Dependent Eligibility Criteria
An eligible dependent is an individual (other than the employee covered by the Plan) who lives in the United States, Puerto Rico, U.S. Virgin Islands, or who accompanies an employee on a Company assignment outside the U.S. and is related to the employee in one of the following ways:
• Spouse, not employed by the Company (Domestic Partners and their children are not eligible to participate in HMOs or Flexible Spending Accounts)
• Unmarried child under age 19, as defined on page 14
American Eagle Airlines Employee Benefits Guide 14 • Unmarried child age 19 through 22, if the child is registered as a full-time student at an
educational institution in a program of study leading to a degree or certification (proof of continuing eligibility will be required from time to time) and either:
o The child maintains legal residence with you and is wholly dependent on you for maintenance and support; or
o You are required to provide coverage under a Qualified Medical Child Support Order (QMCSO) that is issued by the court or a state agency (see page 74).
If, for medical reasons, the child is required to reduce or terminate his or her studies, coverage will be continued for up to nine months. The child must be under a physician’s care, and statements must be provided from the attending physician and educational institution to UnitedHealthcare. After nine months, coverage will end unless the child returns to school full-time or meets the definition of an incapacitated child. If you are enrolled in an HMO, you must contact your individual HMO to determine eligibility requirements and when coverage will be terminated.
Determining a Child’s Eligibility
For the purpose of determining eligibility, “child” includes your: • Natural child
• Legally adopted child
• Natural or legally adopted child of a covered Domestic Partner as defined by the Plan (see page 16)
• Stepchild, if the child lives with you and you the employee, either jointly or individually, claim the stepchild as a dependent on your federal income tax return.
• Stepchild of your Domestic Partner, if the child lives with you and your Domestic Partner claims the child on his or her federal income tax return and the tax return indicates the same address as yours. The child must not have income over the amount of a federal income tax personal
exemptions for that year ($3,200 in 2005).
• Special Dependent, if you meet all of the following requirements:
o You must have legal custody or legal guardianship of the child awarded to you by the court. (The documents must consist of a court order signed by a judge. A document bearing the notarized signature of the custodian or guardian is not sufficient to determine proof of eligibility.)
o You must claim the child as a dependent on your federal income tax return.
o You must submit a Special Dependent Statement to UnitedHealthcare (UHC) and UHC must approve the form. (Complete and return the form to UHC at the address on the form, along with copies of the official court documents awarding you custodianship or guardianship of the child.)
o UHC will send you a letter notifying you of its findings. If your request is approved, the notification letter will include an approval date. If you submit your request within 60 days of the date that legal guardianship or legal custodianship is awarded by the court,
coverage for the child is effective as of that date, pending approval by UHC. If you submit the request after the 60-day time frame, coverage is not effective until the date that UHC approves the coverage.
o The child must have income less than the amount of the federal income tax personal exemption for that year ($3,200 in 2005).
American Eagle Airlines Employee Benefits Guide 15 • You are required to provide coverage under a Qualified Medical Child Support Order (QMCSO)
that is issued by the court or a National Medical Support Notice issued by a state agency (see page 74).
Coverage for an Incapacitated Child
An “incapacitated child” age 19 or over is eligible if all of the following criteria are met:
• The child was covered as your dependent under this Plan before reaching age 19 (or age 23 if registered as a full-time student before reaching age 23).
• The child is mentally or physically incapable of self-support.
• Within 31 days of the date coverage would otherwise end, you must file a Statement of Dependent Eligibility and UnitedHealthcare must approve the application.
• The child continues to meet the criteria for dependent coverage under this Plan.
• You provide additional medical proof of incapacity as may be required by UnitedHealthcare from time to time. Coverage will be terminated and cannot be reinstated if you cannot provide proof or if UnitedHealthcare determines the child is no longer incapacitated. If you elect to drop coverage for your child, you may not later reinstate it.
• And either:
o The child maintains legal residence with you and is wholly dependent on you for
maintenance and support and has income less than the amount of the federal income tax personal exemption for the tax year ($3,200 in 2005).
o You are required to provide coverage under a Qualified Medical Child Support Order (QMCSO) that is issued by the court or a state agency (see page 74).