Guide to Continuation of Coverage (Retiree)
What does my dependent do if he/she loses coverage?
1. Dependent Survivor Coverage
Dependent coverage terminates when a member’s eligibility ends for any reason other than death, or on the date when the dependent no longer meets the definition of eligible dependent, whichever occurs first. In cases of the member’s death, the Welfare Fund extends dependent coverage three (3) months following the month in which the member died.
The election of City (Medical/Hospital) COBRA does not enroll you in UFT Welfare Fund COBRA. A separate UFT Welfare Fund COBRA application is required.
COBRA provides continuation of Fund coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed below. COBRA continuation coverage must be offered to each person who is a "qualified beneficiary" (QB). A qualified beneficiary is someone who will lose coverage under the Fund because of a qualifying event. Depending on the type of qualifying event spouses of members/domestic partners, and dependent children of members may be qualified beneficiaries under the Fund’s plan of benefits. Qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
When am I eligible for COBRA?
Spouses/domestic partners1 of covered members have the right to continue coverage if coverage is lost for any of the following qualifying events:
- death of the member; or
- divorce or legal separation from the member; or
- termination of the domestic partnership with the member.
1The law does not require that COBRA continuation coverage be extended to domestic partners. However, the Fund Board of Trustees has determined that such COBRA continuation coverage will be offered to registered domestic partners of Fund members.
Dependents of members have the right to continue coverage if coverage is lost for any of the following qualifying events:
- death of the parent-member; or
- the dependent ceases to be a “dependent child” under the Fund’s rule of eligibility.
Qualified Beneficiary (QB): Individuals entitled to COBRA coverage on their own are called qualified beneficiaries (QB). Individuals who may be qualified beneficiaries are the spouse/domestic partner of the covered member and the dependent child(ren) of a covered member. In order to be a QB, an individual must be covered under the UFT Welfare Fund on the day before the event that causes the loss of coverage. The Health Insurance Portability and Accountability Act (HIPAA) amended this requirement to allow a child who is born to or adopted by the covered employee, while on COBRA, to become a Qualified Beneficiary.
Notes: Individuals covered under another employer sponsored group health plan prior to their COBRA start date are still eligible to purchase UFT Welfare Fund COBRA. However, individuals who become covered under another employer sponsored group health plan while on UFT Welfare Fund COBRA may not be eligible to continue the UFT Welfare Fund COBRA (except for the period that the new health plan excludes pre-existing conditions).
The Fund offers Medicare eligible enrollees and/or their Medicare eligible dependent(s) continuation benefits similar to COBRA if a COBRA event should occur.
What are the periods of continued coverage?
Continuation of coverage is available for a maximum duration of thirty-six (36) months for the member’s eligible dependents as a result of:
- death of member; or
- divorce; or
- legal separation; or
- termination of a domestic partnership; or
- dependents that cease to be a “dependent child” under the Fund’s rules of eligibility.
COBRA premiums for thirty-six (36) month periods are calculated at 102% of the employer’s cost for coverage to the plan at the group rate.
Continuation of coverage can never exceed thirty-six (36) months in total, regardless of the number of events that relate to a loss of coverage. Coverage during the continuation period will terminate if the COBRA participant fails to make timely payments or if the COBRA participant becomes covered under another employer sponsored group health plan while on the UFT Welfare Fund COBRA (unless the new plan contains a pre-existing condition exclusion).
What are my notification responsibilities?
Under the law, the member, retiree or eligible dependent has the responsibility to notify either their payroll secretary or the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees) and the Welfare Fund within sixty (60) days of an address change, death, divorce, legal separation, termination of domestic partnership or a child losing dependent status.
When a qualifying event (such as a member's death) your eligible dependents will be notified by the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees) of your option to choose continuation coverage.
How do I elect City COBRA coverage?
To elect City COBRA continuation of health coverage, the COBRA eligible person must complete a "COBRA - Continuation of Coverage Application" (Form EB7). This application is available through the payroll secretary, the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees).
City COBRA applications, rates and general information are also available from the Health Benefits Program section of the NYC Office of Labor Relations website (www.nyc.gov).
What should I do if I am interested in electing the UFT Welfare Fund COBRA?
To elect UFT Welfare Fund COBRA you must:
- check off the box marked “yes” on the City COBRA application where it asks “Do you wish to purchase benefits from your Welfare Fund?” The Welfare Fund will receive a copy of your application from your health carrier (this may take up to two (2) months).
- make a copy of your City application and send it directly to the Welfare Fund Office. This will expedite the process.
Upon notification, a Welfare Fund COBRA application will be mailed to you so that you may enroll in the UFT Welfare Fund COBRA benefit plan.
If you do not elect City COBRA but you would like to purchase Welfare Fund COBRA, contact the Fund office directly.
Eligible persons choosing to elect COBRA coverage must do so within sixty (60) days of the qualifying event or of the date on which they receive notification of their rights, whichever is later.
When are my premium payments due?
The initial premium is due within forty-five (45) days of your COBRA election. Thereafter, premiums are due on the first of the month with a thirty (30) day grace period. Since there cannot be a gap in the coverage period, coverage and premiums are retroactive to the COBRA qualifying event date.
When can I change my benefits selected under COBRA?
COBRA participants are entitled to change the selection of COBRA benefits during the City’s Fall Open Enrollment Period as designated for In-Service or Retirees.
Who can I call if I have any questions about COBRA?
If you have questions about your COBRA continuation coverage, you should contact the Fund or you may contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website at www.dol.gov/ebsa.
3. Extension of Coverage for Unmarried Children 29 Years of Age or Under
New York State Insurance Law allows unmarried children to be covered by the member’s insured health plan, if they so choose, by paying the premium cost of the coverage until the unmarried child reaches his/her 30th birthday. Welfare Fund coverage for unmarried children 29 years of age or under, will coordinate with coverage afforded said children under the New York City health plans
Welfare Fund forms hotline: 212-539-0539