment/change form to provide information about the newborn to Health Plan Select. Premium increases, if applicable, will be effective from the date of birth.
The following dependents are not eligible to enroll for coverage:
- Parents.
- A child or spouse on active duty in the armed forces of any country except for temporary duty of 31 days or less.
- Children who are past the plan's maximum age provisions (unless physically or mentally disabled).
- Grandchildren and stepchildren (unless they meet eligibility requirements previously described).
- Sister or brothers (unless Subscriber is appointed the legal guardian by the court and may claim the sibling as a dependent on their federal income tax return and all other eligibility requirements are met).
- Step Children who do not live with the subscriber unless ordered to do so by through a Qualified Child Support Order (QMCSO).
Medicare: Employees are not eligible for coverage under Medicare by reason of age unless Medicare guidelines allow your employee to be coverage and they have specifically requested that Health Plan Select be their primary coverage.
