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APPENDIX A <br />Employer Name: City of Little Canada <br />ELIGIBILITY <br />To enroll for coverage, an employee and his or her dependents must reside in the Service Area and meet the <br />eligibility requirements described below and in the Contract. If there is a conflict between the Certificate <br />and this Appendix A, Appendix A will prevail. <br />The term "Subscriber" as used in the Contract will include any conditions identified in items (1), (2) <br />or (3) below: <br />Applicable Waiting Periods <br />and Effective Dates <br />1. Employees: Employees New Hires: Eligible the first of the <br />working a minimum of 40 month following date of hire. <br />hours per week. <br />2. Early Retirees: <br />3. Retirees: <br />The term "Dependent" as used in the Contract will include the following: <br />4. The Subscriber's spouse. <br />5. The Subscriber's unmarried natural or adopted child. <br />6. The Subscriber's handicapped dependent. The handicapped dependent must be incapable of <br />self- sustaining employment by reason of mental retardation or physical handicap and chiefly <br />dependent upon the Subscriber for support and maintenance. The handicapped dependent shall <br />be eligible for coverage as long as he or she continues to be handicapped, unless coverage <br />otherwise terminates under this Contract. Medica Choice may require proof of handicap and <br />dependency annually. An illness will not be considered a physical handicap. <br />7. The Subscriber must provide satisfactory proof of <br />for either of these: <br />a. The Subscriber's grandchild placed with <br />guardianship of the Subscriber, or <br />dependency, upon request by Medica Choice, <br />the Subscriber for adoption or under legal <br />b. a child under legal guardianship of the Subscriber. <br />Page 12 <br />