SSMC Employee Health Benefit Plan
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Please Note
To obtain Plan coverage for each semester, you may be required, to document appropriate certification of
full-time student status to the SSMC Human Resources Department. Failure to provide the required
information, when requested, will result in that child being removed from enrollment and eligibility for
benefits until proof is provided which supports continued eligibility for Plan enrollment. This could cause
a lapse in coverage and/or loss of benefits.
c) 19 years of age, or older, who is incapable of self-support because of mental or physical
disability and became so disabled before reaching age 19. The eligibility of such a Dependent
should be established as early as possible. This should be done at the time of your initial
enrollment if the child is age 19, or older, at that time. If the child has not yet attained age 19, at
the time you first enroll in the program, eligibility for continued benefits should be established at
the time of his or her 19th birthday. You must request disabled child continuation within 31
days after the child's 19th birthday. Failure to do so could result in loss of eligibility and
benefits.
Please Note
After eligibility for the disabled or handicapped child has been established, proof that the child remains
physically or mentally unable to earn his or her own living and continues to be dependent on you for most
of his or her support and maintenance may be requested periodically from the SSMC Human Resources
Department. After two years, this proof will usually not be requested more than once each year. Failure
to provide requested documentation or proof of eligibility as a disabled child could result in loss of
coverage for that child. SSMC, at its expense, may have a Physician of their choice examine the child to
clarify the extent of the child's disability. Such examinations will not be required more than once each
year. Failure to participate in a required Physician examination will result is loss of coverage for that
child. The SSMC Human Resources Department will advise you, based on their review of the proof
submitted or the results of an independent Physician's examination, whether the child meets the eligibility
requirements for disabled or handicapped child eligibility.
3. Persons Not Considered Eligible Dependents for Plan Enrollment. The following persons are not
considered eligible for Plan enrollment as Dependents:
a. Married children or children who have been married. Eligibility ends on the date of marriage.
b. Any child, other than natural or adopted child, who is not dependent on the Employee for the majority
of his or her support.
c. Any non-enrolled Dependent on active duty in the military service or armed forces of any government
or country.
d.
Any person who does not meet the Plan definition or eligibility requirements as a Spouse or child of
the eligible Employee.
e.
Retiree Spouse/Survivor spouse age 65 or older or retiree's child.
4. Qualified Medical Child Support Orders. Federal Law requires SSMC, under certain circumstances, to
provide Plan coverage for your children when you or your Spouse divorce or separate. The law also
provides for children born out of wedlock. SSMC must comply with qualified medical child support orders
(QMCSO) that relate to Plan benefits. QMCSO means orders, judgment, settlement, or a decree issued
from a court of competent jurisdiction, magistrates or other officials with the power to issue a QMCSO
pursuant to a state's domestic laws, that requires an employer to provide available health plan coverage for
your child. This coverage is provided even if you no longer have custody and even if you would not have
chosen to cover the child under the existing health Plan. The child's custodial parent, legal guardian or
state agency can apply for coverage even if you don't. If the Plan receives a QMCSO for the child of an
eligible active Employee, it will provide immediate Plan enrollment. This means the child identified will
be included under the Employee's Plan coverage, as required according to the QMCSO requirements. You
will be required to pay any new or added monthly participation costs for the child's enrollment. Upon
request, the SSMC Human Resources Department can provide a copy of their QMCSO procedures, free of
charge.
