When Coverage Ends - Plans I, I-A, III, III-A, III-NEWS, IV, V, V-A and V-A-NEWS / Back

When Coverage Ends - All Active Employee Plans (Except Plan A)
Coverage for you and your dependents ends on:

  1. The first day of a month for which your Employer does not send the required contribution to TBT on your behalf.
  2. The first day of a month for which a required self-payment is not received by the 30th day of the same month.
  3. The date when you enter full-time military service.
  4. The date when you are no longer eligible for benefits.
  5. For specific benefits, the date when the maximum benefit is reached for that covered participant or when a specific benefit is discontinued.
  6. The date when your TBT Plan ends.
Coverage for your dependents ends at the same time yours ends, or sooner:
  1. For your spouse, when you divorce (on the first day of the month after your divorce is final).
  2. For your dependent child, the first day of the month after no longer qualifying as an eligible dependent as defined by the Plan (link).

Reinstatement of Eligibility

If you lose eligibility and return to work with a participating Employer within 12 months, your new eligibility date will be the first day of the month immediately following a month in which you work the hours required under your collective bargaining agreement and your Employer makes the required contribution to the Plan on your behalf. If you do not return to work with a participating Employer within 12 months, you are subject to the eligibility requirements for new employees (see page 2 of the Guide To Your Benefits).

Extension of Benefits While Totally Disabled

If you are unable to work because you become totally disabled, as defined by the Plan, coverage for you and your covered dependents will continue for up to three months. If after these three months you remain totally disabled, your collective bargaining agreement may require your Employer to make contributions on your behalf for an additional period. If you remain totally disabled after the first three months and after any Employer-paid extension period, you may further extend your coverage as follows:

  1. Self-pay for up to six months for full coverage (medical, prescription drug, dental, vision and life insurance) at the Employer contribution rate.
  2. Self-pay for up to 18 months (and, if you remain totally disabled, up to 29 months) for COBRA benefits (except if you are eligible for Medicare) at the COBRA rate then in effect (see COBRA Coverage).

If you choose the six-month option, you may elect COBRA for the balance of the COBRA eligibility months remaining. However, if you experience a second disabling condition during your extended coverage, you will not be entitled to a further extension.

If you are enrolled in the Indemnity Medical option (rather than an HMO option) and you or a covered dependent remain totally disabled at the end of the Plan's three-month extension of coverage and of any Employer-paid extension, coverage for the disabling condition only will be continued without self-payment for up to 12 months. However, benefits will end as of the earliest date below:

  1. The date when the total disability ends.
  2. The date when coverage becomes effective without limitation as to the disabling condition, under any other medical benefit or service plan written on a group basis or under any group insurance policy.
  3. The end of the 12-month period following the date when the Employer contributions paid on account of the eligible person stopped.

Proof of disability must be filed with the Plan Administration Office as soon as possible after you become totally disabled. You can request a Proof of Disability Claim Form from the Plan Administration Office. You and your doctor each fill out a portion of the form. Send the completed form to the Plan Administration Office.

What is total Disability?

See the definition in the Guide To Your Benefits.

HEALTH INSURANCE PORTABILITY
When coverage ends, federal law requires that the Plan provide a Certificate of Group Health Plan Coverage to you. This certificate is intended for use by any new plan in which you enroll.


Copyright © 2000 Teamsters Benefits Trust, All rights reserved.