If you elect coverage for yourself, you are also eligible for medical, dental and vision coverage for your eligible Dependents 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, but only if you have submitted a completed written enrollment form that may be obtained from the Trust Fund Office and provided the Plan’s required proof of Dependent status is received by the Trust Fund Office.

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

See below for more information on Qualified Domestic Partners and Dependent Children.

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.

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 Agree-ment.
  • 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

A child is considered 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 paragraph (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 paragraph (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 resides with the Participant in the same residence, is at least 18 years of age and whose relationship with the Participant meets the following requirements:

  • The Domestic Partner and the Participant have an intimate, committed relationship of mutual caring for a period of at least 6 months and are each other’s sole domestic partner;
  • The Domestic Partner and the Participant share joint responsibility for each other’s common welfare and financial obligations and can submit proof of that relationship as required by the Board of Trustees;
  • Neither the Domestic Partner nor the Participant is married;
  • The Domestic Partner and the Participant are each competent to contract;
  • The Domestic Partner and the Participant are not related by blood closer than would prohibit legal marriage in the State of California;
  • Any prior domestic partnership of either person has been terminated at least 6 months prior to the date of the signing of the final declaration of domestic partnership with the Trust Office; and
  • Application for domestic partnership with the Participant is properly made as required by the Board of Trustees.

Domestic Partner Application  Enrollment Form

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