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Eligibility and Family Coverage
Under the State of New York and or Federal Law, you may not be excluded from coverage and/or eligibility based on several factors:
· Health Status
· Medical Condition, including both physical and mental illnesses
· Claims Experience
· Receipt of Health Care
· Medical history
· Genetic information
· Evidence of insurability, including conditions arising out of acts of domestic violence
· Disability
Also, children may not be denied enrollment under the health coverage of the child’s parent for any of the following reasons:
· The child was born out of wedlock,
· The child is not claimed as a dependent on the parent’s federal income tax return, or
· The child does not live with the parent or in the insurer’s service area.
A. Subscriber Eligibility
To be eligible to enroll as a Subscriber, you must be:
An employee or member of an organization having a Group Contract with Atlantis Health Plan
Meet the eligibility requirements of the Group,
Live or reside in the Plan’s Service Area, or work in the Service Area and receive all covered health care there.
B. Dependent Eligibility
To be eligible to enroll as a Dependent, you must be the spouse of the Subscriber under the Group Contract, or an unmarried dependent child who is:
1. Under nineteen (19) years of age, unless a dependent student Rider has been added to the Group Contract;
2. Nineteen years of age or older, but incapable of self-support due to a mental illness, developmental disability, mental retardation, or physical handicap (and this incapacity occurred before the child reached the age at which coverage would otherwise terminate under the Group Contract).
Dependent eligibility ends on the last day of the month in which the child no longer meets these conditions.
A newborn child of the Subscriber or Subscriber’s spouse will be covered from the moment of birth. Medically diagnosed congenital defects and birth abnormalities, including premature birth will be covered the same as any other illness or injury. The Subscriber must notify the Plan within 31 days of the birth.