07-D TML Health Reimbursement Acct

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b. Dependents To cover Dependents under the Health Reimbursement Arrangement, at the time of initial enrollment or during an open enrollment period, a Participant must furnish to the Administrator, in writing, the names of his or her Dependents eligible to receive benefits under the HRA Plan. Coverage for Dependents enrolled at the time of initial enrollment will be effective on the same date that the Participant's coverage is effective. Coverage for Dependents enrolled during an open enrollment period will be effective on the first day of the Plan Year following the open enrollment period. During the Plan Year, certain qualifying events will permit a Participant to add a Dependent(s) other than during an open enrollment period. The Participant must add a Dependent(s) within 31 days of the qualifying event and must submit documentation of the qualifying event to the Administrator, when requested. Coverage for Dependents enrolled within 31 days of a qualifying event will be effective the first day of the month following the Administrator's receipt of an approved enrollment form and any required documentation. Except, in the case of a newborn child, the Participant has 60 days from the child's date of birth to add the child, and, when enrolled within 60 days, coverage for the newborn child will be effective on the child's date of birth. Qualifying events are: 1. Mairiage; 2. Birth or adoption of a child; 3. Termination of a Spouse's employment; 4. Change from full-time to part-time of the Spouse's employment; 5. An unpaid leave of absence from the Spouse's employment; and 6. A significant increase (Le., an increase of at least 10%) in the cost of health coverage under the Spouses employer-sponsored health plan. c. Mentally or Physically Handicapped Children If a Dependent covered under the HRA Plan reaches 19 years of age (at which time coverage would normally terminate) but the child is mentally or physically incapable of supporting himself or herself and is primarily dependent upon the Participant for support, coverage may be continued. The Participant must submit satisfactory proof of the child's incapacity to the Administrator within 31 days of the date the child reaches age 19. Coverage may continue for such child as long as the incapacity continues, subject to payment of the required contribution and all other terms of the Plan. The Administrator may require satisfactory proof of the child's continued incapacity. The Administrator may have a physician examine the child or may request proof to confirm the incapacity, but not more often than once a year. If a Participant fails to submit proof when reasonably required or refuses to allow the Administrator to examine the child, then coverage for the child will terminate. d. Active Duty Reservists Participants who are active duty reservists or guard members and their covered Dependents can maintain eligibility on the HRA Plan for up to 24 months. The date on which the Participant's absence begins is the qualifying event for Continuation of Coverage (COC) to be offered to the reservist or guard member. If a fire fighter or police officer employed by a Texas municipality is called to active duty for any period, the employing municipality must continue to maintain any health, dental or life coverage received through the date the fire fighter or police officer was called to active military duty until the municipality receives written instructions from the fire fighter or police officer to change or discontinue the coverage. Eligibility will meet or exceed requirements of USERRA and/or regulatory compliance. In administering this coverage, TML Intergovernmental Employee Benefits Pool will follow the time guidelines of Continuation of Coverage under 42 U.S.C.A. 300bb-1 et seq. To qualify for this coverage, the Participant must give written notice to the Employer within 60 days of the qualifying event. The Employer must notify TML Intergovernmental Employee Benefits Pool that a Participant has been called to active duty and submit a copy of the Employer's Active Reservist Policy. Page 3