If you elect coverage for yourself, your eligible dependents are also eligible for medical, dental and vision coverage on the later of the day you become eligible for your own coverage or the day you acquire an eligible Dependent, either by marriage, birth, adoption or placement for adoption, once you have submitted a completed an Enrollment Form and the Plan’s required proof of Dependent status to the Trust Fund Office.

A Dependent may not be enrolled for coverage unless the Participant is also enrolled. The Plan requires specific documentation to substantiate Dependent status. An eligible Dependent includes your lawful spouse or Qualified Domestic Partner, and your Dependent children.

Enrollment Form  Summary Plan Description

Adding or Removing Dependents

Adding Dependents requires the completion of a new Enrollment Form and submission of required documentation as described below.

Except when adding a Domestic Partner and his or her dependent children, there is no additional charge for an Active Participant to add an eligible dependent. Retirees will be subject to an increased premium when adding dependents to their coverage.

In addition to a completed Enrollment Form, when adding or removing a dependent, the documentation required is as follows:

  • Adding a Spouse: Provide a legible photocopy of your Certified Marriage Certificate.
  • Adding a Domestic Partner: Complete a Domestic Partner Packet.
  • Removing a Spouse: Provide a copy of your final divorce decree including the filed Marital Settlement Agreement.
  • Removing a Domestic Partner or Domestic Partner's Dependent Child: Complete an Election to Terminate Domestic Partner Health Coverage Form.
  • Initial enrollment of your dependent children, stepchildren, or Domestic Partner’s children: Provide a legible photocopy of their Certified Birth Certificate.
  • Adding Adopted children: Provide a copy of the adoption papers.
  • Adding Children for whom you are the legal guardian: Provide a copy of the filed legal guardianship papers.
  • If your dependent child is 19 or older and enrolled in Medicare, you MUST submit a photocopy of your dependent’s Medicare card.


  • What is a Coordination of Benefits provision? Does this plan have a Coordination of Benefits Provision?

    The Indemnity Plan coordinates benefits with other group-sponsored plans.  Coordination of benefits eliminates duplication of benefits paid by multiple plans you or your dependents qualify for eligibility under.  For example, if your child is covered by your Plan and your Spouse’s plan, in general, the plan of the parent with the earliest birthday in the year (month and day) pays benefits first and the other parent’s plan pays secondary benefits, not to exceed the amount the provider charged.

    The Indemnity Plan requires an eligible Participant’s working Spouse who has the opportunity to enroll in a health plan through his/her employment  to take the offered insurance, even if there is a contribution required for that coverage.  The requirement applies only to the Spouse of an Active Participant and not to Dependent children.  If a working Spouse does not take coverage offered through his/her employer, the Indemnity Medical Plan will estimate the other group plan benefits to be 80% of Covered Expenses incurred and this Plan will pay only 20% of the Covered Expenses submitted for payment.

Dependent Children

The Plan considers a child to be a Dependent if he or she are any of the following:

  • A natural child, stepchild, legally adopted child, or a child that is required to be covered under a Qualified Medical Child Support Order or National Medical Support Notice, who is younger than 26 years of age, whether married or unmarried. Adopted children are eligible under the Plan when they are placed for adoption;
  • An unmarried child for whom you have been appointed legal guardian, provided the child is younger than 19 years of age and is considered your dependent for federal income tax purposes;
  • An unmarried child of your qualified Domestic Partner, provided the child is younger than 19 years of age and is primarily dependent on you for financial support;
  • An unmarried child eligible under point 2 or 3 above who is at least 19 but less than 23 years of age and a full time student at an accredited educational institution, provided the child otherwise meets the requirements of of point 2 or 3 above; or
  • An unmarried child of you or your spouse or qualified Domestic Partner of any age who is prevented from earning a living because of mental or physical disability, provided the child was disabled and eligible as a Dependent under this Plan before reaching the limiting age described in the scenarios above, and provided the child is primarily dependent on the Participant for financial support.

Qualified Domestic Partners

A "Qualified Domestic Partner" is a person who the Participant has registered with as a Domestic Partner by any state or local government agency authorized to perform such registration, and meets the following requirements:

  • Any prior domestic partnership of of the Participant has been terminated at least 6 months prior to the date of the enrollment of the subsequent Domestic Partner,
  • Application for domestic partnership with the Participant is properly made as required by the Board of Trustees, and
  • All required taxes on the imputed income attributable to Domestic Partner benefits are paid to the Fund when due.

To terminate coverage for a Domestic Partner, complete an Election to Terminate Domestic Partner Health Coverage Form. It may also be necessary to terminate your Domestic Partnership with the City, County or State where you registered as Domestic Partners.

Domestic Partner Application  Enrollment Form

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