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Applying for Health Coverage for your domestic partner
2) The participant must complete and NOTARIZE the forms labeled “Equity-League Pension and Health Fund Affidavit of Domestic Partnership” and “Attachment 1, Declaration of Financial Interdependence.” Please note that if the state or municipality in which you reside provides for the registering of Domestic Partners, you must register with such state or municipality and also attach a copy of the registration to the Domestic Partner Affidavit. If you submit proof of Domestic Partner registration or a certificate of marriage (from a jurisdiction legalizing same-sex marriage), you do not need to submit the Declaration of Financial Interdependence or further proof of financial interdependence. 3) Please mail the competed forms and premium to: Equity League Health Trust Fund 4) The Equity-League Funds Office will process your application. If additional information is required in order to process your request, the Equity-League Funds Office will contact you.
EQUITY-LEAGUE HEALTH FUND DOMESTIC PARTNER COVERAGE 1. Definition of Domestic Partners Equity-League Health Fund defines domestic partners as follows: Two adults (both of whom are 18 years or older) of the same or opposite sex, neither of whom is married (to anyone other than the domestic partner) or legally separated who: a) either: i) resided with each other for six months prior to the application for benefits and who intend to live continuously with each other indefinitely, or ii) were legally married in a state or country legalizing same-sex marriage; b) are not related by blood closer than the law would permit by marriage; c) are financially dependent on each other; d) have an exclusive close and committed relationship with each other; e) have not terminated the domestic partnership; and 2. Procedure for Verifying Domestic Partner Status
A participant who seeks domestic partner coverage is required to submit an affidavit attesting to the domestic partner status and a declaration of financial interdependence with two items of proof (such as joint lease or mortgage, joint bank account). (A sample affidavit and declaration is attached). Persons who fraudulently, wrongfully (or negligently) obtain coverage for persons who are not entitled to such coverage, or who fail to timely notify the Plan Administrator of the termination of a domestic partnership, may be subject to disciplinary and/or civil action. You will be required to refund the Fund Office for the costs associated with the wrongfully extended coverage. In addition, those who live in states or municipalities offering a domestic partner registry (such as California and New York City) will be required to show proof that they have registered as domestic partners.
3. Domestic Partner Coverage Domestic Partners of participants would be eligible for self-pay health coverage on the same basis as current dependent coverage. 4. Modification and Interpretation The Trustees reserve the right to amend or modify the eligibility requirements for domestic partner coverage and to amend, modify or terminate domestic partner coverage at any time for any reason. The Trustees reserve the right to interpret all plan documents concerning domestic partner coverage and to interpret the requirements for and extent of such coverage.
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