MISCELLANEOUS INFORMATION
AMENDMENT OR TERMINATION OF BENEFITS
This booklet and amendments constitute the
plan of benefits for members provided by the United Federation of
Teachers Welfare Fund and, as such, include the specific
terms and conditions governing the coverage and the
benefits provided for members by the Fund. In addition,
there are various administrative policies and procedures
that are applied on a uniform basis by the Fund, and
claimants will be informed whenever such policies and
procedures are applied.
The United Federation of Teachers Welfare Fund is maintained for the exclusive benefit of employees and retirees of the New York City Department of Education who are “covered” under agreements with the UFT, and for whom the employer contributes monies to the UFT Welfare Fund. The Fund, as well as the plan terms, was established, pursuant to applicable law and regulation with the intention of being legally enforceable and maintained for an indefinite period of time. However, the Fund reserves its rights, under applicable law, to alter and/or terminate the plan of benefits, as it currently exists.
The benefits provided by this Fund may, from time to
time, be changed, modified, augmented or discontinued
by the Board of Trustees. The Board of Trustees adopts
rules and regulations for the payment of benefits and all
provisions of this booklet are subject to such rules and
regulations and to the Trust indenture that established the
Fund and governs its operations.
Your coverage and your dependent’s coverage will stop on the earliest
of the following dates:
When you are no longer eligible; or
When the NYC Department of Education ceases to make contributions on your behalf to the Fund; or
When the Fund is terminated.
Your dependents’ coverage will also terminate on the date when they no longer meet the definition of “eligible dependent.”
Member benefits under this plan have been made available by the Trustees as a privilege and not as a right and are always subject to modification or termination in the exercise of the prudent discretion of the Trustees. The Trustees may expand, modify or cancel the benefits for 14 members; change eligibility requirements and otherwise exercise their prudent discretion at any time without legal right or recourse by a member or any other person.
THIRD-PARTY REIMBURSEMENT/SUBROGATION
If a covered member or dependent is injured through the
acts or omissions of a third party, the Fund shall be entitled
— to the extent it pays out benefits — to reimbursement
from the covered member or dependent from any
recovery obtained from the responsible third party.
Alternatively, the Fund shall be subrogated, unless otherwise
prohibited by law, to all rights of recovery that the
covered member or dependent may have against such
third party arising out of its acts or omissions that caused
the injury. Subrogation means that the Fund becomes
substituted in the injured person’s place to pursue a claim
for recovery against the third party. Fund benefits will be
provided only on the condition that the covered member
or dependent agrees in writing:
To reimburse the Fund, to the extent of benefits paid by it, out of any monies recovered from such third party, whether by judgment, settlement or otherwise; and
To provide the Fund with an Assignment of Proceeds to the extent of benefits paid out by the Fund on the claim and to cooperate and assist the Fund in seeking recovery. The Assignment will be filed with the person whose act caused the injuries, his or her agent, the court and/or the provider of services; and
To take all reasonable steps to effect recovery from the responsible third party and to do nothing after the injury to prejudice the Fund’s right to reimbursement or subrogation, and to execute and deliver to the Fund Office all necessary documents as the Fund may require to facilitate enforcement of the Fund’s rights and not to prejudice such rights.
OVERPAYMENT/FUTURE OFFSET
In the event you receive an overpayment of Welfare
Fund benefits, on your behalf or on behalf of your dependent,
you are obligated to refund this overpayment to the Fund
immediately. In the event you fail to refund this overpayment,
the Fund can offset the overpayment against future
benefits until the overpayment is fully recouped, or suspend
your benefits until said the overpayment is paid in
full. Such offset and/or suspension can be applied to the
member’s and eligible dependents’ benefits.
Privacy of Protected Health Information under the Health Insurance Portability and Accountability Act (“HIPAA”)
A federal law, the Health Insurance Portability and Accountability Act, (“HIPAA”), requires the Welfare Fund to protect the confidentiality of your private health information. A complete description of your rights under HIPAA can be found in the Fund’s privacy notice, which was distributed to all current members of the Fund prior to April 14, 2004 and is distributed to all new members upon enrollment, a copy of which is available from the Fund Administrator.
The Fund will not use or further disclose information that is protected by HIPAA (“protected health information”), except as necessary for treatment, payment, operations of the Fund, or as permitted or required by law. By law, the Fund has required all business associates to also observe HIPAA’s privacy rules. In particular, the Fund will not, without authorization, use or disclose protected health information for employment-related actions and decisions.
Under HIPAA, you have certain rights with respect to your protected health information, including certain rights to see and copy the information, receive an accounting of certain disclosures of the information, and under certain circumstances, amend the information. You also have the right to file a complaint with the Fund or with the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated.