• 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 form. You may obtain an enrollment form from the Plan office or you may click here to download this form. For instructions on how to complete the enrollment form, click here.
  
  
• 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 form from the Plan office or click here to download the beneficiary form.
  
  
• If you are enrolling your dependent age 19-26 years old for DC37 Health & Security Plan supplemental benefits (prescription drug, dental, optical) you may obtain an application form from the Plan office or you may click here to download this form.
  
  
• To terminate your enrolled dependent(s) (age 19-26) for DC37 Health & Security Plan supplemental benefits, for any reason including the fact that he/s has obtained health coverage through an employer, you may obtain a “Termination form” from the Plan office or you may click here to download this form.

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

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.

Effective July 1, 2011, under the Patient Protection and Affordable Care Act, all eligible dependents, age 19-26, upon enrollment with DC37 Health & Security Plan, will be eligible for the Plans supplemental benefits (prescription drug, dental and optical) only:

• If your dependent(s) prior coverage ended (e.g. his/her coverage by DC37, another health insurance policy or COBRA), or
• If you never enrolled your dependent(s) in DC37 benefits, or if your dependent(s) lost coverage because such coverage ended before he/she reached age 26, or
• If your dependent(s) is/are not covered by his/her employer-sponsored health benefits (dental, prescription drug and optical)

These health-related benefits will be available to your dependent(s) up to the end of the month in which he/she reaches the age of 26; regardless of whether or not: he/she lives at home, is declared as a dependent on your tax return, is in school, is employed (without benefits), or is married or unmarried.For dependents age 19-23, who wish to use the MELS benefit or the PSU benefit, they must have a letter from the Registrar’s office indicating the dependents current full-time status at the time these benefits are sought. Dependents are not eligible for the MELS and PSU benefits after age 23.

A totally disabled child is covered regardless of age, as long as the disability, physical or mental, began before the child reached age 26 and the dependent is residing with the covered member. If the disabled dependent is at any point no longer totally disabled after his/her 26th 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 child reaching the age of 26.

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 need only complete one enrollment form. All changes made after that form is on file, must be done on a change of status card (blue) or change of beneficiary form.

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 forms 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.

Change of Beneficiary

When a member completes an enrollment form 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. Your beneficiary designation is effective on the date an enrollment form or change of beneficiary form is received at the DC 37 Health & Security Plan office. Divorce from your spouse or domestic partner will not revoke your designation. If you do not wish your spouse or domestic partner to receive your death benefit, you must fill out a new change of beneficiary form.

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.