Amendment or Termination of Benefits
The Red Apple 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 the Red Apple 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 employer 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 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 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.
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. 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;
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.
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 the said overpayment is paid in full. Such offset and/or suspension can be applied to the member’s and eligible dependents’ benefits.
“GRANDFATHERED” HEALTH PLAN DISCLOSURE NOTICE
The United Federation of Teachers Welfare Fund (“Fund”) believes it is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (“PPACA”). A grandfathered health plan can preserve certain basic coverage that was already in effect when that law was enacted. A grandfathered plan may not include certain consumer protections of PPACA that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the law, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Fund office at 212-539-0500. You may also contact the U.S. Department of Health and Human Services at healthreform.gov.