The term “child” includes the following:
Legally adopted child
Child placed in the enrollee’s home in anticipation of adoption
Child for whom the enrollee is legal guardian
Child for whom the enrollee has legal custody
Child of the enrollee who is required to be covered by reason of a Qualified
Medical Child Support Order
The enrollee’s unmarried dependent child is eligible for coverage at any age provided the dependent is permanently mentally or physically disabled, so incapacitated as to be incapable of self-sustaining employment, and dependent upon the enrollee for 50% or more support. The disabling condition must have occurred prior to the dependent’s 19th birthday (unless already covered by the Plan as a student, in which case the condition must have occurred prior to the dependent’s 25th birthday). The enrollee must provide written proof of the incapacity (including documentation from a physician). Neither a reduction in work capacity nor an inability to find employment is, of itself, evidence of incapacitation. Coverage may continue for as long as the incapacitation exists and the enrollee remains covered under the Plan.
Proof of disability must be provided to Blue Cross & Blue Shield 31 days prior to the date a child would cease to be covered because of age or loss of full-time student status. The Plan reserves the right to request proof of continuous disability.
It is important to note that the marriage of any dependent child or his entry into full-time military service will end that child’s eligibility, regardless of age or incapacitation.
Initial Enrollment for New Employees Initial enrollment applies to newly eligible active employees. An employee is required to complete an Application for Coverage form to apply for or waive coverage within the first 31 days of employment. The employee’s Social Security number must be provided on the Application for Coverage form in order for an employee to enroll in the Plan. Dependent information on the Application for Coverage form must include birth date, Social Security Number, and mailing address, if different from the enrollee.
An employee who was initially employed before January 1, 2006, is a Legacy Employee. An employee employed on or after January 1, 2006, who has ever been employed by a community/junior college, public library, public school district, State agency or university is a Legacy Employee. An employee initially employed on or after January 1, 2006 is a Horizon Employee.
An employee may choose Base Coverage or Select Coverage at initial enrollment. An employee may apply for High Option for Children under either coverage if covering dependent(s) up to age 18.