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EXNXRXOLLMENT AND ELIGIBILITY
Who are eligible dependents?
Eligible dependents must meet the following criteria. If you misrepresent your dependent eligibility for any plans, you may be subject
to disciplinary action up to termination. Applied® conducts dependent eligibility verification. New dependents must submit verification documents to ensure that only eligible dependents are covered under our benefit plans. Associates may be held responsible for reimbursing Applied for any benefits paid on behalf of an ineligible dependent. If you have questions regarding your dependent’s eligibility, please e-mail hrinquire@applied.com.
Spouse
Your current legal spouse.
Common Law Marriage is recognized only
if recognized in the Associate’s state of residence
To add dependent, submit applicable documents from below:
• Copy of your marriage certificate
• Common Law: Copy of a notarized declaration of marriage
from the state of your residence
• Copy of a joint tax return AND a recent household bill with names of both you and your spouse
If your spouse is eligible for medical / prescription coverage under his or her employer, he or she is not eligible to be covered as your dependent under Applied’s medical plans as primary coverage.
Child(ren)
Your children include naturally born children, stepchildren and adopted children.
To add dependent, submit either:
• Copy of Birth / Adoption Certificate • Legal Guardianship Order
• Medical, Dental, Vision plans: Child(ren) are covered until they reach age 26*. Coverage will end on the last day of the month that the dependent turns age 26.
• Voluntary child life, voluntary child AD&D insurance: Child(ren) are covered up to age 19; or age 26 if a full-time student. You will be asked to specify that your child is a full-time student and submit documentation showing
full-time student status.
• Hospital Indemnity, Accident Injury and Critical Illness: Child(ren) are covered until they reach age 26*.
Children for whom you are a legal guardian are eligible for coverage if they meet ALL of the following criteria:
1. Court Ordered Guardianship applies
2. Child is living with the associate
3. Child is allowed as a federal tax exemption 4. Child is unmarried
5. Child is under age 19
*A child, as described in one of the above categories, who is over age 26, unmarried, and primarily supported by you and incapable of self-sustaining employment by reason of mental or physical disability which arose while the child was covered as a dependent under this plan, or while covered as a dependent under a prior plan with no break in coverage. These criteria must be certified by the child’s physician and the child’s dependency must be allowed as a Federal tax exemption for the associate or the associate’s current legal spouse.
How do I submit documents for my dependents?
Check the message center within JUMP! Benefits after you complete your elections. You will receive a message reminder to submit documentation. Reply to the message with the document added as an attachment.
6 Applied Choices – 2019
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