Benefits

DC 37 Health & Security Plan Benefits

COBRA-Consolidated Omnibus Budget Reconciliation Act

Under the COBRA law, members have the right to purchase continuation coverage of Welfare Fund Benefit. To continue basic Health Insurance under the COBRA law members should contact their personnel office or Employee Benefits Program at 212-306-7300.

The Welfare Fund benefits available are:

Dental, Vision care, Podiatry, Audiology, Supplemental Surgical and Prescription Drug (optional).

In order to continue these Welfare Fund Benefits, there must be a qualifying event as listed.

As the spouse of an employee of a qualified City Agency, he/she also has the right to choose continuation coverage if coverage was terminated for any of the following reasons:

(1) Death of a member;
(2) Termination of member’s employment;
(3) Divorce or separation from member; or
(4) Military active duty

In the case of a “dependent child” of an employee, he or she has the right to continuation coverage if coverage is lost for any of the following reasons:

(1) Death of a member;
(2) Termination of member’s employment;
(3) Parents become divorced or separated;
(4) Dependent ceases to be a “dependent child” under the terms of a basic group health program; or
(5) Military active duty

The law requires that an eligible dependent be afforded the opportunity to maintain continuation coverage for up to a maximum of 36 months, unless he/she lost Welfare Fund coverage because of a termination of employment. In that case, the required continuation coverage period is up to a maximum of 18 months. However, the new law also provides that your continuation coverage may be terminated for any of the following reasons:

(1) Welfare Fund Benefits are no longer provided to anyone;
(2) You fail to pay on a timely basis the applicable premium for your continuation coverage;
(3) You become an employee or eligible dependent covered under another group health plan; (See Pre-existing Conditions Exclusions)
(4) You were divorced from an employee covered by the Welfare Fund Benefits, subsequently remarry, and are covered under your new spouse’s group health plan.

You do not have to demonstrate that you are insurable to choose continuation coverage. You and/or your dependents must pay the entire cost for the Welfare Fund Benefits. The premium of 102% of the Welfare Fund’s premium for providing health benefits to individuals in the same situation as yourself.

On August 21, 1996, the Health Insurance Portability and Accountability act of 1996 (P.L., 104-191) was signed into law. The new law takes effect on January 1, 1997 and contains the following provisions:

Newborn or Adopted Child

If you have a newborn child or have a child placed with you for adoption (for whom you have financial responsibility) while your COBRA continuation coverage is in effect, you may add this child to your coverage. You must notify the Benefits Fund Trust Controller in writing at District Council 37 Benefits Fund Trust, 125 Barclay Street, New York, New York, 10007, within 30 days of the birth or placement in order to add the child to your coverage. Of course, adding a child to your COBRA coverage may cause an increase in your COBRA premiums.

A child born or placed for adoption while you are on COBRA will have the same COBRA rights as your spouse or dependents who were covered by the Plan before the event that triggered COBRA coverage. Like all qualified beneficiaries with COBRA coverage, their continued coverage depends on the timely and uninterrupted payment of premiums on their behalf.

Disability after COBRA Continuation Coverage begins

If the Social Security Administration determines that you (or a member of your family who is also eligible for COBRA continuation coverage) were totally and permanently disabled on the day you lost eligibility for health coverage under the Plan as an active employee, or within 60 days after that, you or your disabled family member may elect to keep COBRA coverage for 29 months instead of 18 months. (Previously, this special extension was only available for people who were disabled on the date of the COBRA triggering event.) The premium for the extra 11 months of coverage is 150% of the Welfare Fund’s cost for providing these benefits.

You or your disabled family member must notify the Benefits Fund Trust Controller in writing, at District Council 37 Benefits Fund Trust, 125 Barclay Street, New York, New York, 10007, of the Social Security disability determination within 60 days of the date it is issued, and before the end of the initial 18-month COBRA coverage period. You or your disabled family member must also notify the Benefits Fund Trust Controller within 30 days of the date of any final determination by the Social Security Administration that you or your family member is no longer disabled. As with all COBRA coverage, a disabled beneficiary’s eligibility for this extension depends on the timely and uninterrupted payment of premiums on their behalf.

Pre-existing Conditions Exclusions

The new law also contains provisions that will restrict the ability of health plans and health insurance companies to exclude coverage for a new enrollee’s pre-existing health problems. In general, the length of time that a health plan will be allowed to exclude coverage for pre-existing conditions will be reduced by the number of months that the person had coverage for the problem under a previous health plan, including COBRA coverage.

If you become covered by another group health plan, your COBRA coverage will be terminated at the point when the new plan may no longer exclude coverage for any of your pre-existing conditions as a result of the new law. (This applies, as well, to any of your family members who are on COBRA coverage.) The new law on pre-existing conditions goes into effect at different time, for different plans; the earliest effective date would be July 1, 1997, but for most employee benefit plans it will not take effect until January 1998.

The monthly and quarterly premium rates quoted below are for all Welfare Fund Benefits (Core & Non-Core) and Core Benefits. (NOTE: Mail Service Maintenance Prescription Program (CFI) is not available to COBRA members.)

These rates and Benefits apply ONLY to DC 37 Welfare Fund Benefits.

ALL BENEFITS
(Core & Non-Core)
Dental, Vision, Podiatry, Audiology, Supplemental Surgical, Second Surgical Opinion and Prescription Drug (Optional)

CORE BENEFITS-ONLY
Excludes Dental & Vision.

NON-CORE BENEFITS
Dental and Vision. These cannot be purchased alone as a package.

I	INDIVIDUAL		FAMILY (more than one individual)
I	monthly	quarterly	monthly	quarterly
ALL BENEFITS With Drugs Without Drugs	$65.44 $15.90	$196.32 $47.70	$176.69 $42.93	$530.07 $128.79
CORE BENEFITS-ONLY (Excludes Dental & Vision) With Drugs Without Drugs	$49.71 $0.17	$149.13 $0.51	$134.23 $0.46	$402.69 $1.38

These rates will remain in effect until June 30, 2008. Monthly premiums are due on the first of the month. YOU WILL NOT RECEIVE ANY OTHER NOTIFICATION REGARDING PAYMENT OF YOUR PREMIUM. If you have any questions, please call the Fund’s office at (212) 815-1234.

Members covered by the Cultural Trust or the New York Public Library Trust, should contact the Plan directly at 212-815-1234 for information about your current COBRA rates and an application form.

Please make all checks payable to:

DC 37 Benefits Fund Trust
125 Barclay Street
New York, NY 10007
ATTN: ACCOUNTING DEPT. - 3RD FLOOR

PLEASE WRITE YOUR SOCIAL SECURITY NUMBER ON ALL PAYMENTS.