Eligible Family

Eligible Participants and their Eligible Dependents are the only people qualified to be covered by the Group's Policy. The following section describes who is qualified as an Eligible participant or Eligible dependent, as well as information on when and who to enroll and when coverage begins and ends.

Who is Eligible to Enroll Under This Plan?

An Eligible Participant

  1. Is a member or employee of a Group covered under the Policy
  2. Has submitted an enrollment form, if applicable, and the premium to the insurer.

Eligible Dependents

An Eligible Dependent means a person who is the Eligible Participant's:

  1. spouse;
  2. unmarried natural child, stepchild or legally adopted child who has not yet reached Age 19;
  3. own or spouse's own unmarried child, of any Age, enrolled prior to Age 19, who is incapable of self support due to continuing mental retardation or physical disability and who is chiefly dependent on the Eligible Participant. The Insurer requires written proof from a Physician of such disability and dependency within 31 days of the child's 19th birthday and annually thereafter;
  4. unmarried child, from his/her 19th to 22nd birthday who is a Full-time student attending an accredited college, university, vocational or technical school, and who is fully dependent upon the Eligible Participant for support. The Insurer may require proof of student status, but not more than once a Period of Insurance;
  5. For a person who becomes an Eligible Dependent (as described below) after the date the Eligible Participant's coverage begins, coverage for the Eligible Dependent will become effective in accordance with the following provisions:
    1. Newborn Children: Coverage will be automatic for the first 31 days following the birth of an Insured Participant's Newborn child. To continue coverage beyond 31 days, the Newborn child must be enrolled within 31 days of birth.
    2. Adopted Children: An Insured Participant's adopted child is automatically covered for Illness or Injury for 31 days from either the date of placement of the child in the home or the date of the final decree of adoption, whichever is earlier. To continue coverage beyond 31 days, as Insured Participant must enroll the adopted child within 31 days either from the date of placement or the final decree of adoption.
    3. Court Ordered Coverage for a Dependent: If a court has ordered an Insured Participant to provide coverage for an Eligible Dependent who is a spouse or minor child, coverage will be automatic for the first 31 days following the date on which the court order is issued. To continue coverage beyond 31 days, and Insured Participant must enroll the Eligible Dependent within that 31-day period.

A person may not be an Insured Dependent for more than one Insured Participant.

Additional Requirements for an Eligible Participant and Eligible Dependents: An Eligible Participant and an Eligible Dependent must meet all of the following requirements:

  1. Home Country is the U.S.
  2. under age 85
  3. enrolled in a Primary Plan
  4. is traveling outside the U.S. or is traveling at least 100 miles from his/her home and is scheduled to spend at least 24 hours away from his/her home
  5. for children under age 6, must be enrolled with a parent
  6. initial purchase must be made in home country prior to departing on trip.