Plan details and coverage
When does coverage begin?
Coverage for eligible members begins on their first day of employment, provided the member has enrolled in a timely manner.
Dependents become eligible on the same date as the member, or on the date they first become eligible dependents.
Access to benefits by either the member and/or his/her eligible dependents is effective on the first day of full-time employment provided the member and dependents have enrolled with the Welfare Fund. Benefits will not be paid until enrollment has been completed.
Coverage of a member’s spouse, domestic partner and/or eligible dependent is effective upon the enrollment of the spouse, domestic partner and/or eligible dependent by providing the necessary information on the enrollment form. A spouse, domestic partner and/or eligible dependent may access benefits effective with the date of marriage, domestic partnership registration with the City of New York or the date of birth or adoption of an eligible dependent, provided the employee enrolls the spouse, domestic partner and/or eligible dependent in the calendar year in which the spouse, domestic partner or eligible dependent becomes eligible for coverage under the rules of the plan.
In the event the covered employee does not enroll his/her spouse, domestic partner and/or eligible dependent in the calendar year in which eligibility for coverage occurred, then eligibility for coverage will be effective January 1st of the calendar year in which enrollment has taken place. For example, covered employee John Doe marries Jane on October 1, 2006. However, John Doe does not enroll Jane as his spouse until March 1, 2007. In this case, Jane’s effective date of coverage by the Fund will be January 1, 2007. Therefore, she may claim Fund benefits for covered services rendered to her on or after January 1, 2007.
Please Note: F-Status and spring term substitutes with a start date after January 15th and no prior continuous service are not eligible for August coverage.
Both health plan and Welfare Fund benefits can be purchased for the month of August through COBRA. Please refer to the COBRA section of this website (also in the Red Apple booklet) for additional information.
When does coverage terminate?
Coverage for a member terminates in the following situations:
- when the member is no longer in an “in-service” status as defined in the Eligibility section; or
- when the Department of Education ceases to make contributions to the Fund on their behalf; or
- upon the death of the member.
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, dependent coverage terminates three (3) months following the month in which the member died.
What do I do when my coverage terminates?
Depending upon your situation, there are many different ways to continue your coverage. They are as follows:
- Special Leave of Absence Coverage (SLOAC) - when on a medically approved Leave of Absence Without Pay For Restoration of Health.
- Family and Medical Leave Act (FMLA)
- Childcare Leave Extension of Welfare Fund Benefits
Refer to the chapter entitled “Continuation of Coverage” for details of the above.
What do my dependents do if they lose coverage?
- COBRA - The Federal Consolidated Omnibus Budget Reconciliation Act of 1985, (COBRA), requires that the City and UFT Welfare Fund offer eligible dependents of members the opportunity to continue health and certain Welfare Fund benefits at 102% of the group rate. The maximum period of coverage is thirty-six (36) months. Refer to the COBRA Section for further details.
- Dependent Survivor Coverage - In cases of the member's death, dependent coverage terminates three (3) months following the month in which the member died.
- Unmarried Dependent 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 the coverage afforded said children under New York City health plans.