Birth or Adoption
All Dependents are considered properly enrolled upon the employees’ completion of a Family Update Form and the submission
of the information required under the Proof of Dependent Status Provisions below.
Special Rule for Newly-Acquired Spouse or Stepchild: A newly acquired Spouse or stepchild of an Eligible Employee
will be covered as of the date of the marriage to the Employee, if properly enrolled within 90 days of the date of
marriage. You will be requested to complete a Family Update Form and provide proof and identification data for the
Dependent Spouse or Stepchild. If a newly acquired Spouse or stepchild is not properly enrolled within this 90 day period,
then eligibility for that Dependent will begin on the first day of the month following their proper enrollment.
Special Rule for Newborns: Newborn Dependent Children of an Eligible Employee will be covered from the date of birth,
if properly enrolled within 90 days of their birth. You will be requested to complete a Family Update Form and provide
proof and identification data for the Dependent. If a newborn dependent child is not properly enrolled within this 90
day period, then eligibility for that Dependent will begin on the first day of the month following their proper enrollment.
Special Rule for Adopted Children: Adopted Children, or children “Placed for Adoption” with an Eligible Employee will
be covered from the date of adoption, or the date of placement for adoption, if earlier, if properly enrolled within
90 days of the adoption or placement for adoption. A child is “Placed for Adoption” with you on the date you first become
legally obligated to provide full or partial support of the child whom you plan to adopt. You will be requested to complete
a Family Update Form and provide proof and identification data for the Dependent. If an adopted child is not properly
enrolled within this 90-day period, then eligibility for that Dependent will begin on the first day of the month
following their proper enrollment.
If a child is Placed for Adoption with you and is properly enrolled, and if the adoption does not become final,
coverage of that child will terminate as of the date you no longer have a legal obligation to support that child.
Proof of Dependent Status: Specific documentation to substantiate Dependent status will be required by the Plan
and may include proof that the dependent is related to the Employee and social security number (SSN) of the
dependent(s) you wish to add to the Plan, and any of the following:
-
Birth: copy of the certified birth certificate.
- Adoption or placement for adoption: court order paper signed by the judge.
- Stepchild: copy of the certified marriage certificate and copy of the certified birth certificate.
- Qualified Medical Child Support Order (QMCSO): valid QMCSO document or National Medical Support Notice.
- Disabled Dependent Child: current written statement from the child’s physician indicating the child’s diagnoses
that are the basis for the physician’s assessment that the child is currently mentally retarded or mentally or
physically disabled (as that term disabled is defined in this document) and is incapable of self-sustaining
employment as a result of that disability, and the child is dependent chiefly on you and/or your Spouse for
support and maintenance; and the disability existed before the child’s attainment of the Plan’s age limit.
The Plan may require that you show proof of initial and ongoing disability and that the child meets the Plan’s
definition of Dependent Child.
Marriage
All Dependents are considered properly enrolled upon the employees’ completion of a Family Update Form
and the submission of the information required under the Proof of Dependent Status Provisions below. If your marriage is a common-law marriage, you must also complete
a Common-Law Marriage Affidavit.
Special Rule for Newly-Acquired Spouse or Stepchild: A newly acquired Spouse or stepchild of an Eligible Employee will be covered as of the date of the marriage to the Employee, if properly enrolled within 90 days of the date of marriage. You will be requested to complete a Family Update Form and provide proof and identification data for the Dependent Spouse or Stepchild. If a newly acquired Spouse or stepchild is not properly enrolled within this 90 day period, then eligibility for that Dependent will begin on the first day of the month following their proper enrollment.
Proof of Dependent Status: Specific documentation to substantiate Dependent status will be required by the Plan and may include proof that the dependent is related to the Employee and social security number (SSN) of the dependent(s) you wish to add to the Plan, and the following:
-
Marriage: copy of the certified marriage certificate.
Disability
If an Eligible Employee (other than a self-pay Employee) becomes Totally Disabled as a result of a non-occupational bodily Injury or Sickness while covered under the Plan, and as a result of the Injury or Sickness is prevented from performing his/her regular or customary occupation, the Fund will, subject to the provisions of the Plan, pay to the Employee a weekly disability income benefit. If you are disabled for at least 30 days, the Plan will provide an Hour Bank Extension, subject to the provisions of the Plan.
If you become totally disabled and are unable to work, you and your physician must complete the Initial Disability Form and submit it to the Fund office, Wilson-McShane Corporation, in order to receive Hour Bank Extension and Weekly Income Benefits.
Loss of Employment/Coverage
If coverage is lost due to reduction in hours or termination of employment, you will have the option to elect COBRA Continuation Coverage
for up to 18 months. The Fund office will notify you of your right to COBRA Continuation Coverage.
Divorce
You or your spouse must notify the Plan and mail a fully executed copy of your divorce decree to Wilson-McShane Corporation. Once the Plan receives the divorce decree, your former spouse’s coverage will be terminated at the end of the month in which the divorce was finalized.
The fully executed copy of the divorce decree must be mailed to Wilson-McShane Corporation within 60 days of the divorce or legal separation date for your spouse to be
eligible for COBRA Continuation Coverage. If you have children for whom you do not have custody, a copy of any QMCSO is also required. At this time, you may also want
to review your beneficiary designation for your Life and AD&D Benefits.
Death
In the event of your death, your dependents may continue coverage for up to 36 months by electing COBRA Continuation Coverage.
