 |
SECTION 1 - ELIGIBILITY REQUIREMENTS
- A.
- Employee
- To be eligible to enroll, a UCAR Employee must:
- 1.
- Be eligible to participate in, or be currently enrolled in, a medical Plan offered by
UCAR; and
- 2.
- Be a resident in a Kaiser Permanente Service Area; and
- 3.
- Be classified as a:
- a.
- Regular Full-Time or Part-Time Employee; or
- b.
- Term, Full-Time or Part-Time Employee; or
- c.
- Term, Post-Doctoral Employee.
- If a Participant is an Hawaiian Employee who claimed an exemption permitted by the Hawaii
Prepaid Health Care Act, and his or her exemption is subsequently terminated, such Employee
will be eligible for Coverage on the date the exemption terminates.
- Casual Employees are not eligible for the medical Plan.
- B.
- Dependent
- 1.
- To be eligible for Coverage as a Dependent under the Plan, a person must be the
lawful spouse of a Participant or a Participant's Dependent unmarried child under age 24.
Dependent children will be covered until the end of the month in which they turn 24 years
old. Dependent children can include natural, step and legally adopted children. If the
covered child is attending school away from home, they are covered for emergency services
throughout the world, and full services if residing in another Kaiser Permanente
service area and enrolled as an inter-regional member.
- A child who is covered as a Dependent on the child's 24th birthday may continue coverage
if incapable of self-sustaining employment by reason of mental retardation or physical
handicap and chiefly dependent upon the UCAR employee for support and maintenance, with
proof of incapacity and dependency furnished annually if requested by Kaiser Permanente.
- Note: An "adopted child" who is awaiting final order of adoption is an Eligible
Dependent from the date the child is placed in the Participant's home.
- Children recognized under a Qualified Medical Child Support Order are also covered under
this Plan.
- A Qualified Medical Child Support Order (QMCSO) is an order or a judgment from a state
court directing the Plan administrator to cover a child for benefits under the medical
Plan.
- Here are a few examples of individuals who may be covered under a QMCSO:
- Child(ren)born to a single parent
- Child(ren) not claimed as a dependent on the parent's federal income tax return
- Child(ren) not residing with the parent
- 2.
- Newborn children will be eligible for Coverage from birth, subject to the enrollment
requirements described in SECTION 2 - ENROLLMENT.
- 3.
- A Covered Dependent who temporarily resides outside of a Kaiser Permanente Service
Area shall be covered in the event of an Emergency for all Health Services performed by
Kaiser Permanente Physicians in a Kaiser Permanente Service Area.
- 4.
- Domestic Partners - To be eligible to be covered under the Plan as a Domestic
Partner, the partner and the Employee must be of the same sex, and must:
- a.
- Complete an affidavit of Domestic Partnership;
- b.
- Be eighteen years of age or older;
- c.
- Share a close personal relationship and be responsible for each other's common welfare;
- d.
- Have lived together continuously for at least six months;
- e.
- Be each other's sole Domestic Partner;
- f.
- Be unmarried or have not had another Domestic Partner within the prior twelve
months;
- g.
- Be unrelated by blood closer than would bar marriage in the State of Colorado;
- h.
- Share the same regular and permanent residence, with the current intent to continue
doing so indefinitely;
- i.
- Be jointly financially responsible for basic living expenses. Note:
Domestic Partners need not contribute equally or jointly to the cost of these
expenses as long as they agree that both are responsible for the cost);
- j.
- Have the power of attorney applicable to medical emergencies; and
- k.
- Have been mentally competent to consent to contract when the domestic partnership
began.
Note: For all Colorado Kaiser Permanente members covered
under the Plan as a Domestic Partner, they must be of the same sex. Opposite sex partners can be covered under a
plan as Common Law Marriage.
- C.
- Duplicate Coverage
- A husband and wife who are both UCAR Employees can be covered as Employees and/or as
Dependents. If a husband and wife are both covered under the Plan as Employees, their Dependent
children may be Covered Dependents of either the husband and/or the wife.
- D.
- Retiree
- To be eligible as a retiree, a terminating employee's age plus years of service with UCAR
must be equal to or greater than 65 with a minimum age of 50 and a minimum of 5 years
of service at retirement. The retiree must live in a Kaiser Permanente Service
Area.
- Surviving spouses of deceased retired UCAR employees are also eligible to remain
covered.
- Note: Some restrictions apply to Retirees upon selecting the
Kaiser Permanente Plan:
- A new enrollee may not be receiving Medicare hospice benefits at the time of enrollment in
the Kaiser Permanente Senior Advantage Plan, unless the person is currently enrolled
under this Plan.
- E.
- Scientific Visitor
- Scientific Visitors are eligible for Coverage under this Plan only if coverage is not
provided by their home institutions and they live in a Kaiser Permanente Service
Area.
- F.
- Foreign Scientific and Student Visitors not on UCAR's Payroll
- Foreign Scientific and Student Visitors at UCAR for one month or longer who are not on
immigration visas are eligible if they have no other U.S. coverage and live in a Kaiser
Permanente service area.
- G.
- Employees on Leaves of Absence
- Employees on certain types of leaves of absence are eligible in accordance with UCAR
policy if they reside in a Kaiser Permanente Service Area.
- Surviving spouses of employees who die while receiving Long-Term
Disability benefits are eligible for COBRA benefits as described in SECTION 5 -
CONTINUATION AND CONVERSION.
- H.
- Staff Reduction
- Employees who have been terminated due to a staff reduction can continue coverage for two
months following termination at UCAR's expense. Coverage may be continued for an
additional 16 months at the employee's expense. Note: If the employee receives a
notice period rather than severance and then terminates voluntarily before that notice
period ends, the two months of coverage at UCAR's expense will not be available to the
employee.
- I.
- COBRA Eligibility
- A Covered Person whose Coverage ends under the Plan may be entitled
to continue Coverage if he or she lives in a Kaiser Permanente Service Area. See
SECTION 5 - CONTINUATION AND CONVERSION.
- J.
- Waiting Period
- There is no waiting period.
- K.
- Employees on Long-Term Disability
- Employees receiving benefits under the UCAR Long-Term Disability Plan are eligible.
January 2004
|
| |
|
