Summary of Eligibility Rules

Eligible Dependents

The following family members are eligible for coverage if they are dependent on the member for support and maintenance:

  1. Legal spouse (The Fund does not provide eligibility for “common-law” spouses or domestic partnerships).
  2. Children under 26 years of age.
  3. Step-children under 26 years of age.
  4. Legally adopted children – children in the process of being legally adopted must live with the eligible participant or they cannot be covered.
  5. Foster children – you must provide a copy of the court order which establishes you as a foster parent. Usually foster parents are paid a subsistence for the child and the government agency will furnish medical coverage.
  6. Legal Guardianship – you must provide the court order which, pursuant to State Law, establishes Legal Guardianship.
  7. Physically or mentally handicapped dependent children over the age of 25 may be covered under certain circumstances. Contact the Fund Office for additional information.

Divorce

If you and your spouse obtain a divorce, or dissolution of your marriage, it is extremely important that you notify the Fund Office immediately.

  • COBRA: A divorced spouse may obtain COBRA Continuation Coverage of his or her medical and dental benefits for up to 36 months by paying the required fee. However, the Fund must be notified of the divorce within 60 days of the divorce date.
  • Benefit payments for ineligible spouse: If the Fund is not notified of a divorce and pays claims on the divorced spouse or other ineligible dependent after the date of the divorce, you will be responsible to repay the Fund for this expense.
  • Beneficiary forms: In the event of a divorce, you may wish to change your beneficiary for Health & Welfare, Pension and/or Vacation-Holiday benefits. The forms are available in the Documents & Forms section under the Health & Welfare Plan and Pension Tabs.
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