The Policyholder must notify Us of all changes that may affect any Insured Person’s eligibility under this Policy.

Other Insured Persons may include the following Family Member(s):

• Your lawful spouse who lives in the Service Area.
• Your children until the end of the plan Year in which the child reaches age 26.

Your own, or Your spouse’s Newborn children are automatically covered for the first 31 days of life. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the date of birth, and pay any additional Premium. Coverage for a Newborn dependent child enrolled within 60 days of birth will be retroactive to the date of the child’s birth.

An adopted child will be considered adopted from the earlier of: (1) the date of placement for adoption; or (2) the date of the entry of an order granting custody of the child to You, is automatically covered for 31 days. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the date of adoption, and pay any additional Premium. Coverage for an adopted dependent child enrolled within 60 days of adoption will be retroactive to the date of the child’s placement for adoption or initiation of a suit of adoption.

A child who is placed with You for foster care is automatically covered for 31 days from the date of the foster child’s placement. To continue coverage past that time, You must enroll the foster child as a Family Member by applying for his or her enrollment as a dependent within 60 days of the date the child is placed with You for foster care, and pay any additional Premium. Coverage for a foster child enrolled within 60 days of placement for foster care will be retroactive to the date of the child’s placement for foster care.

A child for whom You have legal guardianship is automatically covered for 31 days from the date of the placement. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a dependent within 60 days of the date the child is placed with You for legal guardianship, and pay any additional Premium. Coverage for a child enrolled within 60 days of placement will be retroactive to the date of the child’s placement.

If a court has ordered a Policyholder to provide coverage for an eligible child (as defined above) coverage will be automatic for the first 31 days following the date on which the court order is issued. To continue coverage past that time, You must enroll the child as a Family Member by applying for his or her enrollment as a Family Member within 60 days of the court order date, and pay any additional Premium. Court-ordered coverage for a dependent child enrolled within 60 days of the court order will be retroactive to the date of the court order.

• Your stepchildren until the end of the plan Year in which the stepchild reaches age 26.
• Your own, or Your spouse’s children, regardless of age, enrolled prior to age 26, who are incapable of self-support due to medically certified continuing mental, intellectual or physical disability, and are chiefly dependent upon the Insured Person for support and maintenance. Cigna Healthcare may require written proof of such disability and dependency within 31 days prior to the end of the Year in which the child reaches age 26.

NOTE: A child enrolled as a Family Member under this Policy is entitled to receive, while outside the Service Area, only Emergency Services for Emergency Medical Conditions.