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My Health & Welfare

Forms

Documentation Requirements

Age 19 and Over Form

Health Care Affidavit

 

My Health & Welfare

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 within 31 days. 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 within 31 days 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 RMO 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.

Dependent children are eligible for coverage under the plan through the end of the calendar year in which they turn age 24, provided they also meet all of the following criteria:
>They meet the IRS definition of a Qualifying Child (does not include qualified child(ren) who are not otherwise covered as described above).
A Qualifying Child is one who:
>> Is enrolled as a full-time student at least five months of the year,
>> Has the same principal residence as the employee for more than half of the tax year (exceptions apply in certain cases, such as divorce / separation situations, college attendance, etc.), and
>> Is receiving more than one-half of his / her support from you and / or your legal spouse (legal spouses are those for whom the IRS recognizes as a legal spouse; common law marriage is excluded).

Dependent children who are legally disabled are eligible for coverage beyond age 24, provided they also meet all of the following criteria:
> They are enrolled in a creditable plan prior their 19th or 24th birthday, and
> They are deemed legally disabled by mental or physical incapacity prior to their 19th or 24th 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."