Agmt04 San Mateo, County of - Laserfiche WebLink

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Secretary of State. The City must receive the declaration within 60 days of issue. 2. A Statement of Financial Liability for Domestic Partner Health Benefits must be signed' and returned to Human Resources along with the declaration, before enrollment of partner or children. 3. Children of domestic partners may be enrolled providing that the children are economically dependent upon the employee for their financial support and have a parent-child relationship with the employee. 4. Coverage for children will be terminated when the child reaches age 23 (exceptions apply for children with disabilities), or when the child marries. 5. Late enrollment penalty of a gO-day waiting period applies. 6. It is the responsibility of the employee to notify the City to cancel the domestic partner's coverage if the relationship terminates or when the domestic partner no longer shares a common residence with employee. If the employee does not notify the City's Human Resources department of the termination of the relationship within 31 days of the event, the employee will be held responsible for all costs for medical services received by the partner and or children of the partner after the termination of the relationship. 7. COBRA will be offered to the partner of the employee and or children through Ca!PERS, in the event of termination of domestic partnership or the death of the employee, under the same conditions used for tradìtional marriages. Should the partner elect COBRA, the coverage will continue for up to 36 months. The partner of the employee pays for COBRA benefits. ENROLLMENT 1. . A 30 day enrollment period will be scheduled upon the approval of th~ amendment to the contract with CalPERS, and City Council approval 2. The employee, must submit the Declaration of Domestic Partnership and the completed Statement of Financial Liability to the Human Resources department. . 3. Employee will complete CalPERS enrollment form and return the form to Human Resources. .... ."....._..~......,.._..._..._,._......,._-_...,-~_....