X hits on this document

Word document

I.EXECUTIVE ORDERS - page 318 / 359

1491 views

0 shares

0 downloads

0 comments

318 / 359

c.child placed with your family for adoption by agency adoption or irrevocable act of surrender for private adoption who lives in your household and/or will be included as dependent on your federal income tax return for current or next tax year―certified copy of adoption placement order showing date of placement or copy of signed and dated irrevocable act of surrender;
d.child for whom you have been granted guardianship or legal custody, including provisional custody, who lives in your household and/or will be included as dependent on your federal income tax return for current or next tax year―certified copy of signed legal judgment granting you legal guardianship or custody, or the original notarized act granting provisional custody in proper statutory form;
e.grandchild for whom you do not have legal custody or guardianship but who is dependent on you for support and whose parent is a covered dependent―certified birth certificate or adoption decree showing parent of grandchild is dependent child and certified copy of birth certificate showing dependent child is parent of grandchild;
3.never-married child over age 21 but under age 24 years of age, who is enrolled and attending classes as a full time student and is dependent on you for support―documentation as described in Subparagraphs 2.a through 2.d above together with written certification of full-time student from registrar status within 30 days of start date of each semester/quarter;
4.never-married child age 21 or older who is incapable of self-sustaining employment due to mental retardation or physical incapacity who was covered prior to age 21―documentation as described in Subparagraphs 2.a through 2.d above together with an application for continued coverage supporting medical documentation prior to the child's attainment of age 21 as well as additional medical documentation of child's continuing condition periodically upon request by OGB;
5.such other written proof of relationship to the employee deemed sufficient by OGB.

* * *

AUTHORITY NOTE:Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).

HISTORICAL NOTE:Promulgated by the Office of the Governor, Board of Trustees of the State Employees Group Benefits Program, LR 25:1840 (October 1999), amended by the Office of the Governor, Division of Administration, Office of Group Benefits, LR 29:339 (March 2003), LR 32:1894 (October 2006), LR 35:

Part V.  Exclusive Provider Organization (EPO) Plan of Benefits

Chapter 6.Definitions

§601.Definitions

* * *

Dependentany of the following persons who (a) are enrolled for coverage as dependents by completing appropriate enrollment documents, if they are not also covered as an employee, and (b) whose relationship to the employee has been documented, as defined herein:

1. - 4.

Dependent Coverage―plan benefits with respect to the employee's documented dependent(s) only.

* * *

Documented (with respect to a dependent of an employee)the following written proof of relationship to the employee has been presented for inspection and copying to OGB, or to a representative of the employee's participant employer designated by OGB:

1.the covered employee's legal spouse―certified copy of certificate of marriage indicating date and place of marriage;
2.never-married child under age 21 who is dependent on the employee for support
a.natural or legally adopted child of plan member―certified copy of birth certificate listing plan member as parent or certified copy of legal acknowledgment of paternity signed by plan member or certified copy of adoption decree naming plan member as adoptive parent;
b.stepchild―certified copy of certificate of marriage to spouse and birth certificate listing spouse as natural or adoptive parent;
c.child placed with your family for adoption by agency adoption or irrevocable act of surrender for private adoption who lives in your household and/or will be included as dependent on your federal income tax return for current or next tax year―certified copy of adoption placement order showing date of placement or copy of signed and dated irrevocable act of surrender;
d.child for whom you have been granted guardianship or legal custody, including provisional custody, who lives in your household and/or will be included as dependent on your federal income tax return for current or next tax year―certified copy of signed legal judgment granting you legal guardianship or custody, or the original notarized act granting provisional custody in proper statutory form;
e.grandchild for whom you do not have legal custody or guardianship but who is dependent on you for support and whose parent is a covered dependent―certified birth certificate or adoption decree showing parent of grandchild is dependent child and certified copy of birth certificate showing dependent child is parent of grandchild;
3.never-married child over age 21 but under age 24 years of age, who is enrolled and attending classes as a full time student and is dependent on you for support―documentation as described in 2a through 2d above together with written certification of full-time student from registrar status within 30 days of start date of each semester/quarter;
4.never-married child age 21 or older who is incapable of self-sustaining employment due to mental retardation or physical incapacity who was covered prior to age 21―documentation as described in Paragraphs 2.a through 2.d above together with an application for continued coverage supporting medical documentation prior to the child's attainment of age 21 as well as additional medical documentation of child's continuing condition periodically upon request by OGB;
5.such other written proof of relationship to the employee deemed sufficient by OGB.

* * *

AUTHORITY NOTE:Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).

Louisiana Register   Vol. 34, No. 10   October 20, 2008

Document info
Document views1491
Page views1494
Page last viewedSat Dec 03 07:26:30 UTC 2016
Pages359
Paragraphs18243
Words293762

Comments