DEPENDENT VERIFICATION

• Your Spouse who is your legal wife or husband as evidenced by an officially recognized certificate of marriage (a common law wife or husband is not an eligible Dependent but may be an eligible Domestic Partner as described below).
• Your unmarried or married Children under age 26
• Your unmarried Children of any age:
  • who are mainly dependent on you for care and support; and
  • who are not capable of self-support because of:
    • mental handicap (“mental handicap” means a disability that is cognitive and organic, not psychological, and must be permanent, not temporary); or
      • physical handicap; and
      • who became incapable of self-support:
        • before age 26; and
        • while covered as a Dependent under the applicable Component Plan or any other employer group plan providing coverage similar to the applicable Component Plan.

Note: When requested, you must give the Claims Administrator proof that the Child continues to meet the above conditions. The Claims Administrator will not ask for proof more than once a year.

• Your natural child;
• Your stepchild;
• Your legally adopted child (a child is considered legally adopted on the earlier of the date of placement for adoption or the date legal adoption proceedings have been started); and
• Any other child who is your or your spouse’s tax dependent for whom you or your Spouse has legal custody by court order.

The term “Child” does not include a foster child but does include a child who is required to be enrolled according to a Qualified Medical Child Support Order (“QMCSO”). If you become divorced or separated, a QMCSO may require that your Child(ren) be enrolled under a Component Plan. Nestlé will comply, to the extent the Component Plan provides coverage, with a QMCSO presented to Nestlé that meets the legal requirements for these orders. You may obtain without charge a copy of the QMCSO procedures from the Plan Administrator.

• Domestic Partner Affidavit
• Your Domestic Partner of the same or opposite gender who lives in your household with you, provided that you certify and declare you meet the requirements set forth on the enrollment website by going online to MyBenefits (nestle.ehr.com) or by calling the Nestlé Benefits Service Center at 1-877-637-2255. You must request Domestic Partner coverage within 31 days of obtaining your Domestic Partner by enrolling online at MyBenefits (nestle.ehr.com) or by calling the Nestlé Benefits Service Center at 1-877-637-2255.
• Your Domestic Partner’s unmarried or married Children under age 26
• Your Domestic Partner’s unmarried Children of any age:
  • who are mainly dependent on you or your Domestic Partner for care and support; and
  • who are not capable of self-support because of:
    • mental handicap (“mental handicap” means a disability that is cognitive and organic, not psychological, and must be permanent not temporary); or
      • physical handicap; and
      • who became incapable of self-support:
        • before age 26; and
        • while covered under the applicable Component Plan or any other employer group plan providing coverage similar to the applicable Component Plan.

• Your Domestic Partner’s natural Child;
• Your Domestic Partner’s legally adopted Child (a Child is considered legally adopted on the earlier of the date of placement for adoption or the date legal adoption proceedings have been started); and
• Any other Child who is your or your Domestic Partner’s tax dependent for whom your Domestic Partner has legal custody by court order.

Note: A Child of a Domestic Partner is not eligible for coverage unless the Domestic Partner is enrolled for the same coverage (with the exception of the Dependent Life Insurance Plan). The coverage for your Domestic Partner’s Child will terminate when coverage for the Domestic Partner terminates (with the exception of the Dependent Life Insurance Plan). When requested, you must give the Claims Administrator proof that the Child continues to meet the above conditions. The Claims Administrator will not ask for proof more than once a year.