• If you are a new employee enrolling a spouse, domestic partner or dependent child(ren)in the Plan for the first time, then you must attach copies of your marriage certificate, domestic partnership papers and birth certificate(s) of your child(ren) to your enrollment records card.
  
  
• If you are a long-standing member and you recently married, added a domestic partner or recently became a parent, then you must complete a "Change of Status Card" adding your new family members to your file. Be sure to attach copies of the appropriate documents to the card before returning it to the Plan.
  
  
• If you are adding a spouse or domestic partner, be sure to include all spousal or domestic partner employment and insurance related information on the Change of Status Card.
  
  
• If the change in dependent status is due to a death, separation, divorce or dissolution of a domestic partnership, you must notify the Plan office of this, on a change of status card, but documents are not necessary.
  
  
• If you are changing your status, please consider updating your beneficiary information by requesting a change of beneficiary card from the Plan office.

Most of these benefits also cover your legal spouse, domestic partner and children (called dependents).

Your "legal" spouse is your wife or husband. Your "children" are all your natural or adopted children, no matter where they live (if you are responsible for their support), and the children of your spouse or domestic partner who are living with you.

Children are covered until the age of 19. If a child is a student attending a vocational or academic school full-time, the child is covered until the age of 23. However, in order to determine eligibility for such dependents, the Plan must have a letter from the Registrar's Office on file indicating the dependent's current full-time status at the time these benefits are sought. To avoid an interruption in coverage, proof of schooling should be submitted twice yearly, at the beginning of the spring and fall semesters. (See Proof of Schooling section.)

A totally disabled child is covered regardless of age, as long as the disability, physical or mental, began before the child reached age 19 or 23 if attending college full-time and the dependent is residing with the covered member. If the disabled dependent is at any point no longer totally disabled after his/her 19th or 23rd birthday, as the case may be, he/she will thereafter be ineligible as a covered dependent even if a subsequent disability is a recurrence of a prior condition. In order to establish eligibility for a totally disabled child, medical records and/or clinical evaluation(s) must be submitted to the Plan office. You must apply for coverage for a disabled dependent within 6 months of the member becoming eligible for Health and Security Plan benefits. (See Disabled Dependent section.)

Married children are not covered; nor are children who regularly work more than 20 hours a week.

In order to facilitate enrollment, it is necessary that all forms and documents received in this unit have the member's name, social security number or PID number on it. A member needs only complete one enrollment card. All changes made after that card is on file, must be done on a change of status card (blue) or change of beneficiary card (yellow).

Proof of Schooling Required for dependents age 19-23

Children are covered until the age of 19. If a child is a student attending a vocational or academic school full-time, the child is covered until the age of 23. However, in order to determine eligibility for such dependents, the Plan must have a letter from the Registrar's Office on file indicating the dependent's current full-time status at the time these benefits are sought. To avoid an interruption in coverage, proof of schooling should be submitted twice yearly, at the beginning of the spring and fall semesters. A letter from the Registrar's office is the only document that will be accepted as proof of schooling. Bills, programs and bursar's receipts are not acceptable, nor are letters dated prior to the beginning of the semester. Proof of schooling must include the member's name, social security number or PID number. If proof of schooling has to be determined retroactively, a grade report or transcript will be accepted.

Michelle's Law

Effective January 1, 2010 Michelle's law requires employers to provide up to one year of extended health benefits (including DC 37's supplemental health benefits) if the benefit plan receives written certification from a student's treating physician that the student is suffering from a "serious illness or injury, and that a leave of absence from a postsecondary institution is medically necessary, and the resulting loss of student status would cause a loss of health coverage under the terms of the Plan.

Change of Status

A change of status card must be submitted along with the proper documents, to the Health and Security Plan whenever any of the following changes occur:*Effective June 1994, all enrollment cards submitted must include a Marriage Certificate (adding spouse), Birth Certificate if adding a dependent child(ren) and Proof of Schooling if the dependent child(ren) is over 19 years old.

A. Marriage—Submit a copy of the marriage certificate along with the change of status card.

B. Separation/Divorce—Only change of status card is required.

C. Registration of Domestic Partners—Domestic Partners are two people who are both eighteen years or older and neither of whom are married or related by blood in a manner that would bar his or her marriage in New York State; who have a close and committed personal and financial relationship and are living together on a continuous basis; and are residents or employees of, or former employees of New York City. Domestic Partners can obtain a blank Domestic Partner Affidavit from the Office of the City Clerk, or they may contact the office by calling (212) 669-8190 for other locations where the form can be obtained. Both partners must sign the affidavit in the presence of a Notary Public, who will counter sign and notarize the Affidavit.

The notarized affidavit must be submitted to the City Clerk's office, 1 Centre Street, Room 265. Each partner must present one form of personal identification (i.e, drivers license, birth certificate, passport, immigration card, etc.) along with the notarized affidavit.

For those who qualify, the Clerk will issue a signed Certificate of Domestic Partnership, embossed with the City Seal. A copy is made for the City records and the original certificate will be given to the partners.

To register domestic partners with the Health & Security Plan, the following documents have to be submitted:

1. Certificate of Domestic Partnership or "civil union" certificate.
2. Change of Status Card.

• authorizing the Health and Security Plan to contact the child's school for verification of address, custodial arrangements, etc.
• indicating the whereabouts and employment status of natural parents; and
• explaining the circumstances how the member obtained custody of the child.

*grandchildren, nieces, nephews and infant siblings

Change of Beneficiary

When a member completes an enrollment card a beneficiary is also designated for the Plan's Death Benefit. If a member experiences status changes as indicated above, or a previously named beneficiary has moved or is deceased, it is recommended that the member consider updating the Plan's records. Please note that the Plan cannot release the name of your beneficiary to you by phone or in writing. You can call the Plan office and request a change of beneficiary form. This form should be completed naming your current beneficiary of choice, signed, notarized and returned to the Plan office. Once the Plan has received this change of beneficiary form it will replace all previously submitted named beneficiaries.

Retirement and Health & Security Plan Benefits

When you retire, your job status changes and this can affect your Health & Security Plan benefits. You may be eligible to continue benefits as a retiree. If you are pension eligible, you must send a copy of your pension check stub (partial or full) along with a copy of your agency completed and signed health insurance benefits form (ERB2000 for city employees and PS404 for State employees) to the DC 37 Health & Security Plan, 125 Barclay St., NY, NY 10007 Attn: EEU or fax the copies to 212 815- 1649. Failure to contact the Plan or provide the necessary documentation could result in a disruption of your benefits.If you are not pension eligible, but meet certain criteria in the following titles: Former Hourly Dept. of Education employee, Former School Crossing Guard or Former College Assistant, you may be eligible for a non-pensionable benefit package. Please call the Plan office for more information, 212 815-1234.