Yes, your newborn child will be covered by the Plan from the date of birth, as long as you enroll the child within 30 days from the date of birth. If you enroll the child between 31 and 90 days after the date of birth, coverage for the newborn child begins on the first of the following month. If you miss this 90-day period, you will not be able to enroll your newborn child until the next Open Enrollment Period. You will need to provide the Plan with the necessary documentation. For more information, visit the "If You Have a Baby" section on the Life Events page.
Yes, if you get married, you can add your wife and her children to the Plan. You need to notify the Health & Welfare Plan Office about your marriage and new dependents within 90 days of your marriage. You also need to provide the Plan Office with the necessary documentation. For more information, see the “If You Get Married or Add a Life Partner and “If You Acquire a Child Through Marriage” sections on the Life Events page.
Yes, as long as the newborn child is your natural child, your legally adopted child, or you are the child’s legal guardian. If your girlfriend is covered under the Plan as your domestic partner, your child may also be added to the Plan. You’ll need to show documents of proof to the Health & Welfare Plan Office. For more information on dependent eligibility, see Eligibility for Your Spouse and Children.
For various legitimate reasons, some members may have difficulty providing necessary documentation. In this case, it is important that you apply for coverage within the time periods outlined for each plan. Only then will the merits of your unique situation be considered. Contact the Health and Welfare office for more information.
You do not need to come into the Health and Welfare Office for every change. Open Enrollment forms and election forms may be mailed to the office. If documentation is required, however, (e.g., birth certificate, social security cards, proof of other coverage) you may need to supply those documents directly to the office for authentication purposes.
Your spouse’s coverage ends if you get divorced or if your marriage is annulled. If you are separated but still legally married, your spouse is still covered. You can remover him or her during the annual open enrollment. Your domestic partner loses coverage when your relationship no longer meets the criteria for a domestic partner relationship.
If you and your spouse are divorced, you should notify the Health & Welfare Plan Office immediately. If you fail to remove your divorced spouse from the Plan, you could be liable for any expenses claimed by your former spouse after the date of the divorce. For more information, see the Life Events page.
If you are not working, but you are still eligible for Plan coverage under the collective bargaining agreement, you may continue your coverage under the Plan by making monthly payments to the Plan during your period(s) of leave. You must notify the Health and Welfare office when you return to work.
If you are out on Workers’ Compensation, you must also make your monthly payments directly to the Health & Welfare Plan because they are not deducted from your paycheck or from your Workers’ Compensation benefits.
Payments are due on the first of the month. It is your responsibility to make your Health & Welfare payments on time. The Plan does not send notices of delinquent payments, nor will it send you a bill. If you do not make your payments on time, your coverage under the Plan will end. Consider permitting the Plan to deduct payments from your bank account. Contact the Plan for more information.
Coverage will retroactively end as of the monthly premium payment due date if the required monthly premium payment is not paid within 30 days from the due date (e.g., if the monthly premium payment for September, which is due on September 1, is not paid by September 30th, coverage would be terminated as of September 1). If coverage is terminated due to non-payment of the required monthly premium payment, you may again become covered (on a prospective basis) by sending in the required monthly premium payment for future coverage. Your coverage will re-start as of the first day of the month following receipt of the required monthly premium payment. You will not be permitted to retroactively reinstate coverage for any period of coverage that terminated due to non-payment of the required monthly premium payment.
If you are on a leave of absence for military duty, you are permitted to continue medical, dental, prescription drug, and vision benefit coverage under this Plan for you and your covered dependents in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). Please see the “If You Enter Military Service” section on the Life Events page for more information.
If your coverage ends due to termination of your employment with METRO, you may be eligible for COBRA for you and your family. Although METRO will notify the Health & Welfare Plan of your termination, you are also encouraged to inform the Health & Welfare Plan to avoid any delay.
If you lose Plan coverage due to the termination of your employment or any other reason, you may want to look into purchasing health coverage through a Health Insurance Marketplace.
If you are on military leave for 31 days or less, you and your family will continue to receive health care coverage for up to 31 days. Coverage continues until the end of the month, after the month in which you are deployed.
If you are on military leave for more than 31 days, the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) allows you to continue medical, prescription drug, vision, and dental coverage for you and your family at your own expense for up to 36 months. This continuation right is similar to COBRA. Your dependent(s) may also be eligible for health care coverage under TRICARE, the military health plan. For more information on your benefits if you go on military leave, visit the "If You Enter Military Service" on the Life Events page.
If you are a METRO employee and a participant in the Plan, but you leave your METRO employment, lose your eligibility for Plan coverage, and then return to work for METRO at a later date, you will be treated a s a new METRO employee.
You will be asked to complete enrollment forms. Before the end of your probation period, you will receive information from the Health & Welfare Plan about the benefit choices available to you. You must return those forms to the Health & Welfare Plan by the date indicated. Full-time employees who do not make a selection will automatically be enrolled for single coverage in the default HMO (Kaiser), and the Cigna Dental HMO.