Are you a new Teamster member or perhaps you have just started a new job with an employer that provides health and welfare benefits to the Teamster employees? There are several sources to find out what benefits you have through your employment. Your Human Resources Department may have all of the benefit information available for you or you can call Southwest Administrators (SWA) for benefit information and the effective date of your coverage.

You must take the responsibility to enroll in your benefit plan. First determine what benefit options are available to you and determine when you become eligible for the coverage. If you have more than one choice for a medical plan, you may obtain a Benefit Options Brochure from SWA. Once you have made your choice, you will need enrollment forms. The Fund requires that all new employees complete a Participant Data Form. Be sure to enroll all of your dependents now. If you forget, you will be required to submit birth certificates or a marriage license to add a dependent at a later date. Next, if you have chosen an HMO (Health Net, Kaiser or PacifiCare), request the HMO enrollment package from SWA. You must complete the appropriate HMO application and if you are enrolling in Health Net or PacifiCare, you must choose primary physicians for you and any family members. RETURN ALL ENROLMENT FORMS AND HMO APPLICATIONS TO SWA OR YOUR ENROLLMENT WILL BE DELAYED. SWA will determine your effective date, review the forms to insure that no required information is missing and issue temporary identification cards. Permanent identification cards will be issued by your HMO.

If you have the option of the Medical Reimbursement Plan (Indemnity Plan) and you choose to be covered under this plan, you must only complete the Participant Data Form. No other applications are required for enrollment in this medical benefit option.

If your plan of benefits has both Medical Reimbursement Plan and HMO options, you will be automatically enrolled in the Medical Reimbursement Plan unless you complete an HMO application.

Returning to Employment

Are you returning to employment with the same employer or perhaps a new employer after a lengthy absence? If you are returning to active employment with the same employer and within 6 months of your last date of employment, you will be eligible with the first contribution paid by your employer on your behalf. You will also be reinstated to the same medical plan that you were enrolled in prior to leaving active employment. For example, if you were enrolled in Kaiser, your Kaiser coverage will be reinstated and you need do nothing if you are satisfied with your coverage option.

If you are returning to work after more than a six-month absence but less than one year, you must re-qualify and you will be eligible with the third contribution. Your previous medical plan will be reinstated.

If you are returning to work after a period of one year or more, you must re-qualify. You will be eligible with the third contribution paid by your employer. You must also re-enroll with both the Fund and your medical plan. After more than a one-year break in coverage, it is not assumed that you want to remain with the same medical plan. A new Participant Data Form, and if appropriate, a new HMO application is required. See New Employment.

Returning to coverage under this same Fund but with a new employer? If both your former employer and your new employer participate in this Fund, then all of the above information on Returning to Employment also applies to you. If your new employment means that your coverage is being transferred from another Teamster Fund to this Fund, the Returning to Employment Guidelines also apply to you, however you will be required to make new decisions on your medical benefit options, so call SWA for information.

Laid-off

Being laid-off from your employment is a stressful event in your life. One important thing you can control is what happens to your medical benefits. When you are laid-off, you are eligible to the end of the month last worked and paid for by your employer. So, for example, if you were laid-off on October 5^th and your employer pays October, you and your family are covered through October 31^st.

You may have several options for maintaining your medical benefits. A lay-off is a qualifying event under COBRA. You may elect COBRA continuation coverage for 18 months. In order to elect COBRA, you must submit a COBRA Election Form within 60 days of your qualifying event date. You must then make the COBRA payments timely. Refer to the selection on COBRA for more details.

If you are enrolled in an HMO (Health Net, Kaiser, PacifiCare) you may also have the option of converting your group HMO benefits to a private self-pay plan with the HMO. Most HMO's require that you convert your coverage within 30 days of the loss of coverage.

Medical Reimbursement Plan enrollees only have the COBRA election option. There are no other conversion options.

Check out the cost of both COBRA and conversion with your HMO. To find out the cost of conversion coverage, call the Membership Service Number of your provider of medical benefits. The COBRA rate usually includes family coverage. If you are single or have only one dependent, the HMO conversion rate may be less. Just be sure to compare benefits and costs before you make a decision and remember, there are time limitations imposed on you for both COBRA elections and conversion privileges.

Act right away to preserve your options.

Termination of Employment

When you terminate active employment, you are covered through the end of the month for which you last worked and paid by your employer. This is a qualifying event under COBRA. You can extend your benefits up to 18 months or you may be eligible for conversion coverage. See Laid-off for more information on your options.

Marriage

Congratulations! Marriage is a major change in our lives but protecting your spouse with health care is easy. Discuss your benefit options with your new spouse. If you need information, brochures or plan booklets to share with your spouse, call SWA. To cover your new spouse, you must enroll your spouse with the Fund and add your spouse to your medical plan. To enroll your spouse with the Fund, complete a new Participant Data Form (PDF) and mail the PDF with a recorded copy of your marriage certificate to SWA (click here for the mailing address). Your spouse is eligible from the date of your marriage but you must enroll your spouse within 30 days of your marriage or coverage may be delayed.

You must also add your spouse to your medical plan. If you are covered under Health Net or PacifiCare, you must obtain the appropriate HMO change form from SWA. You will need to add your spouse and your spouse should choose a doctor. You need not have the same doctor.

If you are covered under Kaiser, a copy of the recorded marriage certificate along with the Participant Data Form is all that is required. The HMO Department will add your spouse to your Kaiser enrollment and issue a temporary Kaiser card. Kaiser will issue a permanent identification card for your spouse within approximately 90 days.

All Medical Reimbursement Plan participants only need to complete the Participant Data Form and submit the form along with the recorded copy of the marriage certificate to enroll a spouse. The spouse will be automatically covered under the MRP once the spouse is enrolled with the Fund.

Return all enrollment and change forms to SWA or the enrollment of your spouse may be delayed.

Divorce

All coverage for your spouse will cease on the date that the divorce is final. Many times a divorce settlement states that the health insurance must be continued for the spouse. The Fund is not obligated to provide an extension of benefits to a divorced spouse even though you are ordered by the court to continue those benefits. You have two options under the Fund to continue your former spouse’s medical benefits. You may continue benefits for your former spouse for 36 months under COBRA or if you are covered under an HMO (Health Net, Kaiser or PacifiCare), you may convert your former spouse’s group coverage to a private pay plan.  Call the HMO Membership Services Department for conversion information.  Both COBRA and HMO conversion privileges have strict time limitations. Do not delay.

Are you the divorced spouse? A divorce is a COBRA qualifying event. You have the option of electing COBRA for 36 months. The COBRA Election Form must be completed in your name and submitted within 60 days of the final date of your divorce or you will not be eligible to elect COBRA continuation coverage. Once you elect COBRA you must complete new enrollment materials.  You become a participant of the Fund and have the same rights under the Fund as the employee. You may also be able to convert your group HMO plan to a private self-pay plan. See the section on Divorce for more details on HMO conversion.

WARNING

The birth of a child is a wonderful event in your life and you will want to make sure that your child is immediately covered under your medical plan. Your new baby is covered from birth but in order to avoid delays in coverage or eligibility issues, you must enroll your baby with the Fund. Complete the Participant Data Form by adding the baby’s name and birth date. Attach a copy of the birth certificate and mail both documents to SWA. Click here for the address.

If you are covered under an HMO (Health Net, Kaiser or PacifiCare) you must also add the baby to your HMO coverage. Health Net and PacifiCare require that you enroll your newborn within 30 days of birth. Call SWA for a Health Net or PacifiCare Change Form. Add your newborn and submit the form along with the copy of the birth certificate to SWA.

All Kaiser enrollees need only enroll the baby with the Fund by submitting the Participant Data Form along with a copy of the birth certificate to SWA. The Administrative Office will add your baby to Kaiser and send you a temporary identification card. A permanent identification card should be received in approximately 90 days from Kaiser.

All Medical Reimbursement Plan (Indemnity) enrollees need only enroll the newborn with the Fund. Return the Participant Data Form with a copy of the birth certificate to SWA.

A certified/registered copy of the birth record is not always immediately available. The Fund will accept a copy of the hospital issued birth record for 90 days. As soon as you receive the registered birth certificate, you must submit a copy to SWA. After 90 days, the Administrative Office will be required to suspend eligibility on your newborn until the registered birth certificate has been submitted.

Send all Participant Data Forms, Birth Certificates and HMO Change Forms to SWA. Do not mail the forms to your HMO provider or the enrollment of your newborn will be delayed.

Age 19

Your dependent children are covered up to their 19^th birthday as long as they live in a parent/child relationship with you and are dependent upon you for support. What happens when your child turns 19 and how can you continue coverage for your older dependent children? If your child is a full-time student, refer to Student information below.

What can you do to maintain coverage for your child who is not going to school at this time? The loss of coverage at age 19 is a qualifying event under COBRA and either you or your child may elect to continue the child’s coverage for 36 months. A COBRA Election Form must be completed and submitted to SWA within 60 days of the qualifying event which is the 19^th birth date of the child. COBRA mandates time limitations which are strictly enforced by the Fund so do not delay. Refer to COBRA for details or call the COBRA Department at (877) 350-4792.

If you are enrolled with an HMO (Health Net, Kaiser or PacifiCare), you may be able to convert your child’s group coverage to a private conversion policy. Rates for a single healthy young adult are normally lower than say coverage for you. A private policy for a young adult may also be lower than the COBRA cost of continuation coverage. Compare benefits, deductibles and costs with several health care companies. Just remember that there are time limitations, 60 days for COBRA and 30 days for most HMO conversions, so do not delay this matter.

Student

Coverage under your medical plan may be extended for as long as your child maintains full-time student status and is dependent on you for support but only through age 25. A certification of school enrollment must be submitted at the start of each new session and a transcript of grades for the prior session showing the units completed must be submitted at the end of the session or upon request. Refer to Dependent Eligibility for more details.

A full-time student is generally accepted as taking 12 or more units of class work. If your student drops classes or withdraws during the session for which eligibility has been previously approved, coverage ceases retroactive to the date that the student lost full-time status. You, the parent, then become responsible for any claims incurred and mistakenly paid on behalf of your child.

What is acceptable to prove student status? Many schools have their own verification of student status forms which the school will complete for your student. Many parents use the SWA Student Status Form which you may print by clicking here. Your student can take the form to the Administrative Office of his school. Whether you use the Student Status Form or the school has their own form, all school letters must bear the seal of the school or the letter will be returned.

Here are the most common problems that cause delays in verifying coverage for students.

Student Age 26

All coverage ceases for students on the date the student graduates or the 26^th birth date of your dependent student. Student extensions will only be granted through age 25. This loss of coverage is a COBRA qualifying event and your over age student may elect to continue coverage by COBRA election. A COBRA Election Form may be obtained by clicking here. COBRA has time limitations that are strictly enforced so do not delay. See COBRA or the section on Age19 for more details.

Disabled Child

Coverage for your child who is incapable of self-sustaining employment because of a mental or physical handicap will not be terminated at age 19 if the child is chiefly dependent upon you for support provided that written evidence of such incapacity is submitted to the Fund prior to age 19.

What type of evidence does the Fund require? In most cases, a letter from the child’s attending physician certifying the child's total disability is all that is required. The letter must include a diagnosis, when the disability started and the expected date of recovery. Proof of continued disability will be requested from you from time to time. If your child has a permanent disability and has received a Social Security Disability Award, please submit a copy of the award.

Sometimes children are temporarily totally disabled due to a medical condition or accidental injury. If such an event was to occur prior to the child’s 19^th birth date or while the child was a full-time student, coverage may be extended on a temporary basis with written proof of disability.

A child who has either a mental or physical disability which keeps that child from attending school on a full-time basis but is not so severe as to make the child permanently and totally dependent upon you, the parent, for support may be eligible for Dependent Student Status. Documentation from both the school and the attending physician must be submitted for review by the Administrative Office. Depending upon the circumstances, these claims for Student Status may require independent medical review and/or Trustee approval. Each case is reviewed independently and on it’s own merits.

CHILDREN WHO REACH AGE 19 PRIOR TO THE EMPLOYEE'S INITIAL ELIGIBILITY FOR BENEFITS UNDER THIS PLAN WILL NOT BE COVERED UNDER THE DISABLED CHILD PROVISIONS.

Temporary Disability

No one wants to be in the position where you cannot work because of an illness or work related injury. There is loss of income and your medical benefits become more important than ever to you and your family. The Fund provides an extension of your medical benefits when you are temporarily totally disabled from performing your normal work activities. You are covered for three (3) months at no cost to you or your employer. The Fund will continue all your benefits during this three-month period provided that you submit a certification of total disability from your attending physician.

YOUR EMPLOYER IS FIRST REQUIRED TO EXHAUST ALL OTHER EXTENSIONS SUCH AS THE FAMILY MEDICAL LEAVE ACT (FMLA) AND ANY ADDITIONAL CONTRIBUTIONS STIPULATED IN YOUR COLLECTIVE BARGAINING AGREEMENT.

How does this work? If you become disabled, you may qualify for extended medical leave under the FMLA which is a federal act that requires covered employers to provide up to 12 weeks of unpaid family and medical leave to eligible employees. If FMLA applies to your employer and you are eligible for FMLA, your employer may be required to continue your health insurance up to a maximum 12 workweek period. If you become disabled, immediately contact your Human Resources Department for information. It is your responsibility to communicate your need to your employer. If your employer maintains your health insurance during the FMLA period, the Fund’s three-month extension will be applied after the FMLA period if you are still disabled.

Some collective bargaining agreements also call for additional contributions to be paid on your behalf when you are totally disabled. Review your collective bargaining agreement to find out if your employer is obligated to make any additional contributions when you are on medical leave. Your Human Resources Department should also be able to advise you. Any additional contributions for disability leaves will be applied prior to the Fund’s extension.

Once any of the above extensions have been applied, if applicable, the Fund will grant you up to a maximum of three months of coverage at no cost to you or your employer. Any eligible family members are also covered during this period. A certification of disability from your attending physician is required to receive this extension. The certification should include the diagnosis and the period of disability. The certification must be signed and dated by your attending physician. The certification may be submitted on your physician’s letterhead or you may use the SWA Medical Form (click here to download the form).

Once all applicable extensions including the Fund’s three-month extension have been exhausted, you may self-pay for an additional 15 months under COBRA. Obtain a COBRA Election Form by clicking here. COBRA has strict time limitations so review the COBRA provisions immediately.

Permanent Disability

All of the same extensions and Fund provisions discussed in Temporary Disabilities (click here to review Temporary Disability provisions) will also apply if you are permanently and totally disabled from an illness, injury or disease. First explore your eligibility for FMLA and any extensions that may be provided under the terms of your collective bargaining agreement. Communicate with your employer’s Human Resource Department concerning your disability.

Once all applicable extensions have been exhausted and the three-month extension provided by the Fund has been used, you may elect COBRA for an additional 15 months of continuation coverage.

Also review all of your life policies for a disability waiver of premium.

COBRA Disability Extension

A provision of COBRA, known as OBRA (effective in 1996), allows an eleven (11) month extension only to those individuals covered by COBRA who are totally disabled and have received a Social Security Disability Award. The Social Security Disability Award must be received from the Social Security Administration and a copy of that award must be submitted to SWA within the first 18 months of your COBRA election period.

The purpose of the 11-month OBRA extension is to allow a totally disabled person to extend their COBRA coverage until such time as they become eligible for Medicare after being granted a Social Security Disability Award. A Social Security Disability Award includes eligibility for Medicare regardless of age.

This OBRA provision applies to you during the 18-month COBRA election period even if you elected COBRA for a qualifying event other than permanent disability. The OBRA provision also applies to a spouse or dependent children who receive a Social Security Disability Award during their COBRA election period. This OBRA provision terminates the first day of the month in which you become eligible for Medicare or the last day of the eleventh (11^th) month, whichever is sooner.

If either you or your spouse have received or are in the process of applying for a Social Security Disability Award, forward a copy of those documents to the COBRA Department at SWA (click here for the address) or call the COBRA Department at (877) 350-4792, extension 846. Preserve your rights and act now.

Life and Accidental Death & Dismemberment

A death of a loved one is never something we want to think about but we should be prepared to assist our families through this difficult time. Many employees covered under the Fund have a Life and Accidental Death and Dismemberment (Life and AD&D) policy as part of their medical benefits. If you do not have the benefit with the Teamsters Miscellaneous Security Trust Fund, ask if you have benefits with a separate Fund such as the Teamsters Death Benefit Fund. Sometimes your employer will also offer life benefits through a separate policy. Check with your Human Resource Department.

Questions on whether or not you have a Life and AD&D benefit, the amount and beneficiary cards may be obtained by calling SWA. If your Life and AD&D benefit is provided by the Teamsters Miscellaneous Security Trust Fund, the benefits are only for the employee. There are no death benefits for a spouse or dependent children.

The Life and AD & D policy with the Teamsters Miscellaneous Security Trust Fund includes an Accelerated Death Benefit. In brief, if you, the employee, are terminally ill and have 6 months or less to live, you may be eligible to be paid a percentage of your benefits in advance of your death to assist you with financial matters. Call the Life Claims desk for details and the appropriate forms to file for this benefit.

A disability waiver of premium is also a benefit under the Life and AD&D.

Medical Benefits 

Upon the death of the employee, your dependent’s coverage will cease at the end of the last month worked and paid. Dependents may continue their coverage by electing COBRA continuation coverage. A COBRA Election Form may be obtained by clicking here.

If you and your dependents are enrolled with an HMO (Health Net, Kaiser or PacifiCare), your dependents may wish to convert their group coverage to a self-pay conversion policy with the HMO. Call your HMO Membership Service Department for information on conversion.

REMEMBER THAT BOTH COBRA AND CONVERSION RIGHTS HAVE TIME LIMITATIONS SO ACT PROMPTLY TO PRESERVE YOUR MEDICAL BENEFITS.

Member Assistance Program (MAP)

Don’t Go It Alone. Most events in our lives are pleasant but even some of the best changes in our lives such as marriage or the birth of a child can require us to have to make changes in our lives. Sometimes those changes are not easy. And then there are those events that cause pain, stress or grief. The Membership Assistance Program (MAP) was developed by Managed Health Network especially for union members and their families. You can handle most problems but sometimes a little help gets those problems under control and life becomes good again.

Kaiser enrollees: Mental Health and Chemical Dependency benefits are provided by Kaiser. Call Kaiser Member Services at (800) 464-4000 (English) or (800) 788-0616 (Spanish).

MAP is a free, confidential counseling and referral service designed to help you and your family members resolve personal problems that may be interfering with your work or home life. You or any member of your household may call MAP for services. Dependents living away from home may also access your MAP services. MAP provides assistance with many problems such as Anger Management, Child and Elder Care, Debt Management, Job Stress and Relationship Problems. This program also provides your exclusive Mental Health and Chemical Dependency benefits.