Special Enrollment Opportunity to Extend Dependent Child Coverage to Age 26

Effective June 1, 2011, the plan will cover dependent children up to age 26, regardless of circumstances such as being a full-time student, being married, or place of residence. Specifically, the Plan will cover eligible dependent children as follows:

To enroll your child(ren), please complete this special enrollment form. Coverage will not begin until the first of the month following the month the Fund Office receives your enrollment form.