In an emergency, always look for the best medical care you can find, as quickly as you can find it. Often, your best option will be the nearest hospital emergency room. Don’t worry about which medical option you’re enrolled in. Just focus on getting help.

If you are enrolled in an HMO, you or someone acting on your behalf must call your HMO Primary Care Physician within 48 hours after you are treated for an emergency.

Note: If you visit a hospital emergency room, you’ll be charged a $50 copay unless, as a result of the emergency, you’re admitted directly from the emergency room to the hospital.

Dental Emergencies

Certain problems with your jaw, teeth, or gums can be emergencies. This would include cases of severe trauma resulting in jawbone fracture, extensive bleeding of the mouth or jaw, or severe swelling from trauma or infection. In some cases your best option for emergency dental care may be the nearest hospital emergency room. Other dental problems, such as lost fillings, chipped teeth, or tooth decay are not emergencies and should be treated by your dentist on a routine appointment basis.

Mental Health & Substance Abuse Emergencies

If you or a dependent has a mental health or substance abuse emergency, call the TeamstersCare Mental Health & Substance Abuse Hotline, at 800-851-8326. The Hotline is open 24 hours a day, seven days a week. If, as a result of the emergency, you are admitted to the hospital, you must call TeamstersCare Mental Health—or have someone do it for you—within 24 hours of the hospital admission.

Your options depend on where you live. The three basic options include:

Although both TeamstersCare HMO’s provide the same general benefits, each HMO covers only those members who live within certain geographical boundaries, or “service areas.” Here are the service areas for our two TeamstersCare HMO’s:

If you live in a service area covered by both TeamstersCare HMO’s (for example, Massachusetts), you may choose either one. If you live in a service area covered by only one of the HMO’s, you must select that HMO (for example, Maine residents must choose Network Blue New England).

Suppose I live outside the HMO service areas?

If you or an eligible dependent permanently lives outside the service areas covered by the two TeamstersCare HMO’s, you will be covered under the TeamstersCare Tufts Out of Area Option.

Can I be in one Option and have my dependents in another?

No. The Option you elect for yourself is the same for all your eligible dependents.

Once I’m in a particular Option, can I change to another Option?

If there’s more than one Option where you live, you can change from one to another, but only during our Annual Enrollment Period. If you move from one service area to another, call Charlestown Member Services to discuss how to change your Option.

What are TeamstersCare’s “clinical services” benefits
In addition to your basic medical coverage, you and your family members are also eligible for the following TeamstersCare Clinical Services Benefits: pharmacy and prescription drugs; dental, vision, hearing, and mental health & substance abuse care; wellness programs and adult health screenings.TeamstersCare Clinical Services Benefits are available through our dedicated facilities in Charlestown, Chelmsford, Malden, and Stoughton. Vision care and additional dental services are available through other healthcare providers with whom we’ve contracted. For more information about your TeamstersCare Clinical Services Benefits, see SECTION V.

What benefits do I have besides healthcare coverage?

Besides your medical benefits, TeamstersCare provides valuable protection through three other benefit coverages:

Depending on the number of hours worked in an eligibility determination period, United Parcel Service part-time benefit members may be eligible for these additional insurance benefits. (See UPS Part-time Benefit Members, click here.)

For more information about these other benefits available to you as a TeamstersCare member, see SECTION VI, OTHER BENEFITS.

How does the TeamstersCare weekly disability benefit work?

If you become disabled by a sickness or injury that’s not job-related (including maternity), you may be eligible for up to 26 weeks of weekly disability benefits. Since timing is an important factor in your coverage, call TeamstersCare as soon as you’re aware of the disability—or have someone do this on your behalf. While disabled, you may remain eligible for TeamstersCare medical benefits. Also, your TeamstersCare life insurance benefit may remain in effect for a certain period of time, depending on how long you’re disabled. (See Continuing Life Insurance While Disabled, click here.)

United Parcel Service part-time benefit members are eligible for TeamstersCare weekly disability benefits if they work more than 400 hours in an eligibility determination period and their employer makes contributions on their behalf. (See UPS Part-time Benefit Members, click here.)

For more information about weekly disability benefits, click here.

Does TeamstersCare cover work-related sickness or injury?

TeamstersCare does not cover medical or disability claims resulting from a sickness or injury related to your job. You need to submit these claims through your employer’s mandatory Workers’ Compensation insurance. For more information about Workers’ Compensation, click here.

Does TeamstersCare cover claims resulting from motor vehicle and motorcycle accidents?

If you have a benefit claim related to a motor vehicle or motorcycle accident, you
(or someone acting on your behalf) must notify TeamstersCare as soon as possible. Coverage will depend on a number of factors, including whether or not you are covered by no-fault auto insurance. For more information on coverages for motor vehicle/cycle accidents, click here or here.

How do I become eligible for TeamstersCare benefits?

Once you’re covered by a contract requiring contributions on your behalf, you have to work a total of 400 or more hours [UPS Part-time employees: 225 hours or more] over a period of three consecutive months. Once you reach your 400 hours during that three-month period—provided your employer has made the appropriate contributions—you become eligible for benefits. As soon as you complete your enrollment, coverage for you and your eligible dependents begins on the first day of the next month following the accumulation of the 400 hours.

To enroll, you’ll be required to provide TeamstersCare with benefits-related information about yourself and your dependents. Your continuing coverage depends on the completeness and accuracy of this eligibility information.

How do I maintain my eligibility?

Once you’re eligible for TeamstersCare benefits, you maintain eligibility by working a pre-determined number of hours during a specified time period. Also, your employer must contribute to TeamstersCare on your behalf. You must make certain that the eligibility-related information you’ve provided TeamstersCare remains accurate and up-to-date. If you lose eligibility, you must fulfill certain requirements in order to reinstate coverage.

For more information about maintaining eligibility, see How You Continue to Remain Eligible, click here.

How do my dependents become eligible?

In general terms, your dependents’ eligibility coincides with your own. However, there are often specific eligibility provisions for a particular dependent, such as a student, a newborn, or an ex-spouse. Also, in a given program, your own member coverage may be somewhat different from specific benefits available to your dependents (for example, number of pairs of eyeglasses).

Who can be covered as “eligible dependents”?

“Eligible dependents” can include your spouse and your unmarried children up to certain age limits. There are special rules for student and disabled dependents. Also, under very specific circumstances, the Plan may permit you to cover an ex-spouse. (TeamstersCare may cover a spouse or an ex-spouse—but not both.) For more information about dependent eligibility, click here.

What happens if I lose eligibility?

If you do not work enough hours to maintain eligibility for TeamstersCare benefits, and you are either not eligible for—or you elect not to exercise—the Plan’s “buy-up” option, then your coverage continues through the last day of your current benefit coverage period—either August 31, November 30, February 28/29, or May 31. (For more information, see SECTION II.)

After that date, you may be eligible to continue medical coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). For complete information on your rights under COBRA and other Federal laws, see SECTION VII.

In certain cases, you may be eligible for coverage under a TeamstersCare retiree health program. For more information, call Charlestown Member Services.

If you become ineligible for TeamstersCare life insurance benefits, you and each of your eligible dependents may be able to convert your TeamstersCare life insurance to individual coverage. In this case, you can convert to an amount that equals the coverage you had when you became ineligible. (See Converting TeamstersCare Life Insurance to an Individual Policy, click here.)

For more information about losing and reinstating eligibility, see SECTION II.

What information do I need to provide TeamstersCare in order to be covered for benefits?

You’re covered for TeamstersCare benefits only if Charlestown Member Services has complete, accurate, and up-to-date information on you and your covered dependents. You’re responsible for providing this information at several different times:

A change in family status is any event that affects the records we currently have on file for you and your dependents, based on the most recent information you’ve provided us.

If you have a change in family status, you (or someone acting on your behalf) must notify TeamstersCare within 31 days of the change. If you fail to do so, TeamstersCare cannot ensure continuous or timely coverage for any claims you may incur.

For more information about changes in family status, see Information You Must Provide to Remain Eligible, click here.

Yes. To cover a new dependent, call Charlestown Member Services for the proper Enrollment Form. You will need to send in copies of pertinent legal documents. Newborns who otherwise qualify as eligible dependents are covered from date of birth. New spouses and adopted children are covered as of the date of the marriage or adoption, respectively, provided we receive documentation within 31 days of the marriage or adoption date.

If you send documentation later than 31 days, coverage for the new spouse or adopted child begins on the first day of the month following the date we receive your completed paperwork.

Note that adding a dependent is a change in family status, which—in order to ensure eligibility for the dependent—you’re obligated to report to TeamstersCare within 31 days of the change. If you fail to do so, TeamstersCare cannot ensure continuous or timely coverage for any claims you may incur. For full details on changes in family status, see Information You Must Provide to Remain Eligible, click here.

What happens to coverage when a member or dependent dies?

If you’re a Plan member at the time of your death, TeamstersCare will continue to provide your family with medical, prescription drug, dental, and vision care benefits, as well as the clinical health services available at dedicated TeamstersCare facilities. These extended benefits will apply for up to three months beyond the benefits coverage period when your dependents were last eligible. Your family will then be able to continue coverage under COBRA.

If you, your spouse, or dependent child dies, TeamstersCare pays life insurance benefits according to a schedule determined by the Plan. (See Life Insurance Benefit, click here.)
If you die as the result of an accident, your beneficiaries might also be eligible to receiveition addal accidental death benefits. (See Accidental Death & Dismemberment Benefit, click here.)

Please note that UPS part-time benefit members who work fewer than 400 hours in an eligibility determination period are not eligible for TeamstersCare life insurance benefits.

Note that death of a member or dependent is a change in family status, which—in order to ensure that the appropriate coverage changes are made—you (or someone acting on your behalf) are obligated to report to TeamstersCare within 31 days of the change. For full details on changes in family status, see Information You Must Provide to Remain Eligible, click here.

What if I divorce or become legally separated?

In the case of divorce or legal separation, a court might order you to provide medical coverage for your former spouse and eligible dependents. You will need to provide Charlestown Member Services with the effective date of the divorce and documentation of the court order.

If you are not required to provide coverage, your ex-spouse and dependents may be eligible to purchase temporary extended healthcare coverage under COBRA for up to 36 months. TeamstersCare may cover either a spouse or an ex-spouse—but not both. (See Continuing Coverage for Your Spouse after Legal Separation or Divorce, click here.)

What TeamstersCare options do I have when I retire?

If you retire while you’re still covered by the TeamstersCare Active Medical Program, your active coverage continues through your current benefit coverage period. Also, you may be eligible for one of the TeamstersCare Retiree Programs.

TeamstersCare retiree healthcare coverages include the Early Retiree Medical Program (for members, spouses, and eligible dependent children under age 65), the Retiree Prescription Drug Program (for members and spouses age 65 and older), and certain TeamstersCare clinical services benefits. Retiree eligibility depends on your age, credited service, and coverage under the TeamstersCare Active Medical Program. Call Charlestown Member Services for more information.

What if I become eligible for health coverages other than what I have with TeamstersCare?

You must inform TeamstersCare immediately if you or a family member has—or acquires—health benefits under another plan (for example, your spouse’s medical plan or Medicare). This includes medical, prescription drug, dental, vision, hearing care, or mental health & substance abuse benefits.

Your eligibility for this other coverage is a change in family status, which—in order to ensure that your benefits are provided accurately and fairly—you’re obligated to report to TeamstersCare within 31 days of the change. If you fail to do so, TeamstersCare cannot ensure continuous or timely coverage for any claims you may incur. For full details on changes in family status, see Information You Must Provide to Remain Eligible, click here.

If you have a claim, TeamstersCare will “coordinate” its own benefits with any coverage you may have under other plans. To avoid confusion, TeamstersCare needs to know about these other coverages in advance.

It’s extremely important to understand how multiple coverages are “coordinated.”
For a full explanation of Coordination of Benefits (COB), click here.