Enrolling for Coverage

If you’re a full-time employee, you’re automatically enrolled in the Health and Welfare Plan. However, you should pick the medical/vision plan and dental plan you want to join. The Fund Offers a choice of three medical plans:

  • Kaiser/NVA Vision
  • BlueChoice HMO Medical/Davis Vision
  • CareFirst PPO Medical/Davis Vision

Please note that new employees may only select between the two HMOs during their first 39 months of employment.

And you can choose between the two dental plans (available if you elect medical/vision):

  • CareFirst
  • CIGNA DMO

If you don’t select a medical plan, you will be automatically enrolled for single coverage under the default HMO plan and default dental plan. To enroll family members, you must complete and submit forms during your initial enrollment or the open enrollment period (see below).

Employees working under the collective bargaining agreement referred to as the New Service Agreement have different choices. Refer to your agreement for details.

If you work part-time, you may also enroll for coverage. Your enrollment is not automatic or required; you must elect your plans to be covered.

If you were hired before January 1, 2010 and you retire, you can elect to continue your medical coverage. You will have to enroll; coverage is not automatic.

When you start working for METRO, you complete enrollment forms to enroll in the plans. You should list all of your dependents, even if you do not plan to enroll them as dependents.

If you do not enroll by the date indicated on your enrollment material, you will be automatically enrolled in our default program (currently the Kaiser HMO plan) under single coverage. You will not have an opportunity to change your plan or elect coverage for your dependents until the next open enrollment period.

Open Enrollment is your once-a-year opportunity to make changes to your benefits (unless you experience a change in status). Each May, you’ll receive an Enrollment Guide to help you make your choices.

To make changes, you’ll need to complete an Enrollment Form and submit it to the Fund Office. Your changes will be effective the following July 1.

If you are adding dependents, you must bring the documentation to the Health & Welfare Plan. If you miss the deadline, your next opportunity to make changes will be the next Open Enrollment Period.

Read more about this year's Open Enrollment.

Outside of Open Enrollment, you are not permitted to make changes to your benefits unless you experience a “qualified status change.” Qualified status changes include:

  • Marriage or divorce;
  • Birth, adoption, or placement for adoption of a child;
  • Death of a dependent;
  • Change in work status; and
  • Change in your spouse’s health insurance coverage;

Depending on the status change, you will have either 30 days or 90 days from the date of the event to make changes to your health care elections. Your Plan coverage will generally start the first of the month following completion of the enrollment process.

If you’re covering a newborn, coverage will be effective the date of the child’s birth as long as you enroll your child within 30 days of the day the child was born. If you’re adding an adopted child, coverage will be effective as of the date of adoption or placement, as long as you enroll the child within 30 days of that date.

30 Days to Make a Change90 Days to Make a Change
To enroll for Plan coverage if you or a dependent lose other healthcare coverage To add a new dependent
To enroll a newborn, to be effective from the date of birth, or to enroll a child adopted or placed for adoption, to be effective from the date of adoption or placement for adoption To enroll a newborn, to be effective from the first of the following, or to enroll a child adopted or placed for adoption, to be effective from the date of adoption or placement for adoption
To change from part-time to full-time or from full-time to part-time or 36 months after completing your probationary period  

If you are a full-time METRO employee or you are working under the supplemental collective bargaining agreement between ATU Local 689 and METRO (the “New Service Agreement”) and you can provide proof that you have coverage from a source other than METRO, you may be eligible to “opt out” of coverage and receive a cash payment amount.

You can opt out of medical coverage when you first become eligible as a full-time employee. After that, you can elect to opt out only during the Open Enrollment Period each year. You must provide proof of other coverage during each subsequent Open Enrollment Period; otherwise you will be re-enrolled in the last plan that you selected or the default plan if you never made an election.

The annual cash payment amount is set by the collective bargaining agreement between METRO and Local 689. For 2014, it is $1,500 for active full-time members and $500 for New Service Agreement employees.

If you opt out of participation in the Plan’s health care coverage, but you later lose your other coverage, you may be eligible to re-enroll in this Plan.

If you and your spouse are married and are both employed by METRO, one of the Participants must carry family health coverage, and the other will be a dependent on that Participant’s plan.

A spouse or adult child who is employed by METRO and is enrolled as a dependent on the plan of another METRO employee is not eligible for the “opt-out” cash payment.

Both Participants will continue to be eligible for life and accidental death and dismemberment, short-term disability, long-term disability benefits.

The collective bargaining agreement permits employees to receive a credit of up to $1,200 if their spouse opts out of the Transit Employees’ Health & Welfare Plan’s health insurance program. It can only be used as a credit against medical and dental benefit expenses incurred as a Participant in the Plan. You must elect the spousal opt-out option each year.

Read more about the Spousal Opt Out Credit and download a Spousal Opt Out form.

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FAQs

How does the Spousal Credit work?

The 2012 collective bargaining agreement permits employees to receive a credit of up to $1,200 if their spouse opts out of the Transit Employees’ Health & Welfare Plan’s health insurance program. It can only be used as a credit against medical and dental benefit expenses incurred as a Participant in the Plan. You must elect the spousal credit option each year.

Up to $100 per month will be applied to reduce the cost of your medical and dental insurance. It cannot be applied to reduce the cost of any supplemental life insurance you may have elected or of any other voluntary benefit.

Example

Your plan requires a monthly contribution of $80 toward single coverage and $208 toward family coverage. Here is how the credit will work:

  • For a family with only employee and spouse coverage, the spousal credit would change your plan from family to single (from $208 to $80) and the credit would further reduce the monthly contribution for single coverage ($80) to zero.
  • For a family with employee, spouse and children coverage, the spousal credit would not change your family plan coverage ($208), but it would reduce the $208 amount you pay to $108 (the maximum credit of $100 per month).

This credit is available to employees and retirees, but cannot be combined with the employee opt-out payment. This credit is available only if the employee or retiree remains covered in the Transit Employees Health and Welfare program.

You can only elect the spousal credit option during the annual open enrollment period, usually in May of each year. It will be effective for your premiums for the following July 1st. Download the Spousal Credit form here.

If you have more questions, please contact the Health and Welfare Plan Office.

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