Trinity Health Dependent Verification

In order for new family members to be eligible for coverage under any Trinity Health benefit plan, you are required to provide proof of their dependent status by November 18, 2009 . If you do not submit the required paperwork by the deadline, your newly added dependents will not be enrolled in coverage and you will be required to wait until the next annual enrollment period to enroll new dependents in the plan.

Forms

Please refer to the documentation requirements list for details regarding required forms and documentation.

Documentation Requirements
Age 19 and Over Form
Health Care Affidavit

Who is Eligible for Coverage?

You are eligible to participate in the plan provided you meet the employment requirements defined by your Trinity Health Ministry Organization.

Below is a list of dependents who are eligible for coverage under the plan. Coverage for your dependents will remain in an "ineligible" status until appropriate documentation is provided. Failure to provide appropriate documentation by November 18, 2009 will result in the voluntary termination of coverage for your covered dependents.

Please note: If you and your legal spouse (legal spouses are those for whom the IRS recognizes as a legal spouse; common law marriage is excluded) are employed with any Trinity Health Ministry Organization in a benefits-eligible position, you may either carry individual coverage as employees or one of you may cover the other as a dependent spouse. You and / or your spouse are not eligible to be covered as both an employee and a dependent under any Trinity Health plan. In addition, if both you and your spouse are covered as employees under a Trinity Health plan, only one of you may cover dependent children.

Dependent Spouse
A dependent spouse is eligible for coverage under the plan provided they meet of the following criteria:

> The person is legally married to you. Legal spouses are those for whom the IRS recognizes as a legal spouse; common law marriage is excluded.
> The person is not otherwise covered under any Trinity Health plan.

Dependent Children by Birth, Marriage, Adoption, Legal Guardinaship or Qualified Medical Child Support Order (QMCSO)
Dependent children are eligible for coverage under the plan through the end of the calendar year in which they turn age 19, provided they meet all of the following criteria:
> They are unmarried.
>They are the natural, legally adopted or court appointed dependent child of either you and / or your legal spouse (legal spouses are those for whom the IRS recognizes as a legal spouse; common law marriage is excluded).
> They are not otherwise covered under any Trinity Health plan.

Coverage from age 19 through age 26
1. He/she is unmarried;
2. He/she is the natural, legally adopted or court appointed dependent child of either you and/or your legal spouse (a “legal spouse” is a person whom the IRS recognizes as a legal spouse; common-law marriage is excluded); and
3. He/she is not otherwise covered under any Trinity Health plan

AND

Meets the definition of “Qualifying Child,” provided he or she meets all of the following criteria:

1. He/she is under age 24 at the end of the calendar year;
2. He/she is enrolled as a full-time student for at least five months of the year;
3. He/she either:

*Has the same principal place of abode as you for more than half of the taxable year, and does not provide more than half of his/her own support for the taxable year (also a “qualifying child”); or

*Has gross income for the taxable year that is less than the exemption amount under Code Section 151(d) ($3,650 for 2009), you provide over half of his/her support, and he/she is not anyone else’s qualifying child

OR

Meets the definition of a “Qualifying Relative,” provided he or she meets all of the following criteria:

1. He/she is under age 26 at the beginning of the calendar year;
2. He/she has gross income for the taxable year that is less than the exemption amount under Code Section 151(d) ($3,650 for 2009);
3. You provide over half of his/her support for the taxable year; and
4. He/she is not anyone else’s qualifying child

Coverage beyond age 26
Dependent children by birth, marriage, adoption, legal guardianship or Qualified Medical Child Support Order (QMCSO) who are totally and permanently disabled are eligible for coverage beyond age 26, provided they meet all of the following criteria:

* He/she is continuously enrolled in a creditable plan prior to his/her 19th or 26th birthday, and

* He/she is deemed legally disabled by mental or physical incapacity (that is, unable to engage in any substantially gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months) prior to his/her 19th or 26th birthday

Who is Not Eligible for Coverage?

> Your common law spouse;
> Your legal spouse and / or dependent child(ren) if covered under any Trinity Health plan as an employee or dependent;
> Any individual who begins active service in the armed forces of any country, unless coverage is continued as provided under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), and
> Any individual who does not meet the definition of an employee or dependent as described in the section of the Summary Plan Description titled "Who Is Eligible For Coverage."