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 30 days
of your new hire or status change date. 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
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 30 days of your new hire or status change date.
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 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 guardianship 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 26,
provided they meet all of the following criteria:
- They are the natural, legally adopted or court appointed
children of either you and/or your legal spouse (a legal
spouse is a person who is legally married to you under applicable
State and Federal law and who the IRS recognizes as your
spouse for income tax purpose; a spouse by common law marriage
is not considered your legal spouse for Plan purposes).
- They are not otherwise covered under the Plan or any
other group health plan offered by the Employer.
Dependent children who are totally and permanently disabled
are eligible for coverage beyond age 26, provided they also
meet all of the following criteria:
- They are continuously enrolled in a creditable plan prior
to their 26th birthday, and
- They are deemed legally disabled by mental or physical
incapacity (i.e., 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
their 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."
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