Participating in the Health and Benefit Trust Fund

Effective January 1, 2014 in accordance with the applicable requirements under PPACA the Fund will implement new initial eligibility requirements for new participants as follows:

Your dependents, such as your spouse or children can participate in the Health and Benefit Trust Fund benefit plans. They are eligible for coverage as soon as you are, provided you comply with all the documentation required for your spouse or children.

Effective as of January 1, 2014, you will have 90 days to enroll all new eligible dependents (e.g., spouses and/or children) as of their applicable date (i.e.,the date of marriage, the child’s birthdate, date of adoption or placement for adoption or foster care, or, in the case of step-children, the date of marriage to the step-child’s parent) that establishes their spousal relationship or dependent status with you.  If you fail to do so within the applicable 90-day period, dependent coverage will not be available under the Plan for your dependent child until the first day of the month following the date in which you provide the Fund Office with the required documentation and any other verifying information requested. 

Effective January 1, 2014 the Plan will extend coverage to a participant’s eligible children up to the end of the month in which the child attains age 26 regardless of the child’s marital status, student status, employment status, eligibility for other health insurance coverage, financial dependency on the participant, or any other factor other than the relationship between the child and the participant. Effective January 1, 2014, your otherwise dependent child is not excluded from dependent coverage under the Plan solely because the child has access to health insurance coverage through an employer (as was previously the case). However, if your dependent child has other group health insurance including coverage through an employer, the Plan will generally consider that other coverage to be primary and the Plan’s coverage for such child will be secondary in accordance with its Coordination of Benefit (“COB”) rules which can be found in the SPD. You must complete a Coordination of Benefits Form.  If you fail to do so within the applicable 90-day period, dependent coverage will not be available under the Plan for your dependent child until the first day of the month following the date in which you provide the Fund Office with the required documentation and any other verifying information requested.

Your dependents (other than your spouse) over age 19, who are incapable of self-sustaining employment by reason of being mentally and/or physically disabled (as such terms are defined by the New York Mental Hygiene Law), will remain eligible for benefits provided they became so incapable prior to their 19th birthday, were covered as Eligible Dependents under the Plan prior to their 19th birthday and are primarily supported by you. For more information on extending eligibility for disabled dependent children, contact the Health and Benefit Trust Fund Office.

If you are a retiree, you are eligible for certain benefits under the Health and Benefit Trust Fund’s Retiree Benefits Plan. Click here to find out more about your benefits if you are a retiree of the Commercial Division or the School Division (in the Eligibility and Enrollment sections).  

COMMERCIAL DIVISION

Retiree Eligibility Requirements for Commercial Division Retiree Benefits Until December 31, 2019.

If you are retired, you are eligible for certain benefits under the Health & Benefit Trust Fund’s Retiree Benefits Plan if you meet the following:

• 15 years of Total Credited Service (as defined in the Central Pension Plan)
• Be receiving a pension from the Central Pension Plan
• Must have continuous coverage under the Health & Benefit Fund for the five (5) years immediately preceding their Central Pension Plan retirement date and
• Must pay the required Retiree premium

 Retiree Eligibility Requirements for Commercial Division Retiree Benefits Effective January 1, 2020

Effective January 1, 2020, in order to be eligible for Retiree Benefits under the Plan (as described under Section 4 of the SPD), Retirees, regardless of disability status, must satisfy all of the following requirements:

• Must be at least age 62 on their respective retirement date under the Central Pension Fund
• Have at least twenty-five (25) years of Total Credited Service (as defined in the Central Pension Plan)
• Be receiving a pension under the Central Pension Plan
• Must have continuous coverage under the Fund for the fifteen (15) years immediately preceding their respective retirement date under the Central Pension Plan, and
• Must pay the required premiums set forth under Section 4 of the SPD, as amended from time to time

 SCHOOL DIVISION

Retiree Eligibility Requirements for School Division Retiree Benefits

Eligibility for Medicare Retirees’ Death and Medicare Related Premium Reimbursement Benefits

Medicare Retirees are eligible for the Death and Medicare Related Premium Reimbursement Benefits if you meet the following:

• 15 years of Total Credited Service (as defined in the Central Pension Plan)
• Be receiving a pension from the Central Pension Plan
• Must have continuous coverage under the Health & Benefit Fund for the five (5) years immediately preceding their Central Pension Plan retirement date. 

Eligibility for PPO Retiree Benefit Effective January 1, 2020

Effective January 1, 2020, in order to be eligible for Retiree Benefits under the Plan, Retirees, ages 62-64, regardless of disability status, must satisfy all of the following requirements:

• Must be at least age 62 on their respective retirement date under the Central Pension Fund
• Have at least twenty-five (25) years of Total Credited Service (as defined in the Central Pension Plan)
• Be receiving a pension under the Central Pension Plan
• Must have continuous coverage under the Fund for the fifteen (15) years immediately preceding their respective retirement date under the Central Pension Plan, and
• Must pay the required premiums set forth under Section 4 of the SPD, as amended from time to time

To enroll new dependents, such as a newborn child or a spouse if you get married, contact the Health and Benefit Trust Fund Office.

When enrolling dependents, or when making a change in a dependent’s status, the Fund Office may contact you asking for documentation to confirm dependent eligibility. Types of documentation include:

• a birth certificate (or court-certified declaration or acknowledgement of paternity);
• a marriage certificate;
• a court-certified judgment of adoption or placement for adoption;
• a divorce decree.

If you or your dependent has medical coverage elsewhere (for example, if your spouse has coverage through an employer), the Health and Benefit Trust Fund will coordinate benefits. That means the Fund will determine which medical plan provides primary and secondary coverage.

When enrolling dependents, you must download and fill out Coordination of Benefits forms.

• Coordination of Benefit Form (PDF)

After filling out the Coordination of Benefit forms, mail them to the Health and Benefit Trust Fund Office at:

Health and Benefit Trust Fund
Local 94-94A-94B AFL-CIO
331-337 West 44th Street
New York, NY 10036

Once you have applied for your pension and your application has been approved and processed by the Central Pension Fund, the Health and Benefit Fund will receive notification of your retirement date. The Health & Benefit Fund Office will then verify if you meet the eligibility requirements for medical coverage. You will receive notification advising you whether you are eligible for medical coverage as a retiree and what coverage options you have.

To get more information on participating in the Health and Benefit Trust Fund, you can visit the SPD for Actives and Retirees in the Commercial Division or the SPD for Actives and Retirees in the School Division or contact the Fund Office.