SECTION THREE: Life Events
Your coverage under the Health and Insurance Plan may be affected when certain life events occur. The Fund Office should be contacted if:
- You get married
- Your spouse gets coverage under another health plan
- You have a baby or adopt a child
- You take Family Medical Leave
- Your child's eligibility for benefits changes
- You become divorced or legally separated
- You become disabled
- You stop working
- You enter active military service
- You retire
- You or your spouse become eligible for Medicare or Medicaid
- You or your dependent dies
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If You Get Married
If you marry, you must apply for Family Membership within 60 days of your marriage to include coverage for your spouse under this Plan. To apply, contact the Fund Office. You will need to supply the Fund Office with a copy of your marriage certificate, your spouse's date of birth and Social Security Number.
Your spouse will be covered on the first day of the month following the date of your marriage for all of your benefits that are available to eligible dependents.
If you would like to name your spouse as your beneficiary for your Life Insurance and/or Accidental Death And Dismemberment benefit (Level I coverage only), contact the Fund Office for a "Change of Beneficiary" card.
If Your Spouse Gets Coverage Under Another Health Plan
Contact the Fund Office if your spouse is eligible for coverage under another health plan so that you and your spouse will get the maximum amount of benefits available. Refer to the section entitled "Coordination of Benefits" to learn how claims are paid for your spouse and/or your dependent children when more than one family member has health care coverage.
If You Have a Baby or Adopt a Child
If you have a baby, notify the Fund Office. A copy of your child's birth record or birth certificate and the Social Security Number within 60 days of delivery in order for your child to be covered under the Medical Plan. If the Fund office does not receive this information within 60 days, your child will not be eligible until the Fund's anniversary date — October 1.
If you become a parent by adoption or marriage, notify the Fund Office within 60 days of the date the child is placed with you. You are required to submit the court document, adoption papers, a copy of the birth certificate and the child's Social Security Number to the Fund Office to verify your child's eligibility for coverage.
Your child will be eligible for coverage under this Plan from birth, however, if you have Level I coverage, eligibility for dependent Life Insurance will not begin until your child is 14 days old.
If you wish to name your child as a beneficiary for your Life Insurance and/or Accidental Death and Dismemberment benefit, contact the Fund Office for a beneficiary card to complete. If you have a trust fund set up for your children, you must note this on your beneficiary card.
If You Take FMLA Leave
If you are entitled to FMLA leave, your health care coverage continues during your leave. Your employer may be obligated to pay your contributions for that coverage during the leave period.
You may be covered under this Plan if you take leave under the Family Medical Leave Act (FMLA). Under FMLA, you have the right to take up to 12 weeks of unpaid leave for your serious illness, after the birth or adoption of a child, or to care for your seriously ill spouse, parent or child without losing your coverage.
If you do not return to covered employment after your FMLA leave ends, you may continue your coverage under COBRA (see Section 2, Continuing Your Coverage). You may be required to repay the amount your employer paid toward your coverage during your leave.
If Your Child's Eligibility For Benefits Changes
Generally, your child is covered under this Plan until the first of these dates occur:
- through December 31 of the year in which he or she turns 19; or
- through December 31 of the year in which he or she is no longer a full-time student if over 19 or, the date he or she turns 25, whichever comes first;
- the date he or she marries; or
- the date your coverage ends.
* Your child may remain covered if he or she meets certain conditions described in Section 2, Coverage For Your Dependents.
When your child is no longer eligible for coverage under this Plan, notify the Fund Office as soon as possible. Your child may be eligible for coverage under the Blue Cross Blue Shield Direct Payment program (see following page) or through COBRA Continuation Coverage for up to 36 months. See Section 2, Continuing Your Coverage for more information about COBRA.
If You Divorce or Legally Separate
If you divorce or legally separate from your spouse, your benefits and those of your spouse may be affected. Notify the Fund Office at (401) 467-3323 as soon as possible.
The Fund has adopted the terms of the Rhode Island Insurance Continuation Act, which may allow benefits to continue so long as you remain a participant and the divorce judgment requires it. Spousal benefits will terminate if you or your spouse remarry, or your spouse becomes eligible for comparable coverage. If benefits terminate, your spouse may also be eligible for continued benefits under COBRA.
Qualified Medical Child Support Orders
A Qualified Medical Child Support Order (QMCSO) is a court order, judgment or decree that recognizes that an alternate recipient may be entitled to benefits under this Plan in the event of divorce or other family law action. Orders must be submitted to the Fund Office to determine whether the order is a QMCSO as required under federal law. As required under the Federal Retirement Income Security Act (ERISA), this Plan will recognize a QMCSO that:
- provides for child support of child(ren) under this Plan;
- provides for health coverage to the child(ren) under state domestic relations laws (including a community property law); and
- relates to benefits under this Plan.
If Your Spouse or Child Dies
If your spouse or child dies, notify the Fund Office as soon as possible. If your spouse dies, you will be eligible for a Life Insurance benefit of $10,000 if you have Level I coverage. You must provide the Fund Office with a copy of your marriage certificate and your spouse's certified death certificate.
If your eligible child is at least 14 days old and he or she dies, you will be eligible for a $10,000 Life Insurance (Level I only) benefit. You will need to provide the Fund Office with a copy of the child's death certificate.
If you have Level I coverage, you may wish to review your beneficiary designations for your Life Insurance and your Accidental Death and Dismemberment benefit and determine whether any changes are necessary.
If You Become Disabled
If you become disabled due to a non-work-related disability, notify your employer and the Fund Office. If you have Level I coverage, you may be eligible for certain benefits under this Plan, depending on the type and/or cause of your disability.
Weekly Accident and Sickness Benefits
If you become temporarily disabled and cannot work due to a non-work related disability, you may be eligible to receive a Weekly Accident and Sickness Benefit from this Plan for up to 26 weeks.
Contact the Fund Office within six weeks of the disability to receive forms for you and your doctor to complete. You must return these forms to the Fund Office by the expiration date on the forms. The Fund will require initial proof of your total disability as well as subsequent proof upon request. The Fund may also require a medical examination or documentation. (See Section 8, Weekly Accident and Sickness Benefits for more information).
Accidental Death and Dismemberment Benefits
If you become disabled due to an injury that is covered by the Accidental Death and Dismemberment Insurance Benefit, you may also be eligible for a lump sum payment from this benefit. (See Section 8, Accidental Death and Dismemberment Benefits for more information).
Extended Death Benefits During Total Disability
If you become totally disabled while you are covered by this Plan, and you are less than age 60 when your disability starts, your death benefit protection may be extended while you are totally disabled (see Section 8, Life Insurance for details).
Workers' Compensation Benefits
| Apply for Social Security Disability Benefits You should apply for Social Security benefits in your fifth month of disability. Contact your local Social Security Office, or visit www.ssa.gov on the web. |
If you are out of work due to a work-related disability, you may be eligible for Workers' Compensation. Notify the Fund Office, your employer's personnel office and your local or state Workers' Compensation Office to apply for Workers' Compensation benefits.
If You Stop Working
If your eligibility for coverage ends because you are laid off, your hours are reduced, or you've terminated employment, you may elect to continue coverage under COBRA for yourself and your family for up to 18 months. To apply for COBRA, you must inform the Fund Office within 60 days:
- The date of your reduction in hours or termination of employment; or
- the date of loss of coverage. If you do not contact the Fund Office, you will lose your right to elect COBRA.
If within the first 60 days of your COBRA Continuation Coverage you or one of your dependents is totally disabled (as determined by Social Security), you may continue your coverage through COBRA for an additional 11 months. See Section 2, Continuing Your Coverage for more information.
Blue Cross Blue Shield Conversion Privilege
If your coverage under this Plan terminates, you can transfer to a group at your new place of employment or you can keep your membership under a Blue Cross Blue Shield direct-payment plan.
When your coverage terminates, Blue Cross Blue Shield will send a conversion letter to the home address shown in our files. To keep your membership, you must apply and pay to convert within 30 days of termination notice. Your dependent children are also covered under your membership as long as they remain dependents under Blue Cross Blue Shield's definition. When their eligibility ends, they may elect to convert to their own Blue Cross Blue Shield direct payment plan.
Contact Blue Cross Blue Shield for information on a Conversion.
If You Enter Active Military Service
If you enter the Armed Forced of the United States, you will be eligible to continue coverage under the Plan for yourself and your eligible dependent(s) as required by the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) for up to 18 months during your military service.
If the period of military service is less than 31 days, your coverage (and your dependents' coverage, if applicable) will continue during the period of military service without charge.
If the period of military service exceeds 31 days, you will be required to pay the applicable COBRA premium to continue coverage. You are entitled to have your coverage reinstated on the date you return to covered employment with a contributing employer. No exclusion or waiting period will be imposed, except in the case of certain service-connected disabilities.
If You Retire
If you are ready to retire, you should apply for Retiree coverage under the Retiree Plan by calling the Fund Office at (401) 467-3323. The Retiree Plan offers you a choice of retirement benefit options.
The Retirees coverage include Medical, Prescription Drug, Hearing, Vision, MAP and Legal Services benefits for you and your eligible dependents. The Retiree benefits do not include dental coverage. You may also be eligible for a $5,000 Life Insurance Benefit.
You must make monthly payments and meet certain eligibility requirements to qualify for coverage under the Retiree Plan. Payments are due on the first of the month in order to have coverage for the following month. For more information, see Section 10, Retiree Benefits.
Vested Death Benefit (Frozen as of December 31, 1990)
If you meet all of the eligibility requirements for the Vested Death Benefit you may be entitled to a minimum benefit of $500 to use for eligible medical expenses when you retire. See Section 8, Vested Death Benefit for more information.
If You Become Eligible for Medicare
When you reach age 65 you are entitled to enroll in Medicare — the federally-sponsored health care program consisting of hospital insurance (Part A) and supplementary medical insurance (Part B). At that time, you will no longer be eligible for most of this Plan's regular benefits unless you are still working and covered as an active employee. You may wish to seek out coverage through a Medicare Supplemental health plan.
| Don't forget to Enroll in Medicare! You must enroll in Medicare three months before your 65th birthday. To enroll:
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If you are eligible for Medicare and you are still an active employee, the Plan will continue to cover your eligible medical expenses. You may submit claims to Medicare for any unpaid balances. However, if you become entitled to Medicare because of a disability, you will no longer be considered an active employee, and Medicare will pay first. See "Coordination of Benefits" for more information.
If You Die
If you die from any cause while you have Level I coverage under this Plan, your beneficiary may be eligible to receive a benefit from your Life Insurance, and/or your Accidental Death and Dismemberment Insurance Benefit, depending on your cause of death. Your designated beneficiary must provide a certified death certificate and complete an application for the Life Insurance benefit within one year of the date of your death in order to receive a benefit.
If you die from any cause while a Retiree, your beneficiary may be entitled to a $5,000 life insurance and any balance remaining in your account if you were eligible for the Vested Death Benefit at the time of your death. (See Section 8, Vested Death Benefit for more information.)
Your dependents may purchase COBRA to continue their health coverage for up to 36 months. See Section 2, Continuing Your Coverage for more information.
