Page 9 - Skyline Windows | 2022 Benefits Guide

If a child cannot support himself/herself due to intellectual disability or physical handicap, the age limitation requirement for such a child is waived provided that the disability or handicap arose prior to attaining the limiting age and the child is chiefly dependent upon the subscriber for economic support and maintenance. Proof of such incapacity and dependency must be furnished to UHC.
Dependent Verification: To enroll a family member onto the health plan, you will be required to show proof that the dependent you are enrolling is an eligible dependent.
Medical - High Plan - Choice Plus POS Hired Prior to January 1, 1997
If Married: A copy of your marriage certificate (or 2019 or 2020 tax return showing you filed as married).
If Adding Children:
Coverage Tier
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Current Weekly Rate
$55.92 $126.86 $119.63 $173.86
Coverage Tier
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Current Weekly Rate
$32.14 $76.89 $78.01 $101.31
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Copy of Birth Certificate or Social Security Card for each child showing relationship to employee
Copy of Adoption paperwork
Copy of court papers conveying legal guardianship
Medical - Low Plan - Choice EPO + Health Reimbursement Account (HRA)
Hired Prior to January 1, 1997
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