Eligibility for Health Benefits

The following dependents may be enrolled under the Plan:

• Your Lawful Spouse
• Your Children
  Your children include your biological children, stepchildren, legally adopted children, children placed for adoption, and children by virtue of legal guardianship. Your children are eligible dependents covered under Medical, Prescription, Dental, and Vision benefits to the age of 26 whether they are married or unmarried. For Dependent Life Insurance, children (they must be unmarried) are covered up to age 19 or up to age 23 if they are full-time students.

• Your Disabled Children
  Your unmarried child who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than twelve months, can be covered as a dependent after age 26 while such condition exists, provided such dependent was an eligible dependent under the Plan at the time coverage would otherwise terminate due to age and you provide more than 50% of the child’s support. This provision does not apply to Dependent Life Insurance. Appropriate documentation must be provided to the Administrative Office within 60 days of the dependent’s termination date and periodically as requested by the Administrative Office.

• Your Children Covered by a Qualified Medical Child Support Order (QMCSO)
  A child covered by a QMCSO will be considered an eligible dependent for coverage. For information on the Plan’s procedures regarding QMCSO’s contact the Administrative Office.

• If you are divorced or legally separated from your spouse, your ex-spouse and any children enrolled by virtue of marriage are not eligible for coverage under the Plan. Participants must submit a copy of the final Divorce Decree or court approved Legal Separation to the Administrative Office within 30 days of the event. Otherwise participants will be responsible for any costs the Trust incurs on behalf of a former spouse and/or their children.
• A domestic partner of an eligible participant who is not a lawful spouse of the eligible participant will not be an eligible spouse under the Plan.
• Any spouse or child that is eligible under the Trust as an employee (carpenter or special class employee) cannot also be eligible as a dependent. Nor can children be covered as dependents of more than one employee (carpenter or special class employee) under the Trust.

Enroll your spouse within 31 days from the date of marriage. Provide a Certified Marriage Certificate from the Hall of Records, and Page 1 and the Signature Page (or a copy of the Certificate of Electronic Filing) of your most recent Federal Income Tax Return. If you enroll your spouse after 31 days, your spouse will be covered on the first of the month following the date the Administrative Office receives the enrollment form and the required documents.

Please note: A copy of your final divorce decree or legal separation must be submitted to the Administrative Office to remove an ex-spouse before a new spouse may be enrolled.

Your newborn will be covered by the Plan from their date of birth as long as you enroll the newborn within 31 days of their birth date and provided the required documents are submitted to the Administrative Office. If you enroll the newborn after 90 days from their date of birth, the newborn will be covered on the first of the month following the date the Administrative Office receives the enrollment material for the child.

If your covered dependent daughter becomes pregnant, only the Kaiser HMO Plan will cover the related prenatal and delivery services. Pregnancy services are not covered while insured under the Anthem PPO Medical Plan except as required by federal law for routine prenatal and postnatal visits. The grandchild is not an eligible dependent, and services related to the birth of the grandchild are not covered under the Kaiser HMO Plan or the Anthem PPO Medical Plan. 

If you acquire a child through marriage you must provide the Administrative Office with a copy of the child’s Certified Birth Certificate from the Hall of Records within 31 days of the date of the marriage. The name of the spouse who is eligible to participate must appear on the Birth Certificate. Coverage for the child will be effective on the first day of the month after you provide the required documentation. 

Important Notice about Changes in Your Family

If there is a change in your family status (for instance, if you get divorced), you must complete a family status form and mail it along with any required documentation to the Administrative Office within 31 days of the event. Otherwise, coverage is delayed or, in the case of divorce, you will be responsible for any costs the Trust incurs on behalf of ineligible dependents including but not limited to, your former spouse and any step-children after divorce from the parent of the step-children.

The Plan will cover your child from the date of adoption or placement for adoption if you enroll the child within 31 days. If you enroll the child after 90 days from the date of the adoption or placement, the child will be covered on the first of the month following the date the Administrative Office receives the enrollment material for the child. If you are unable to get the required paperwork to the Administrative Office within the 90-day period due to circumstances beyond your control, notify the Administrative Office immediately in writing to request an extension.

If you are the legal guardian of a child the Plan considers that child eligible for coverage. You must enroll the child within 31 days from the date the legal guardianship is granted. The Trust requires the legal guardianship paperwork that appoints the participant, or the spouse of participant, as the legal guardian of the child.

The child for whom the active participant or spouse is the court appointed Legal Guardian prior to the age of 18 and has a domestically enforceable court order granting Legal Guardianship for the child where the meaning of such order is that the participant or participant’s spouse has legal responsibility for custody and maintenance of the child. 

For Non-Bargaining employees, paid premium coverage for a dependent’s eligibility terminates at the end of the last day of the calendar month in which he/she turns 26. Please refer to the Non-Bargaining section in the Employer Resources Tab of this website or contact the Administrative Office for eligibility requirements.