R2010-233 AUTHORIZING AGREEMENT - Laserfiche WebLink

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3. The Effective Date of termination for a person who ceases to meet the definition of Eligible Person: i � The date such person ceases to meet the definition of Eligible Person. � ❑ The last day of the calendar month in which such person ceases to meet the definition of an Eligible Person. ' ❑ Other: 4. Domestic Partners covered: ❑ Yes � No , If yes: A Domestic Partner, as defined in the Plan, shall be considered eligible for coverage. The Employer is responsible for ', providing notice of possible tax implications fo those Covered Employees with Domestic Partners. , If yes, are Domestic Partners eligible to continue coverage under COBRA? ❑ Yes ❑ No ' If yes, are dependents of Domestic Partners eligible for coverage? ❑ Yes ❑ No If yes, the Limiting Age � for covered children of Domestic Partners means finrenty-six (26) years, regardless of presence or absence of a �i child's financial dependency, residency, student status, employment, marital status or any combination of those �, factors. I 5. The Limiting Age for covered children is Twenty-six (26) years, regardless of presence or absence of a child's i financial dependency, residency, student status, employment, marital status or any combination of those factors. For plan years beginning before January 1, 2014, an ASO grandfathered group health plan may exclude an adult child under 26 from coverage only if the child is eligible to enroll in an eligible employer sponsored health plan (as defined in Section 5000A(fl(2) of the Internal Revenue Code) other than a group health plan of a parent. I If Employer is an Illinois county, municipality, the State of Illinois, or subject to the Illinois School Code, this Limiting Age is extended to thirty (30)years, for unmarried eligible military personnel as described in the Employer's Plan. To cover dependent children age finrenty-six (26) and over other than unmarried eligible military personnel described above, you may select and complete option i. or ii. below: i. ❑ The Limiting Age for covered children age twenty-six (26) or over, ❑ who are unmarried ❑ regardless of marital status, is years. (Twenty-seven (27)through thirty (30) are the available options.) ii. ❑ The Limiting Age for covered children who are full-time students and age twenty-six (26) or over, ❑ who are unmarried ❑ regardless of marital status, is years (Twenty-seven (27)through thirty (30) are the available options.) Coverage based on the Limiting Age(s) elected above terminates on: ❑ The birthday on which the Limiting Age is reached. ❑ The last day of the calendar month in which the Limiting Age is reached. However, such coverage shall be extended in accordance with any applicable federal or state law. 6. The Eligibility Date for a person who becomes an Eligible Person after the Effective Date of the Employer's health care plan: � The date of employment. ❑ The day of employment. ❑ The day of the month following month(s) or days of employment. ❑ The day of the month following the date of employment. ❑ Other: 7. Enrollment: Special Enrollment.� An Eligible Person may apply for coverage, Family coverage or add dependents within thirty-one (31) days of a qualifying event if he/she did not apply prior to his/her Eligibility Date or when eligible to do so. Such person's Coverage Date, Family Coverage Date, and/or dependent's Coverage Date will be the effective date of the qualifying event or, in the event of Special Enrollment due to termination of previous coverage, the date of application of coverage. In the case of a qualifying event due to loss of coverage under Medicaid or a state children's health HCSC IL GEN ASO BPA Rev. 9.1.10(On-line Version) page 2