HEALTH AND WELFARE BENEFITS
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1 -- Q.: How can I get clarification on the ‘ins and outs’ of my UFT Health and Welfare Benefits: A.: UFT Health and Welfare Benefits are described in a booklet entitled ‘THE RED APPLE.’ This is available to you by calling the UFT Welfare Fund and requesting the booklet, which has recently been revised. The UFT Welfare Fund is open Monday through Friday, from 10 A. M. to 6 P. M. The telephone number is 212-539-0500. (Avoid calling from 1 P. M. - 2 P. M., unless it is an emergency.) You can also download this guide from the UFT website: www.uft.org 2 -- Q.: Do I automatically receive Health and Welfare Benefits if I am a school system employee? A.: No. You must first file a Form ERB-2000 for health insurance from the Department of Education and a UFT Welfare Fund enrollment form - you should do this as soon as you begin your school system employment. The Chapter Leader of your school should have UFT Welfare Fund applications. Benefits begin as soon as the application is filed. In addition, if you want to become a member of a Dental HMO, where you select a dentist from a set list and incur no out-of-pocket expenses, you must file a separate application for that specific dental program. 3 -- Q.: What are the crucial deadlines for various membership plans? A.: NYC Health Plan Transfer Period is October 15 through November 15 (it is effective the first payroll of the succeeding January). Welfare Fund Dental Plan Transfer Period is September 1 through October 15. Filing for coverage for a dependent full-time student is due by October 31. 4 -- Q.: How do I get answers to specific questions regarding the various health insurance plans, or get help regarding specific benefit reimbursements? A.: Call or send written questions to the Health and Welfare Unit of the Department of Education, 65 Court 5 -- Q.: How can I obtain copies of the various forms necessary for reimbursement? A.: A 24-hour hotline, 212-539-0539, can be called to request optical or hearing aid service certificates. These forms should be obtained prior to visits for these services, and be submitted for processing within 30 days of the initial request. Other forms may be obtained by mail, or downloaded from the UFT website. 6 -- Q.: What are the different Health and Welfare benefits available to me through the UFT benefits membership program? A.: They are prescription drug, dental, optical, hearing aid, disability, death benefit, and special leave of absence coverage. These are described in detail in the ‘THE RED APPLE’ benefits handbook.
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HEALTH AND WELFARE BENEFIT COVERAGE CRITERIA
| 7 -- Q.: What is the coverage for children who are age 19 or older? A.: Coverage terminates for children over age 19, unless they are enrolled in a full-time accredited educational program that offers a degree or diploma. If this is the case, coverage terminates at the end of the calendar year (December 31st) of the student’s 23rd birthday, loss of full-time status, or graduation, whichever occurs first. Eligibility must be established annually, with the filing of a ‘Dependent Student Verification Form,’ with both the UFT Welfare Fund AND the health insurance company. A student who is disabled before the age of termination of coverage may continue to receive benefits if a ‘Certificate of Disability’ is filed and approved. Contact the UFT Welfare Fund to obtain forms. 8 -- Q.: What other status changes require updating my coverage? A.: The UFT Welfare Fund must be informed of all changes in marital status or dependents by submitting a UFT Welfare Fund Change of Status Form. The DOE must also be informed, within 30 days of the event, by filing a Form ERB-2000. Both must be accompanied by appropriate documentation.
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COVERAGE CHANGE WITH EMPLOYMENT STATUS CHANGE
| 9 -- Q.: What happens to my coverage when my employment status changes? A.: Call the hotline for guidance regarding what forms to complete, and clarification as to coverage condition and length of time. Loss of coverage may occur for different reasons. There are a variety of provisions made for extending your coverage. These vary, based on the circumstances of your work, leave, or change of employment circumstances, and include:
* COBRA - The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 requires that the City and the UFT Welfare Fund offer members, retirees, and their families the opportunity to continue coverage at 102% of the group rate. The maximum period of coverage is 18, 29, or 36 months, depending on the reason for termination. This allows members to purchase their current health plan should there be a loss of coverage, e.g., should your child become a full-time student and he/she is over the age of 23, or coverage to the family is lost because employment is terminated, or the member has died, leaving the family uncovered by the initial plan. |
DISABILITY COVERAGE
| 10 -- Q.: What disability coverage is there for therapists? A.: Disability coverage for therapists is the same as it is for teachers. Special forms must be filed in a timely fashion, and with the required certification, to establish disability. DBL-1 must be filed no later than 30 days following the 28-day waiting period. It is necessary to exhaust your sick leave bank [Cumulative Absence Reserve - (CAR)], and to have been removed from the Department of Education payroll. Once the required waiting period of 28 consecutive days has elapsed, therapists are entitled to $275 per week, for a maximum of 28 weeks. The conditions for disability include: an authorized leave of absence without pay for the restoration of health, or an authorized FMLA for personal illness. These must be substantiated by a doctor’s authorization. The employee must return to work for 40 consecutive days before being eligible for additional disability pay.
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