If you have dependents and you are eligible for benefits under the Plan, then your dependents may be eligible for dependent benefits under the Plan at the same time. If your child is eligible for benefits as a working Laborer under the Plan, he or she cannot be covered as your dependent under the Plan.
If you add a dependent while you are eligible for benefits under the Plan, the dependent’s eligibility for benefits begins on the date that he or she becomes your dependent. You should enroll a newborn child in the Plan within 31 days of birth. You must provide the Plan with a certified copy of the newborn’s birth certificate, listing you as a parent, within 90 days of the date of birth to continue your dependent’s coverage under the Plan.
If you do not provide a copy of your newborn’s birth certificate within 90 days of the date of birth, benefit coverage will be suspended. In addition, if the birth certificate is received by the Fund Office more than one year after the child’s birth, eligibility will resume on the date the birth certificate is received, if you, the Member, are eligible for benefits.
If Your Spouse Has Employer-Sponsored Benefits
If your spouse has employer-sponsored medical coverage that he or she does not elect, your spouse may not be eligible for coverage under the Plan or benefits may be limited. No benefits will be payable under the Chicago Laborers’ Welfare Plan if your spouse’s employer-sponsored medical plan does not provide your dependent with the same level of benefits provided to other participants in that plan. To ensure that your spouse receives the maximum level of benefits payable under this Plan, your spouse should elect coverage under any available employer-sponsored medical coverage your spouse is eligible to receive.
Your dependents are:
- Your spouse if you are not divorced.
Your child who is less than 26 years old. Specifically, coverage is determined as follows:
- A child through age 25,
- Full time student status is not required,
- Financial or marital status does not effect eligibility, and
- The Plans exclude eligibility for enrollment to any child who is eligible for other group coverage through the child’s employer or through the employer of the child’s spouse regardless of whether the child enrolls in such coverage.
Under the Plan, your child is defined as:
- Your natural child;
- Your stepchild;
- Your adopted child or child placed with you, the Eligible Member, for adoption;
- Your child who is entitled to coverage pursuant to a Qualified Medical Child Support Order (QMCSO);
Your child for whom you have legal guardianship, provided:
- You, the Member, are named legal guardian;
- The child resides in your home in a parent-child relationship;
- The child depends on you for more than half of his or her financial support;
- You have taken full parental responsibility and control for the child;
- The child is not temporarily living in your home;
- The child is not still under the control of the social service agency that placed the child with you; and
- The natural parents do not share parental responsibility and control of the child with you. Parental responsibility includes monetary support of any kind, maintenance of health coverage, and other supportive functions.
Your unmarried child who is age 26, if the child becomes physically or mentally disabled before reaching age 26. The disabled child must depend on you for more than half of his or her financial support and maintain a principal residence with you for more than one-half of the calendar year. If the disabled child does not live with you after a divorce or separation, the child will be a dependent child, provided that:
- You and the other parent are: 1) divorced or legally separated under a decree of divorce or separate maintenance; 2) separated under a written separation agreement; or 3) live apart at all times;
- You and the other parent provide over one-half of the child’s support; and
- The child is in the custody of one or both of his or her parents for more than one-half of the calendar year.
The disabled child must not be a “qualifying child” of any other taxpayer as defined in Internal Revenue Code Section 152(c).
You must give the Fund Trustees written proof of your child's disability. Please contact the Fund Office three to six months before your child's coverage would otherwise end to request a Proof of Incapacitated Child Form for completion. You must provide the Fund Office with this completed form and a copy of your child's medical records for review before your child's coverage would otherwise end. When the Trustees receive proof of your child's disability, they have the right to have a physician of the Trustees' choice examine the child. The Trustees may require such an examination as often as they believe is reasonable. The Trustees may request continuing proof of your child's disability and will notify you when this proof is required.
The term child does not include:
- A child who is living in your household if you are not the legal custodian, unless your divorce or separation decree requires that you provide benefit coverage for the child;
- A child who is in full-time armed forces service; or
A child who is not otherwise defined as your child, except for a child who is the subject of a paternity order that calls for health insurance coverage, limited as follows:
- There will be no pre-existing condition coverage before the date of the paternity order;
- If the paternity order is entered because of knowledge of the child’s illness, all coverage will be excluded under the Plan; and
- If the paternity order is entered into by consent or without contest, the Plan is entitled to and may require verification of paternity through a blood test or other scientifically recognized and commonly used examination to determine paternity.
Coverage Ends For Your Dependents
Your dependent’s eligibility for benefits under the Plan will end on the same day that your coverage ends. Your dependent’s coverage under the Plan also ends:
- When your dependent no longer meets the Plan’s definition of an eligible dependent (e.g., due to divorce, legal separation, or a child reaching age 19 or age 26 if a full-time student);
- At the end of the period for which the last contribution was paid for your dependent’s coverage;
- The date the Plan is terminated;
- The date that your Employer ends coverage for its employees;
- When your dependent enters the armed forces; or
- The date your dependent marries.