  
Coverage for your eligible dependents begins on the later of:
- The date your coverage begins; or
- The date they become eligible dependents.
Eligible dependents include:
Your Legal Spouse
In accordance with the Federal Government’s definition, your legal spouse is a person of the opposite sex to whom you are legally married in the state of your permanent residence. In the event of divorce, medical expenses incurred by your spouse on or after the date of the final divorce are not covered by the Plan.
Your Qualified Same-Sex Domestic Partner
This is the person with whom you have a committed same-sex relationship that has been in existence at least 12 months. The Plan also requires financial interdependence and that the relationship is intended to be permanent. Both you and your domestic partner must be at least 19 years of age.
Your partner is not a qualified domestic partner if either you or your partner have a spouse or other domestic partner, or you are related by blood closer than the law would permit for marriage.
Your Dependent Children
This includes your unmarried children who are younger than 19 years of age or who are age 19 through age 22 and attending an accredited school or college as a full-time student. The children must be your:
- Natural children.
- Stepchildren.
- Foster children.
- Legally adopted children.
- Children who live in your home and for whom you or your legal spouse are the legal guardian.
- Permanently disabled dependent children. Older children who are physically or mentally disabled may be considered dependents if they were disabled prior to turning age 19 (or 23, if a full-time student), they were covered as dependents at the time they became disabled, and you are eligible for benefits.
Your children can only be eligible dependents under the Plan if they are dependent on you for at least half of their support and if they reside with you for over six months during the year. The Plan may require proof that you are providing this support or proof of the dependent’s residence during the year.
Dependents do not include the children of your domestic partner unless they are your legal dependents as well. Dependents also do not include parents or any other relatives not listed above.
Verifying Eligible Dependents
When you become eligible for health coverage, the Plan requires documentation for your dependents as detailed in the chart below. In addition, you are responsible for notifying the Plan Office when you move, acquire new dependents, marry or divorce. Plan records cannot be changed until the Plan Office receives a new Performer Information Form signed by the participant with appropriate documentation. The Performer Information Form is discussed on page 65. There are deadlines in connection with some of these notices. For details contact the Plan Office or visit our Web site: www.sagph.org
and click on “Life Events”.
| Life Event |
Documentation Required by the Plan |
| Marriage |
A copy of the recorded marriage certificate. |
| Domestic Partnership |
Contact the Plan Office for an enrollment packet. |
| Divorce |
A copy of the recorded judgment of Dissolution of Marriage. |
| Birth |
A copy of the recorded birth certificate.
Exception: The Plan will accept a copy of the birth certificate from the hospital to add your natural child who is younger than one year of age for a period not to exceed 120 days while you obtain a recorded copy. |
| Adoption |
A copy of the adoption papers issued by the court. |
| Guardianship |
A copy of the guardianship papers issued by the court. |
| Students |
A completed Student Certification Form indicating full-time student status from an accredited school. |
| Physically and/or Mentally Disabled Dependents |
A completed Total Disability application and a copy of the medical records for the six months prior to the date coverage would have otherwise terminated due to age. |
| Death |
A certified copy of the death certificate. |
For children, the Plan will require proof that you are providing at least half of the child’s support and/or proof that the child resides with you for over six months during the year.
Coverage for Same Sex Domestic Partners
The Plan Office can provide you with an enrollment packet for your same-sex domestic partner. This packet contains all of the necessary forms that must be completed and all details about the program and the coverage available. You and your partner must complete and sign an Affidavit of Domestic Partnership and provide the Plan with specific items of evidence to prove that you meet the Plan’s requirements.
Depending on the tax status of your domestic partner, you may be responsible for federal and state withholding tax on the value of the coverage provided by the Plan to your domestic partner. Basically, the tax laws view the value of such health coverage as wages. There is no withholding if your domestic partner is your dependent for tax purposes.
The Plan will request verification of this dependent status from the Internal Revenue Service. If your domestic partner is not your dependent, you must prepay the taxes on a quarterly basis. The Plan Office can advise you of the rates.
Medical Child Support Orders
In order to pay benefits in accordance with a medical child support order, the Health Plan must determine that the order is a Qualified Medical Child Support Order (QMCSO). A medical child support order is a court order which provides for medical child support or health benefit coverage with respect to your dependent child. You may obtain a copy of the Plan’s procedures for determining whether or not an order is qualified by contacting the Plan Office. There is no charge to obtain the procedures.
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