Life Event changes 

You have the right to change your benefit election when certain life events occur, but you must act within a specific time frame. You should notify the Health & Welfare Plan as soon as possible if you experience a life event that may affect your coverage. Benefits are designed to meet your needs at different stages of your life. This section shows how your coverage is affected when you experience certain “life events” and what you must do to ensure you get the most from your coverage.

If you Move

If you have a change of address, you should notify the Health & Welfare Plan and change your address at METRO Kiosk if you are an active employee or just the Health & Welfare Plan if you are a retiree. It would help if you did this as soon as possible to ensure your records are up to date and avoid any delay in the payment of claims.

If you’re retired, enrolled in an HMO, and move out of the HMO area, you may be required to change your enrollment to a POS plan. Contact the Health & Welfare Plan for more information.

If you get Married or add a Life Partner

If you get married, your spouse can receive dependent benefits under the Plan. You have 90 days to notify the Health & Welfare Plan that you are married and want to add a new spouse to your coverage. You will need to provide the Health & Welfare Plan with the following required documentation:

  • a copy of your original marriage certificate
  • your spouse’s birth date
  • a copy of your spouse’s Social Security Card or W-9 number
  • your most recent income tax form (if married for more than two years).

If you have married previously and are adding a new spouse to your coverage, you must present a valid divorce decree or death certificate.
If you have a new domestic partner, you must wait until open enrollment to add them to the Plan.

If you want to designate your new spouse as your beneficiary on your life and other forms of insurance, you need to fill out a “Change of Beneficiary” form and submit it to the Health & Welfare Plan.

For more information on designating beneficiaries, visit the Designating a Beneficiary section.

If you have a Baby

If you have a baby, your child will be covered by the Plan from birth, as long as you enroll the child within 30 days. If you enroll the child between 31 and 90 days after delivery, the child will be covered on the first of the following month. If you miss these 90 days, you will not be able to enroll your newborn child until the next Open Enrollment Period.

You should provide the Health & Welfare Plan with the following within 90 days of your child’s birth:

  • a copy of your baby’s Social Security card number
  • a copy of your baby’s original birth certificate from vital records or the certificate of live birth with your name on it (or with your spouse’s name on it)
  • an English translation (if applicable).

If your dependent daughter becomes pregnant, the Plan will cover the related pre-natal and delivery services. However, the grandchild is only covered for the first 30 days and is NOT an eligible dependent.

If you Acquire a Child through Marriage

If you acquire a child through marriage, you must provide the Health & Welfare Plan with the child’s birth certificate within 90 days of the marriage date. The parent’s name who is eligible to participate must appear on the birth certificate. Coverage for the child will be effective on the first day of the month after providing the required documentation. If you miss the 90 days, you must wait until the next annual Open Enrollment Period to enroll your child.

If you Adopt a Child

The Plan will cover your child from the date of adoption or placement if you enroll the child within 30 days. If you enroll the child between 31 and 90 days after the date of adoption or order, the child will be covered on the first of the following month. If you cannot get the required paperwork to the Health & Welfare Plan within 90 days due to circumstances beyond your control, notify the Health & Welfare Plan immediately in writing to request an extension. If you miss the 90 days, you will have to wait until the next Open Enrollment Period to enroll your child for coverage.

If you become the Guardian of a Child

If you become the legal guardian of a child, you may be able to add them as a dependent, provided the child meets the guardianship requirements of the Plan. You must enroll the child within 90 days or wait until the next annual Open Enrollment Period.

If you take Family and Medical Leave

If you take family and medical leave to deal with a severe illness, the birth of a child, or to care for a seriously ill parent or spouse, the Family and Medical Leave Act (FMLA) allows you to continue coverage for the period of authorized leave up to 12 weeks. You must continue paying your share of monthly health care premiums.

If your Employment is Terminated

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. For more information on COBRA.

If you Divorce

If you and your spouse divorce, you should immediately notify the Health & Welfare Plan. 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.

If you divorce, your former spouse may continue coverage under COBRA for up to 36 months. They must notify the Plan within 90 days of the day that the divorce becomes final.

If you want to change your beneficiary on your life and accidental health insurance after your divorce, you must fill out a “Change of Beneficiary” form and submit it to the Health & Welfare Plan.

If you obtain a Qualified Medical Child Support Order

A Qualified Medical Child Support Order (QMCSO) is a court order, judgment, or decree recognizing that children residing with a custodial parent may be entitled to benefits in a divorce or other family law action. Orders must be submitted to the Health & Welfare Plan to determine whether the order is a QMCSO under federal law.

For information about how these orders are handled, you can obtain a copy of the Plan’s QMCSO procedures for no charge from the Health & Welfare Plan.

If the Plan receives a QMCSO, you must enroll in a plan that will cover the non-custodial child.

If you have a change in your Work Schedule

If you transfer from a part-time to a full-time position and have not already selected a medical program, you must notify the Health & Welfare Plan to choose a medical plan. Medical and dental coverage is mandatory for you if you are a full-time employee unless you opt out of the Plan because you have coverage from another source.

You will automatically be enrolled in the default medical and dental plans with single coverage if you do not respond. You have 30 days from the date you become full-time to change your coverage elections.

If you transfer from a full-time to a part-time position, you will have to pay more for your benefits coverage. Medical/vision and dental coverage are not mandatory for part-time employees. You have 30 days to notify the Health & Welfare Plan if you want to change or drop your coverage.

If you enter Military Leave

If you are on military leave for 31 days or less, you will continue to receive health care coverage for up to 31 days under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). 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, USERRA allows you to continue the medical, prescription drug, vision, and dental coverage for you and your dependents at your own expense for up to 36 months. This continuation right is similar to COBRA. Your dependents(s) may also be eligible for health care coverage under TRICARE, the military health plan.

Coverage under the Plan is not offered for any illness or injury incurred in or aggravated during service performance in the uniformed services. The Department of Veterans Affairs will provide care for service-connected disabilities.

If you become Disabled

If you become disabled and cannot work, you may qualify for short-term disability benefits from the Plan or long-term disability benefits.

While you are on extended sick leave for any reason from METRO, you must make your monthly premium payments directly to the Plan. The Plan does not send out a notice that a payment is due. If you do not make timely payments, you will lose your medical coverage, short-term disability, life insurance, and accidental death and dismemberment coverage.

Your Health & Welfare Plan monthly premium payments can be deducted from your short-term disability payments and your long-term disability payments.

If you are disabled long enough to establish eligibility for a Social Security Disability award, you must enroll in Medicare as soon as you are eligible for Medicare.

If you Retire

If you retire under the Transit Employees’ Retirement Plan and are a member of the Health & Welfare Plan, you are eligible for life insurance, medical (including prescription drug and vision) coverage, and voluntary retiree dental coverage through Delta Dental. Retirees do not qualify for short-term disability (STD), long-term disability (LTD), or accidental death and dismemberment (ADD) coverage. If you were hired on or after January 1, 2010, you are not eligible for retiree coverage.

Your dependents remain covered through your retiree benefits as long as they meet the requirements of an eligible dependent.

Retirees must make monthly premium payments. Your premium costs are automatically deducted from your pension check in most cases.

If you retire and discontinue enrollment in the medical plan, you cannot re-enroll later. A retiree who does not maintain medical plan coverage also loses Delta Dental Plan coverage but continues to have life insurance coverage.

If you become eligible for Medicare

When you or your dependent becomes eligible for Medicare, you or your dependent should enroll in Medicare Part A and B. For most people, enrollment in Medicare Part A is automatic (there is no premium) when you get benefits from Social Security. You should sign up for Medicare Part B with the Social Security office three months before becoming 65. You pay a monthly Medicare premium for Part B, which will be deducted from your Social Security check.

When you become eligible, you are not required to enroll in Medicare Part B, but benefits will be paid by the Plan as if you are enrolled. If you do not enroll in Medicare or notify the Health & Welfare Plan Office of your enrollment, you or your dependent will be responsible for paying for the benefits Medicare Part B would have covered. Your Health & Welfare Plan premium will be reduced after you submit evidence of your Part B enrollment for yourself or your dependent; Health & Welfare Plan premium will be reduced.

If you die while a Participant.

If you die while covered under the Plan as an employee or retiree, your life insurance benefit will be paid to your designated beneficiary(ies). For your beneficiary(ies) to receive the benefit, they must contact the Health & Welfare Plan and provide a certified copy of the death certificate.

Survivors may be eligible to continue health coverage (medical and dental) until the last day of the month in which they: reach age 65, remarry, or fail to make required monthly payments.

At the end of this period, your survivor(s) may be able to continue their benefits through COBRA if the 36-month COBRA period has not expired, counting from the date of your death. Your dependent children may continue their coverage until they would otherwise age off the Plan.

 

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