Reso 2010-1529 - Laserfiche WebLink

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4.01 To be eligible to enroll as a Subscriber, a person must be: 4.01.01 An employee of the Subscribing Group who works the required number of hours per week as set forth in the Master Application for this Contract. The employee must either work or reside in the Service Area. Except as provided for Emergency Medical Services and Care, the covered services and benefits are available only from Participating Providers. Employed for the period of time required for eligibility as set forth in the Master Application; and Entitled on his own behalf to participate in the medical and Hospital care benefits arranged by the Subscribing Group under this Contract. ') ) 4.01.02 4.01.03 10 IV. ELIGIBILITY To be eligible to enroll as a Dependent, a person must be: 4.02.01 The spouse ofthe Subscriber; a new spouse must be enrolled within 31 days after rnarriage in order to be covered; or 4.02 4.02.02 ) A V -01 00-2009 MP-5319 (10/09) A child of the Subscriber, or a child of a covered Dependent of the Subscriber, provided that all ofthe following conditions apply: a) The child is the natural child or stepchild of the Subscriber; a legally adopted child in the custody of the Subscriber from the time of placement in the home (written evidence of adoption must be furnished to AvMed opon request); a child for whorn the Subscriber has been appointed legal guardian, pursuant to a valid court order; or a newbom child of a covered Dependent of the Subscriber (such coverage terminates 18 months after the birth of the newborn child); b) The child resides with the Subscriber (except for 'e' and 'g' below); c) The child is under the age of 19 (except for 'e' and 'f' below, or Section 4.04 below); d) The child is principally dependent upon the Subscriber for maintenance and support and is not regularly ernployed by one or more employers for a total of 30 hours or more per week; e) The child, from age 19 through the end of the calendar year when the child turns 25, if the child meets the following requirements: I) The child is dependent upon the Subscriber for support; and 2) The child is living in the household of the Subscriber or the child is a Full- Tirne or Part-Time Student. See Section 3.19. 3) It is the Subscriber's responsibility to notifY AvMed when the child no longer meets these requirements. Termination of coverage may be retroactively applied if AvMed is not notified within 31 days. Subscriber agrees to provide supporting documentation upon request by AvMed. 4) In the event the enrolled Dependent child, who is a Full-Time or Part-time Student, suffers frorn a serious illness or injury requiring a leave of absence from school which would otherwise cause the Dependent child to lose eligibility under the plan, coverage will be extended for one year from the ftrst day of the leave of absence or the date on which coverage under the plan would otherwise terminate, whichever occurs fIrst. AvMed will require written certifIcation from a treating physician 8