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The Teamsters Union
25 Health Services & Insurance Plan offers you and your
family the security of high-quality healthcare—and
an added measure of financial protection through disability,
life, and accident insurance plans.
If you’re an eligible TeamstersCare
member, you, your spouse, and your dependent children have
the following health benefits:
• medical
• pharmacy
and prescription drugs
• dental care
• vision care
• hearing care
•
mental health & substance abuse care
• wellness
programs and adult health screenings
As the member, you also have the
additional financial protection provided by TeamstersCare:
• weekly disability
benefits
• life insurance
• dependent life
insurance
• accidental
death and dismemberment (AD&D) insurance
Certain bargaining agreements may
provide different benefits. If you come under one of these
agreements, you’ll receive additional information
specific to your benefits.
TeamstersCare benefits for retirees, NCH members (formerly called
Non-Carhaulers), and
other groups affiliated with the Plan are described in
separate booklets. For copies of these booklets or for
more information, call Charlestown Member Services.
FImportant
Note for UPS Part-time Employees: If
you are a UPS part-time employee, and you work 400 or more
hours in a fixed three-month eligibility determination period, you will receive all the benefits listed above during the corresponding
three-month benefit coverage
period—just as though
you were a full-time employee. If you work 225 hours or more,
but fewer than 400 hours, you are eligible for all TeamstersCare
benefits except weekly disability, life, dependent life,
and AD&D. For more information, see UPS Part-time Benefit Members, immediately following.
FImportant
Note: In this Answerbook, anytime the word “work” is used
as relates to eligibility, it means credited
with required contributions according
to the Collective Bargaining Agreement or by law. In
this context,
“required contributions” means contributions owed to the Fund for those hours—or parts
of hours—for which wages are paid or due, figured
to the nearest quarter hour, as well as hours of paid
vacation, paid holidays, and other hours for which pay
is due or received by the employee.
United
Parcel Service (UPS) Part-time Benefit Members
If you are an eligible United Parcel
Service (UPS) part-time employee, your Teamsters Union
25 Health Services
& Insurance Plan coverage differs from the coverage
for other members in two basic ways: the benefits you receive
and your eligibility rules.
UPS Part-time Benefits
If you’re a UPS part-time
employee, and you work 400 or more hours in a fixed three-month eligibility determination period, then you receive the same benefits as a full-time employee during
the corresponding three-month benefit
coverage period.
If you work 225 hours
or more, but fewer than 400 hours, you’re
eligible for the following TeamstersCare benefits:
• medical
• pharmacy
and prescription drugs
• dental care
• vision care
• hearing care
•
mental health & substance abuse care
• wellness
programs and adult health screenings
However,
you would not be eligible for:
• weekly disability
• life insurance
• dependent
life insurance
• AD&D insurance
With respect to these last four coverages, information
in SECTION VI of this Answerbook would not apply to you.
UPS Part-time
Eligibility
As a UPS part-time employee, the
same eligibility rules apply to you as to full-time employees,
except that you have to work 225 rather than 400 hours
in a three-month eligibility determination period.
Also, you are not eligible for weekly disability, life
insurance, dependent life insurance, or AD&D insurance.
For more information on your eligibility,
see the description immediately following in this Participation section, keeping in mind that your eligibility is based
on 225 rather than 400 hours.
FImportant
Note: In this Answerbook, anytime the word “work” is used as relates
to eligibility, it means credited
with required contributions according
to the Collective Bargaining Agreement or by law. In this
context,
“required contributions” means contributions owed to the Fund for those hours—or parts
of hours—for which wages are paid or due, figured
to the nearest quarter hour, as well as hours of paid
vacation, paid holidays, and other hours for which pay
is due or received by the employee.
TeamstersCare
Membership: Full Benefits
You can become eligible for TeamstersCare
benefits in one of two ways:
• You begin working
for an employer who is already participating with Teamsters
Local 25 (or some other participating Local or other organization
where coverage under this Plan is part of the agreement).
In this case, you become an active participant by fulfilling
the eligibility requirements.
or
• You are already
working for an employer who begins participating with Teamsters
Local 25 (or some other participating Local or other organization
where coverage under this Plan is part of the agreement).
In this case, you become an active participant when:
• your employer contributes
to TeamstersCare an amount equal to the remittance rate
times the required number of hours
and
• you fulfill
the eligibility requirements.
How You First
Become Eligible
To become eligible for benefits once
you’re covered by a contract requiring contributions
on your behalf, you have to work a total of 400 or more
hours over a period of any 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.
FImportant
Note: In this Answerbook, anytime the word “work” is used as relates
to eligibility, it means credited
with required contributions according
to the Collective Bargaining Agreement or by law. In
this context,
“required contributions” means contributions owed to the Fund for those hours—or parts
of hours—for which wages are paid or due, figured
to the nearest quarter hour, as well as hours of
paid vacation, paid holidays, and other hours for
which pay is due or received by the employee.
FImportant
Notes: In order to count towards your eligibility, the 400 hours
must be hours for which your employer has made the required
contribution to TeamstersCare. Also, you cannot receive
benefits under the Plan unless and until we receive your
correctly completed Enrollment
Form.
Example #1
Suppose you are first covered
by a contract on October 1. In that October, you work a
total of 160 hours, then another 160 in November. You
continue working in December for an additional 80 hours.
At that point, you’ve worked a total of 400 hours
and so—once your employer has made the appropriate
contributions and you have completed the enrollment process—your
eligibility begins, and your coverage takes effect, on
the first day of
the next month—January 1.
How You Continue to
Remain Eligible
Eligibility Review Dates
After you’ve become
eligible for the first time—regardless of what month
your eligibility starts—you remain eligible: either
(1) for three months, or (2) through the next eligibility review date—whichever date gives you the longer period of coverage. The eligibility
review dates, which are used to determine your continuing eligibility, are
February 28/29, May 31, August 31, and November 30.
FImportant
Note: Under a special Plan provision, the first time you become
eligible, you’re entitled to no less than three months
coverage. Thus, if the period between the day you first become
eligible and the following eligibility review date is less
than three months, your eligibility automatically extends
to the next following eligibility review date.
Example #2
In Example #1, we said you
reached your 400 hours in December and so became eligible
on January 1. You stay eligible from that January 1 through
the nearest eligibility
review date—which in
this case would be February 28 (or 29). However, because
of the Plan rule which says that when you first become
eligible, you have to
be covered for at least three months,
in this example your eligibility would continue through
the next May 31 eligibility review date.
From this point on, the eligibility review date will
be used to determine whether you continue to be eligible.
Eligibility Determination Period
On each eligibility
review date (each February
28/29, May 31, August 31, and November 30), we look back
at the number of hours you’ve worked during a defined,
three-month period earlier in that year (or in the prior
year). That three-month period is called the eligibility determination period.
If you’re at the February 28
(or 29) eligibility review date,
then the eligibility determination
period we review is October, November, December of the prior
year.
If you’re at the May 31 eligibility review date, then
the eligibility determination
period we review is January, February, March of the current
year.
If you’re at the August 31 eligibility review date, then
the eligibility determination
period we review is April, May, June of the current year.
If you’re at the November 30 eligibility review date, then
the eligibility determination
period we review is July, August, September of the current
year.
So long as you worked 400 or more
hours during the previous eligibility
determination period, and your employer has made the required contributions,
then you continue to be eligible—from your review
date on—for the next three months going forward.
These next three months make up what is called a benefit
coverage period.
Example #3
In Example #2, we determined that
your eligibility review date was
May 31. On that date, we look at the previous eligibility determination period—in
this case, the previous January, February, March. Your
eligibility continues without interruption because, during
that period, you worked at least 400 hours. Your benefit
coverage period is the
three-month period going forward, i.e., June, July, and
August.
Benefit Coverage Period
If it’s determined on February
28 (or 29) that you’re eligible on March 1, then
you’ll continue to be covered during the three-month benefit
coverage period from March
1st through the following May 31.
If it’s determined on May 31
that you’re eligible on June 1, then you’ll
continue to be covered during the three-month benefit
coverage period from June 1 through the following August 31.
If it’s determined on August
31 that you’re eligible on September 1, then you’ll
continue to be covered during the three-month benefit
coverage period from
September 1 through the following November 30.
If it’s determined on November
30 that you’re eligible on December 1, then you’ll continue to be covered during the three-month benefit
coverage period from December 1 through the following February 28 (29).
In effect, you’ve started on
the cycle we will use to determine your continuing eligibility
in the future, on each succeeding eligibility
review date. Here’s a diagram of how
that cycle works:
If You Fall Short of
400 Hours in a Fixed Three-Month Period
Under certain circumstances,
you may work more than the required 400 hours in each
of three consecutive calendar quarters, but then fall
short of 400 hours in the next quarter. If this happens,
you’re eligible to continue coverage under COBRA.
However, you may also elect to continue coverage by “buying-up”
for the number of hours you need to remain eligible.
To be eligible for the buy-up, the
following conditions must apply:
• you must have
worked at least 400 hours in each of the three consecutive
quarters immediately preceding the quarter in which you have
the shortfall
• you must work
at least one hour in the quarter you’re buying up
• the buy-up
rate is your employer’s contracted hourly remittance
rate that is in place during the quarter you have the shortfall
• the amount
you pay is your buy-up rate times the number of hours you
fall short of the required 400 hours
• there’s
a $1,000 maximum on the amount you’re required to pay
in order to buy-up in any given quarter—once you reach
this $1,000 cap, you do not have to pay any additional amount
for that quarter
• you pay for
your hours, by check or money order, directly to TeamstersCare
• you make your
payment within 30 days of losing your eligibility
Once you buy-up for a particular
quarter, you cannot count that same quarter as the first
in a new series of consecutive three-month periods. In
other words, once you
buy-up for one quarter, you must then work—and
have remittances paid on your behalf by your employer—for
three consecutive quarters before you again have the
opportunity to buy-up.
Example
1. Suppose you work 400 hours in the period October, November,
& December; 520 hours in January, February, & March;
and 475 hours in April, May, and June. However, in the
July-August-September quarter, you work only 330 hours
and so are 70 hours short. You can buy-up the shortfall
and retain your eligibility by paying, per hour, at the
contracted remittance rate that’s in place for
July, August, and September. So, if that rate were $5.0125
per hour, your buy-up payment would be $350 ($5.0125
x 70 hours.)
Example 2. Suppose
you have the same three consecutive quarters as in Example
1, but in the fourth quarter you work only 40 hours, and
so, are 360 hours short. Again, if we assume your employer’s
contracted remittance rate is $5.0125 per hour, then the
dollar value of your 360-hour shortfall is $1,804. However,
your total contribution is capped at $1,000. If you pay
the $1,000 buy-up, your eligibility continues without interruption.
FImportant Note: UPS part-time
members must work at least 225 hours in a fixed three-month
period. If you’re a UPS part-time employee, the buy-up
option described above applies to you—except that
you use 225 hours rather than 400 in figuring your eligibility.
As a UPS part-time employee, you cannot buy-up for a total
of more than 225 hours.
Information You Must
Provide to Remain Eligible
You’re covered for TeamstersCare
benefits only if we have complete, accurate, and
up-to-date information on you and your covered dependents.
You’re responsible for providing this information:
• when you first
become eligible and enroll for TeamstersCare coverage
• at Annual Enrollment,
if you elect any changes in your coverage
• anytime you
have a change in family status
• whenever TeamstersCare
conducts a re-enrollment
A change
in family status is any
event that affects the records we currently have on file
for you and your dependents. This includes, but may not be
limited to, the following:
• moving out
of the geographic area covered by your HMO
• a change in
your address or the address of an eligible dependent
• marriage, divorce,
legal separation, or the mandate of a court order
• adding a new
dependent by: (1) birth, adoption, or placement for adoption;
(2) marriage; or (3) the mandate
of a Qualified Medical Child Support Order (QMCSO)
• death of an
eligible participant
• loss of dependent
eligibility; or change in physically or mentally disabled
status; or loss of/return to full-time student status
• returning to
work after a disability
• any
change in your own or your dependent’s employment-related
healthcare coverage
• eligibility
for Medicare and/or Social Security disability status
• coverage for you and/or any
of your dependents under any group benefit plans other
than TeamstersCare
FImportant
Note: If you have a change in
family status, you—or
someone acting on your behalf—must notify Charlestown
Member Services 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. TeamstersCare may
require proof of your change
in family status at the time you notify us of the change.
There are certain instances
where, although you may be otherwise eligible for TeamstersCare
benefits, your benefits and those of your dependents could
be suspended until such time as the situation causing your
suspension is remedied.
A member’s suspension could
result from:
• not responding
to a request to repay an overpayment of a disability claim
• not paying
a lien after you receive a monetary reward
• not submitting
an Enrollment Form when TeamstersCare requires you to do
so
• enrolling an
ineligible dependent
• committing
fraud or misrepresenting information to TeamstersCare
• bouncing a
check for a buy-up, COBRA payment, or TeamsterShare Payment
TeamstersCare manages all
eligibility and enrollment issues. Anytime you provide
us with eligibility-related information that your HMO
should also know, we’ll communicate with the HMO
on your behalf.
Reinstating Lost Eligibility
If for some reason you fall short
of 400 hours in any fixed, three-month eligibility
determination period, and
you are either not eligible to buy-up (or you decline),
then you lose eligibility when you reach the end of your
current benefit coverage
period.
To regain coverage, you must reinstate
your eligibility.
How You Reinstate Lost Eligibility
You reinstate eligibility
by working 400 or more hours in a “rolling” three-month reinstatement period.
You can work these 400 hours before or after the date
on which your eligibility ends. The number of months you
lose coverage and the number of months of eligibility you
earn when you reinstate both depend on the relationship
between:
• the date you
lose eligibility
• when you work
your 400-hour rolling three-month reinstatement
period
Once you become ineligible,
you must always lose at least one month of coverage before
you can regain eligibility. Note that you can elect COBRA
to bridge this one-month gap in coverage.
The following example shows how
rolling reinstatement works if you fall short of 400
hours in a Jan./Feb./March eligibility determination period and therefore lose eligibility on May 31.
Table A
Example of Rolling Three-Month
Periods
To follow the example in Table A
say you fall short of 400 hours in a January/February/
March eligibility determination
period. Your eligibility
ends May 31. Regardless of how or when you reinstate
you must lose at least the month of June.
The earliest three-month period you
can use to reinstate is February/March/April. So, on May
31, you look back at those three months. If you made 400
hours during that period, you lose June but reinstate as
of July 1.
However, for purposes of this example,
assume you don’t make your
400 hours in February/March/April. You then “roll”
forward to the next three-month period, March/April/May.
On June 30, you look back on that period to see if you’ve
worked 400 or more hours.
If yes, you lose June, and your eligibility
reinstates on July 1. If no, then you “roll” forward to the next three-month period, April/May/June ... and so on, from one three-month period to the next, until you work 400 or more hours in any
three-consecutive month period.
Once that happens—so long as
you lose at least one month’s eligibility between
the date you become ineligible and the date you reinstate—your
coverage begins on the first of the month immediately following
the month in which you reach or exceed your 400-hour target.
The Earliest You Can Regain Eligibility
The earliest rolling period
you can use to regain eligibility always begins with the
middle month of the three-month period when you fell short.
Table A shows eligibility ending May 31. This means the
shortfall occurred in the previous January/February/ March eligibility determination period.
Since February is the middle month
of that period, the earliest three-month rolling period
that can be used to regain eligibility starts with February.
This arrangement allows for the one month that a member
must always lose before reinstating.
When You Can Complete Your 400 Hours
As Table A indicates, you
can complete your 400 hours before or after the date on
which you lose eligibility.
• You can complete
your 400 hours before the date on
which you lose eligibility. In the Table A illustration,
this would be either one of the first two rolling reinstatement
periods (Feb./Mar./Apr. or Mar./Apr./May). If you work your
400 hours in either of those periods, you lose the month
of June, and resume coverage on July 1.
• You can complete
your 400 hours after the date on which
you lose eligibility.
When this happens, your coverage resumes on the first of
the month immediately following the month when you make your
400 hours. In the Table A illustration, suppose you don’t
work your 400 hours until the May/June/July reinstatement
period. You lose coverage for June & July, but regain
eligibility as of August 1.
* Note: UPS Part-time
members—substitute 225 hours for all references
in this text to 400 hours.
General
Guidelines that Apply to Reinstatement
Loss of One Month
Once you become ineligible,
you must always lose at least one month of coverage before
you can regain eligibility.
12-Month Limit on Reinstatement
To reinstate, your
400 hours in a rolling three-month reinstatement period must
occur either before or within 12 months after you’ve
lost coverage. Once you’re ineligible for more than
12 months, you have to re-enroll just as though you were
a new member.
More Than One Employer
The 400 hours you work
to regain eligibility can come from more than one contributing
employer. (Exception: for UPS Part-timers, all hours must
come from UPS.)
Length of Reinstatement
When you reinstate,
you’ll always be covered for a minimum of three months,
but you could be covered for as long as five months. The
length of time you’re covered depends on the month
when your reinstatement begins.
• If your coverage begins in
the first month of a benefit
coverage period (March, June, September, or
December), then you’re covered for the full three
months in that period.
Example: your first month of reinstated coverage is September. You’re
covered for September, October, &
November. Your eligibility is reviewed on November 30.
• If your coverage begins in
the second or third month of a benefit
coverage period
(i.e., April/May, July/August, October/November, or January/February),
you’re covered for the two months in that period,
plus the three months of the next coverage period.
Example: your first month of reinstated coverage is October. You’re
covered for October and November of that benefit coverage period, plus
December/January/ February of the following coverage period.
Your eligibility is reviewed on February 28/29.
Reinstatement & the
Buy-Up Provision
Effective since July
1, 2003, a member who works the required 400 hours in each
of three consecutive quarters—but who then falls short
of 400 hours in the next, fourth, quarter—may continue
eligibility by “buying-up”
for that fourth quarter.
When buying-up, the following conditions
apply:
• you must have
worked at least 400 hours in each of the three consecutive
quarters immediately preceding the quarter in which you have
the shortfall
• you must work
at least one hour in the quarter you’re buying up
• the buy-up
rate is your employer’s contracted hourly remittance
rate that is in place during the quarter you have the shortfall
• the amount
you pay is your buy-up rate times the number of hours you
fall short of the required 400 hours
• there’s
a $1,000 maximum on the amount you’re required to pay
in order to buy-up in any given quarter—once you reach
this $1,000 cap, you do not have to pay any additional amount
for that quarter
• you pay for
your hours, by check or money order, directly to TeamstersCare
• you make your
payment within 30 days of losing your eligibility
If you buy-up for a quarter, and,
in any month during that same quarter, you reinstate eligibility,
the reinstatement counts. Depending on exactly where in
the quarter you reinstate, the Fund will reimburse you
for 1/3 or 2/3’s of your buy-up costs.
FImportant Note: You must still lose at least one month of coverage
before you can regain eligibility through reinstatement.
As is the case with any buy-up,
if you reinstate during a quarter you’ve bought-up,
you cannot count that same quarter as the first in a
new series of consecutive three-month periods. To be
eligible to buy-up again, you have to work—and
have remittances paid on your behalf—for three
consecutive quarters.
If you have any questions about
reinstating lost eligibility, please call Charlestown
Member Services.
When Your Eligibility
Ends
Your TeamstersCare eligibility ends
on the earliest of the following dates:
• the first eligibility
review date following an eligibility determination period in
which you did not work 400 or more hours
• the date on
which the Plan’s grace period ends for your employer
to make a required contribution
• 30 days from
the date TeamstersCare receives the last contribution from
your employer, in cases where your employer leaves the Plan
through the collective bargaining process
• the last day
of the month following the last month for which contributions
are due from an employer who leaves the Fund through the
collective bargaining process
• the date Teamsters
Union 25 Health Services & Insurance Plan ends
Dependent Eligibility
When Your Dependents
Are Eligible
Once your own eligibility begins,
your dependents also become eligible for TeamstersCare
medical, prescription drug, dental, vision, hearing, and
mental health & substance abuse benefits—as well
as for the wellness services available at our dedicated
TeamstersCare facilities. Also, your family has the additional
security of TeamstersCare disability, life insurance, and
accidental death & dismemberment coverage for you as
the active Plan member—and life insurance coverage
for your dependents.
FImportant
Note: For purposes of TeamstersCare eligibility, so long
as your dependent meets the Plan’s definition of “eligible
dependent,” you cannot decline coverage for that dependent.
“Eligible dependents” include:
• your spouse
• one ex-spouse
who was covered by the Plan when you divorced, in cases where:
– you have
a court order mandating ex-spousal coverage, and
– you decline
coverage for your current spouse
(note: new members cannot cover ex-spouses that the member divorced
or separated from before joining the Plan)
• your unmarried
children, through the end of the calendar year in which they
turn age 19
• your unmarried
children, through the end of the calendar year in which they
turn age 25, provided they:
– are full-time
students (or part-time for a final semester required for
graduation), and
– attend a
licensed academic or trade school, and
– depend on
you for more than half their support
• your unmarried
children, through the end of the calendar year in which they
turn age 25, who become ineligible but then :
– return to
full-time student status, and
– depend on
you for more than half their support
• your unmarried
children who are incapable of self-care because of a physical
or mental disability, provided they:
– depend on
you for support, and
– first become
disabled before the end of the year in which they turn age
19
(or age 25 for a full-time student) and were covered by the
Plan at that time
Defining “Eligible
Children”
“Eligible children” include
your natural children; legally adopted children; children
placed with you for adoption; and stepchildren. TeamstersCare
also covers any children named under a Qualified Medical
Child Support Order, provided a copy of this order is filed
with Charlestown Member Services, Teamsters Union 25 Health
Services & Insurance Plan, 16 Sever Street, Charlestown,
MA 02129-1309. Call Charlestown Member Services at (617)
241-9220 for a copy of TeamstersCare’s procedures
regarding Qualified Medical Child Support Orders. Please
note that, under the Plan, foster children are not considered
eligible dependents.
Defining “Disabled
Children”
Under certain circumstances, TeamstersCare
may continue to provide medical benefits for a disabled
child beyond the date dependent eligibility would normally
have ended. For coverage to be extended, the child must
be first disabled before the end of the year in which they
turn age 19 (or age 25 for a full-time student), and, at
that time, they must be:
• covered by
the Plan
• currently unmarried,
and
• mentally or
physically disabled so as not to be able to earn his or her
own living on the date eligibility would normally end
In addition, to determine whether
your child can continue to be covered, you will
need to provide medical or other information for review
by the TeamstersCare Medical Review Committee. For
further details, contact Charlestown Member Services
at (617) 241-9220.
In order for your dependent to be
eligible for continued medical coverage, you have to provide
TeamstersCare with proof of the disability within 30 days
after the latest of the following dates:
• the end of
the calendar year in which your child reaches age 19, or
• the end of
the calendar year in which your child reaches age 25, if
he or she is a
full-time student
Annually, you’ll also need
to provide TeamstersCare with a doctor’s statement
that your dependent continues to be disabled. The TeamstersCare
Medical Review Committee will evaluate this information
to determine whether the dependent is still eligible for
continuing TeamstersCare coverage.
FImportant
Note: If you have a disabled dependent when you—as
a member—first become eligible for TeamstersCare coverage,
the Plan may provide medical benefits for that dependent
so long as you submit proof of disability, to the TeamstersCare
Medical Review Committee, within 30 days of the date you
become eligible.
Defining “Full-Time
Student”
To cover a full-time student over
age 19 through the end of the calendar year in which he
or she reaches age 25, you need to submit a letter from
a licensed academic or trade school each semester, verifying
your dependent’s continuing status as a full-time
student.
FImportant
Note: Normally, dependent students are required to be enrolled
solely on a full-time basis in order to be eligible for coverage.
However, TeamstersCare may extend coverage one additional
semester for students who are enrolled on a part-time basis in order to fulfill final
requirements for graduation.
When a Dependent’s
Eligibility Ends
Your dependents lose coverage at the
same time your own eligibility ends. Individual dependents
lose coverage if they no longer meet the definition of
an eligible dependent.
Other Participation
Notes
Family Medical Coverage
in Case of Your Death
If you die while covered by the TeamstersCare Active Medical Program, 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 can apply
for up to three months beyond the benefit
coverage period when your dependents were last eligible. After three
months, your family will have the option of continuing
coverage under COBRA, or, if eligible, may be able to join
a TeamstersCare Retiree Program. When extending benefits
under any of these options, certain conditions may apply.
For more information, call Charlestown Member Services.
Continuing Medical
Coverage if You’re Disabled
If you’re disabled and are receiving
either TeamstersCare Weekly Disability benefits (for
a non-work-related disability) or
Workers’ Compensation (for
a work-related disability),
you may be able to continue receiving TeamstersCare medical
benefits during the period of your disability. In either
case, you must meet all of the Plan’s eligibility
rules.
Non-Work-Related Disability
If you’re disabled from
a non-work-related injury and are receiving TeamstersCare
Weekly Disability benefits, you may be eligible to continue
your TeamstersCare medical benefits.
For the first four weeks you’re
disabled, your employer must contribute to TeamstersCare
at the rate of 32 hours per week. After those four weeks,
TeamstersCare will credit you with hours toward continuing
eligibility at a rate of 32 hours per week, for up to 22
weeks. If you worked an average of fewer than 32 hours
per week during your most recent eligibility
determination period, TeamstersCare will credit you with the average number of
hours you worked per week.
You cannot be credited with a total
of more than 800 “disability” hours in any
consecutive three-year period.
Work-Related Disability
If you’re disabled from
a work-related injury and are receiving Workers’ Compensation,
you may be able to maintain your TeamstersCare medical
coverage so long as you meet all of the Plan’s eligibility
requirements and your employer continues to contribute to TeamstersCare
at a rate of 32 hours a week (17.31 hours for UPS part-timers)
for up to 12 months.
Disputed Work-Related Disability
If you’ve filed a Workers’
Compensation claim which is disputed by your employer
or the Workers’
Compensation carrier, then—during the period when
the claim is being adjudicated—TeamstersCare may
pay you a weekly disability benefit provided:
• you sign a
notarized agreement committing to repay any amounts you have
received from the Plan should you or your dependents: (1)
become eligible for Workers’ Compensation benefits
or (2) receive proceeds from a settlement of your Workers’ Compensation
claim
• you provide
TeamstersCare with a copy of the Workers’ Compensation
denial
• you complete
a TeamstersCare Third-Party Questionnaire Form
FImportant
Note: During the period when you are disabled from a work-related injury or illness and you’re receiving Workers’
Compensation, TeamstersCare does not cover any medical expenses
that are attributable to the injury or illness. In addition,
the maximum benefit you can collect is 26 weeks from the
date of injury. Any payments you receive from Workers’ Compensation
count toward this 26-week maximum.
Continuing
Health Coverage under COBRA
In certain cases where you or your
dependents would otherwise lose healthcare benefits, you
may be able to continue medical coverage under a Federal
law known as COBRA. For full details, see SECTION
VII.
Continuing Coverage
for Your Spouse after Legal Separation or Divorce
In the event of divorce or
legal separation, a court might order you to provide medical
coverage for your former spouse and eligible dependents.
In certain cases, TeamstersCare may extend the same coverage
to which your ex-spouse had been previously entitled, except
for life insurance. To be eligible, your ex-spouse must
have been covered by the Plan at the time of your divorce.
You will need to provide Charlestown Member Services with
the effective date of the divorce and documentation of
the court order.
If coverage is extended, but your
ex-spouse subsequently remarries,
then the extended coverage ends. If you remarry, you may elect to continue coverage for your
ex-spouse—instead of your new spouse—provided
your new spouse agrees in writing to waive all current
and future coverage under the Teamsters Union 25 Health
Services & Insurance Plan and provides proof of other
health coverage. Under the Plan, you cannot cover a spouse
and ex-spouse at the same time.
If, upon divorce, 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.
FImportant
Note: Divorce or legal separation is a change in family status, which—in
order to ensure coverage for your eligible dependents—you
must 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.
Coverage on Returning
from Military Duty
If you return to your job after authorized
military duty, your TeamstersCare coverage is reinstated
immediately, provided:
• you were eligible
for benefits at the time you went on duty
• you work at
least one hour for a contributing employer after returning
to work
• your employer
provides TeamstersCare with documentation that you have returned
to work
• you provide
proof of military service
Your reinstated coverage continues
for the remainder of the eligibility
determination period during which you were reinstated through the subsequent
benefit coverage period, according to the following schedule:
Eligibility Determination Period
Benefit Coverage Period
January, February, March
June, July, August
April, May, June September,
October, November
July, August, September
December, January, February
October, November,
December March, April, May
For example, if you return to work
on August 20, and work at least one hour, then coverage
for you and your eligible dependents begins on August 20
and continues through February 28/29. |
