Cobra
Under the
COBRA law, members have the right to purchase continuation coverage of Welfare Fund
Benefit. To continue basic Health Insurance under the COBRA law members should
contact their personnel office or Employee Benefits Program at 212-306-7300.
The benefits available are:
Dental, Vision care, Podiatry, Audiology,
Supplemental Surgical and Prescription Drug (optional).
In order to continue these Welfare Fund Benefits, there must be a qualifying
event as listed.
As the spouse of an employee of a qualified City Agency, he/she also have the
right to choose continuation coverage if coverage was terminated for any of the
following reasons:
(1) Death of a member;
(2) Termination of member’s employment;
(3) Divorce or separation from member; or
(4) Military active duty
In the case
of a “dependent child” of an employee, he or she has the right to continuation
coverage if coverage is lost for any of the following reasons:
(1) Death of a member;
(2) Termination of member’s employment;
(3) Parents get divorced or seperated;
(4) Dependent ceases to be a “dependent child”
under the terms of a basic group health program; or
(5) Military active duty
The law
requires that an eligible dependent be afforded the opportunity to maintain
continuation coverage for up to a maximum of 36 months, unless he/she lost Welfare
Fund coverage because of a termination of employment. In that case, the
required continuation coverage period is up to a maximum of 18 months. However,
the new law also provides that your continuation coverage may be terminated for
any of the following reasons:
(1) Welfare Fund Benefits are no longer
provided to anyone;
(2) You fail to pay on a timely basis the
applicable premium for your continuation coverage;
(3) You become an employee or eligible
dependent covered under another group health plan;
(4) You were divorced from an employee
covered by the Welfare Fund Benefits, subsequently remarry and are covered
under your new spouse’s group health plan.
You do not
have to demonstrate that you are insurable to choose continuation coverage. You
and/or your dependents must pay the entire cost for the Welfare Fund Benefits.
The premium of 102% of the Welfare Fund’s premium for providing health benefits
to individuals in the same situation as yourself.
On
Newborn or Adopted Child
If you have a newborn child or have a child placed with you for adoption (for
whom you have financial responsibility) while your COBRA continuation coverage
is in effect, you may add this child to your coverage. You must notify Melvin
K. Streisand, Controller in writing at District Council 37 Benefits Fund Trust,
125 Barclay Street, New York, New York, 10007, within 30 days of the birth or
placement in order to add the child to your coverage. Of course, adding a child
to your COBRA coverage may cause an increase in your COBRA premiums.
A child born or placed for adoption while you are on COBRA will have the same
COBRA rights as your spouse or dependents who were covered by the Plan before
the event that triggered COBRA coverage. Like all qualified beneficiaries with
COBRA coverage, their continued coverage depends on the timely and
uninterrupted payment of premiums on their behalf.
Disability after COBRA Continuation Coverage begins
If the Social Security Administration determines that you (or a member of your
family who is also eligible for COBRA continuation coverage) were totally and
permanently disabled on the day you lost eligibility for health coverage under
the Plan as an active employee, or within 60 days after that, you or your
disabled family member may elect to keep COBRA coverage for 29 months instead
of 18 months. (Previously, this special extension was only available for people
who were disabled on the date of the COBRA triggering event.) The premium for
the extra 11 months of coverage is 150% of the Welfare Fund’s cost for
providing these benefits.
You or your disabled family member must notify Melvin K. Streisand, Controller
in writing, at District Council 37 Benefits Fund Trust, 125 Barclay Street, New
York, New York, 10007, of the Social Security disability determination within
60 days of the date it is issued, and before the end of the initial 18-month
COBRA coverage period. You or your disabled family member must also notify
Melvin K. Streisand, Controller within 30 days of the date of any final
determination by the Social Security Administration that you or your family
member is no longer disabled. As with all COBRA coverage, a disabled
beneficiary’s eligibility for this extension depends on the timely and
uninterrupted payment of premiums on their behalf.
Pre-existing Conditions Exclusions
The new law also contains provisions that will
restrict the ability of health plans and health insurance companies to exclude
coverage for a new enrollee’s pre-existing health problems. In general, the
length of time that a health plan will be allowed to exclude coverage for
pre-existing conditions will be reduced by the number of months that the person
had coverage for the problem under a previous health plan, including COBRA
coverage.
If you become covered by another group health plan, your COBRA coverage will be
terminated at the point when the new plan may no longer exclude coverage for
any of your pre-existing conditions as a result of the new law. (This applies,
as well, to any of your family members who are on COBRA coverage.) The new law
on pre-existing conditions goes into effect at different time, for different
plans; the earliest effective date would be July 1, 1997, but for most employee
benefit plans it will not take effect until January 1998.
The monthly and quarterly premium rates quoted below are for all Welfare Fund
Benefits (Core & Non-Core) and Core Benefits. (NOTE: Mail Service
Maintenance Prescription Program (CFI) is not available to COBRA members.)
These rates and Benefits apply ONLY to DC 37 Welfare Fund Benefits.
ALL BENEFITS
(Core & Non-Core)
Dental, Vision, Podiatry, Audiology, Supplemental
Surgical, Second Surgical Opinion and Prescription Drug (Optional)
CORE BENEFITS-ONLY
Excludes Dental & Vision.
NON-CORE BENEFITS
Dental and Vision. These cannot be purchased alone as a package.
These rates
will remain in effect until June 30, 2009. Monthly premiums are due on the first
of the month. YOU WILL NOT RECEIVE ANY OTHER NOTIFICATION REGARDING PAYMENT OF
YOUR PREMIUM. If you have any questions, please call the Fund’s office at (212)
815-1234.
Members covered by the Cultural Trust or the
Please make all checks payable to:
DC 37 Benefits Fund
Trust
125 Barclay Street
ATTN: ACCOUNTING DEPT. - 3RD FLOOR
PLEASE WRITE YOUR
SOCIAL SECURITY NUMBER ON ALL PAYMENTS.
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