ELIGIBILITY
AND ENROLLMENT
ELIGIBILITY
For information concerning your eligibility for DC 37 Health &
Security Plan benefits, call the Inquiry Unit at (212) 815-1234. The current
hours of operation are Monday through Thursday, from 8 AM to 6 PM and Fridays 8
AM to 5:30 PM. The lines are very busy on Mondays and Tuesdays. The best time
to call is later in the week, between 8 am and 9:30 am.
ENROLLMENT
An enrollment card must be on file with the Health & Security
Plan before you can obtain benefits.
- If you are a new
employee enrolling a spouse, domestic partner or dependent child(ren)in
the Plan for the first time, then you must attach copies of your marriage
certificate, domestic partnership papers and birth certificate(s) of your
child(ren) to your enrollment records card.
- If you are a
long-standing member and you recently married, added a domestic partner or
recently became a parent, then you must complete a "Change of Status
Card" adding your new family members to your file. Be sure to attach
copies of the appropriate documents to the card before returning it to the
Plan.
- If you are adding a
spouse or domestic partner, be sure to include all spousal or domestic
partner employment and insurance related information on the Change of
Status Card.
- If the change in
dependent status is due to a death, separation, divorce or dissolution of
a domestic partnership, you must notify the Plan office of this, on a
change of status card, but documents are not necessary.
- If you are changing
your status, please consider updating your beneficiary information by
requesting a change of beneficiary card from the Plan office.
Most of these benefits also cover your spouse, domestic partner
and children (called dependents).
You have to be living with your spouse or domestic partner if she or he is to
be covered by these benefits.
Your "children" are all your natural or adopted children, no matter
where they live (if you are responsible for their support), and the children of
your spouse or domestic partner who are living with you.
Children are covered until the age of 19. If a child is a day student attending
a vocational or academic school full-time, the child is covered until the age
of 23. However, in order to determine eligibility for such dependents, the Plan
must have a letter from the Registrars' Office on file indicating the
dependents' current full-time status at the time these benefits are sought. To
avoid an interruption in coverage, proof of schooling should be submitted twice
yearly, at the beginning of the Spring and Fall semesters. A totally disabled
child is covered regardless of age, as long as the disability, physical or
mental, began before the child reached age 19 or 23 if attending college full-time
and the dependent is residing with the covered member. If the disabled
dependent is at any point no longer totally disabled after his/her 19th or 23rd
birthday, as the case may be, he/she will thereafter be ineligible as a covered
dependent even if a subsequent disability is a recurrence of a prior condition.
In order to establish eligibility for a totally disabled child, medical records
and/or clinical evaluation(s) must be submitted to the Plan office. You must
apply for coverage for a disabled dependent within 6 months of the member
becoming eligible for Health and Security Plan benefits. Married children are
not covered; nor is a child who regularly works more than 20 hours a week.
In order to facilitate enrollment, it is necessary that all forms and documents
received in this unit have the member's name and social security number on it.
A member needs only complete one enrollment card. All changes made after that
card is on file, must be done on a change of status card (blue) or change of
beneficiary card (yellow).
- All enrollment cards
must be completed and signed by the member.
- Change of beneficiary
cards must be signed and notarized.
- All change of status
requests must have proper documentation attached (i.e, copy of birth
certificate).
PROOF OF SCHOOLING
When a dependent reaches the age of 19 and is in school, a letter
from the Registrars' office must be submitted stating that the dependent child
is a full-time student. A letter from the Registrars' office is the only
document that will be accepted as proof of schooling. Bills, programs and
bursars' receipts are not acceptable. Proof of schooling must include the
member's name and social security number.
Proof of Schooling must be submitted for each semester the child is in school.
Spring Semester is February 1st to August 31st and Fall Semester is September
1st to January 31st. If proof of schooling has to be determined retroactively,
a grade report will be accepted.
CHANGE OF STATUS
A change of status card must be submitted along with the proper
documents, to the Health and Security Plan whenever any of the following
changes occur:
*Effective June 1994, all enrollment cards submitted must include
a Marriage Certificate (adding spouse), Birth Certificate if adding a dependent
child(ren) and Proof of Schooling if the dependent child(ren) is over 19 years
old.
A. Marriage—Submit a copy of the marriage certificate
along with the change of status card.
B. Separation/Divorce—Only change of
status card is required.
C. Registration of Domestic Partners—Domestic
Partners are two people who are both eighteen years or older and neither of
whom are married or related by blood in a manner that would bar his or her
marriage in New York State; who have a close and committed personal and
financial relationship and are living together on a continuous basis; and are
residents or employees of, or former employees of New York City. Domestic
Partners can obtain a blank Domestic Partner Affidavit from the Office of the
City Clerk, or they may contact the office by calling (212) 669-8190 for other
locations where the form can be obtained. Both partners must sign the affidavit
in the presence of a Notary Public, who will counter sign and notarize the
Affidavit.
The notarized affidavit must be submitted to the City Clerk's office, 1 Centre
Street, Room 265. Each partner must present one form of personal identification
(i.e, drivers license, birth certificate, passport, immigration card, etc.)
along with the notarized affidavit.
For those who qualify, the Clerk will issue a signed Certificate of Domestic
Partnership, embossed with the City Seal. A copy is made for the City records
and the original certificate will be given to the partners.
To
register domestic partners with the Health & Security Plan, the following
documents have to be submitted:
1. A Notarized
Domestic Partner Affidavit
2. Certificate of
Domestic Partnership
3. A Notarized
Interdependence form, with two proofs of financial Interdependence.*
4. Change of Status Card.
Domestic
Partners who are retired and are Non-Residents of N.Y.S., must submit the
following:
1. Alternative
Affidavit
2. A Notarized
Interdependence Form
3. Two Proofs of
Financial Interdependence.**
4. Change of Status Card.**
*Examples of Proofs of Financial Interdependence:
a. Joint
Checking/Savings Account
b. Joint Loan Obligation
c. Joint Ownership of a Car
d. Joint Credit Cards
e. Living Wills
f. Power of Attorney
g. Rental Agreement—with both names
h. Partner Listed as beneficiary on Insurance/Pension
**Once the domestic partner is added for coverage, the member will
receive a letter indicating the effective date of coverage. (The effective date
will not be earlier than 1/1/94).
D. Separation/Termination of Domestic Partners
Once a Domestic Partner severs its partnership, the member cannot re-register
with another partner until after six (6) months have passed.
E. Adding a Dependent
If the member or a spouse gives birth, adopts, or marries someone with dependent
children, a copy of the birth or adoption papers must be submitted to the Plan.
F. Widowed
If a member becomes widowed, only a change of status card is necessary,
indicating month and year of spouse's death or call the Eligibility Enrollment
Unit at 212-815-1620 to notify the Plan.
DISABLED DEPENDENT
The following documents must be submitted for a disabled dependent who was
disabled prior to age 19 or before age 23 if attending college as a full-time
student, in order to establish eligibility for Health & Security Plan
Benefits.
A medical transcript from the physician/psychologist/psychiatrist. Medical
records must indicate diagnosis, dates of treatment, and hospitalization dates
if applicable.
Upon receipt of the required documents, an in-house review will be made by the
Health & Security Plan in consultation with the Plan's Medical Consultant
and a determination will be made regarding the eligibility of the dependent. If
the dependent is considered not eligible, a rejection letter will be sent to
the member. The member then has the option of appealing the decision to the
Appeals Committee of the Health & Security Plan Board of Trustees.
GUARDIANSHIP
The arrangement by which certain close relatives* under age 18, may be treated
as "dependent children of the member" for the purposes of making them
eligible to receive Health and Security Plan Benefits.
In order to establish eligibility, the following
must be submitted:
- Current guardianship
papers or other court documents indicating current custodial rights.
- Copy of the latest
federal income tax form (1040) indicating that the dependent child was
claimed as a dependent.
- Provide name and
location of the school the child is attending (if child is of school age).
- A letter...
(A) Authorizing the Health and Security Plan to
contact the child's school for verification of
address, custodial
arrangements, etc.
(B) Indicating the whereabouts and employment status of natural parents; and
(C) Explaining the
circumstances how the member obtained custody of the child.
*Grandchildren, nieces, nephews and infant siblings
 |