GENERAL ELIGIBILITY RULES

You become a “Covered Member” eligible for the full range of benefits offered by the Social Service Employees Union Local 371 Welfare Fund, Educational Fund, and Legal Services Fund on the first day of employment if you meet one of the following requirements:

1. You are a full time per annum employee on active pay status in a title for which contributions are payable by the City of New York or other qualified employer to the Social Service Employees Union Local 371 Administrative Fund, or;

2. You are a per diem employee on active pay status who works at least 20 days per month in a title for which contributions are payable by the City of New York or other qualified employer to the Social Service Employees Union Local 371 Administrative Fund.

3. You are on approved educational leave and have not resigned, and contributions are received by the Social Service Employees Union Local 371 Administrative Fund from the City of New York or other qualified employer for any part of the calendar year for which benefits are requested (Education Fund benefits only).

You become a “Covered Member” eligible for the benefits of the Social Service Employees Union Local 371 Part time Employee Benefit Program on the first day of employment if you meet all of the following requirements:

1. You work on a part time, per annum, per diem, hourly, per session or seasonal basis for the City of New York or other qualified employer;

2. You are employed and paid on a regular basis at least one half the regular hours of full time employees in the same title;

3. You are an employee for whom contributions are payable to the Social Service Employees Union Local 371 Administrative Fund.

If no full time equivalent title exists, then the minimum number of hours required in order to be eligible shall be based upon the nature of employment; “white collar” employment requires 17 hours per week, while “blue collar” employment requires 20 hours per week.

The benefits of the Part-Time Employee Benefit Program include the Welfare Fund’s Dental Plan, Optical Benefit, $10,000 Life Insurance Benefit, Accidental Death and Dismemberment Benefit, Prescription Drug Benefit and Burial Benefit. The Dental Plan, Prescription Drug Benefit and the Optical Benefit provide family coverage; therefore, your eligible dependents are able to receive these benefits. The benefits included for part-time employees are identical to those described under the applicable section in the Welfare Fund section of this book.

Eligible part time employees are also entitled to receive the Legal Services Fund’s benefits (please see the Legal Services Fund section).

If you have any questions about the Part Time Employees Benefit Program, we urge you to contact the Funds’ office.

All other General Eligibility Rules, including those that describe Termination of Coverage, Dependents of Covered Members, Time Limits for Claims Filing, Enrollment, Audit and Verification of Claims, and Procedure for Claims Review are identical for full-time and part-time employees.

If you have any questions concerning whether your title is covered, please contact the Funds’ office.

If you have used the maximum 26 weeks of Disability Benefits, you and your eligible dependents remain covered by other Welfare Fund and Legal Services Fund benefits for up to an additional six months, provided that you remain disabled.

Dependents of Covered Members

Family benefits are available to your eligible dependents. Eligible dependents include:

1. Your spouse;

2. Your unmarried dependent children up to their 19th birthday and between their 19th and 23rd birthdays if they are full time students in an accredited educational institution. This includes your natural children, legally-adopted children, including children in a waiting period prior to finalization of adoption, and your dependent stepchildren.  Other children who reside permanently with you in your household who are chiefly dependent on you for support are also eligible if a court of competent jurisdiction has issued a certificate of guardianship.  For this coverage, a Statement of Dependency must be filed with the Fund Office.  Foster children are not eligible. Also included as eligible dependents are unmarried children, regardless of age, who are incapable of self sustaining employment by reason of mental retardation or physical incapacity, provided such incapacity existed prior to their attainment of age 19 and further provided that such children reside with a covered member and are wholly dependent on the covered member for support.

Student Certification for Funds’ Coverage:  Full-time student dependents of covered members may continue to be covered  for Fund benefits up to their 23rd birthdays, as long as they provide the Funds’ office with a copy of the bursar’s receipt or a letter from the educational  institution each semester certifying their status as a full-time student. Covered members who have any questions regarding Student Certification should call the Enrollment section at (212) 777-9000 Ext. 3064 or 3089.

Coverage for prescription drug benefits only will continue for children until their 26th birthday, regardless of whether the child is dependent on the Fund member for support or is a full-time student.

3. Your domestic partner and children of your domestic partner. You must provide the same documentation required by the City to enroll domestic partners for health insurance coverage. This includes a completed Domestic Partner Registration Certificate and at least two documents proving the financial interdependence of the member and domestic partner.  (The cost of coverage for domestic partners by the Fund may be taxable as income to the Fund member.)

Please note that any references to spouses are also intended to refer to eligible domestic partners.  Likewise, references to children are also intended to refer to children of eligible domestic partners.

It is to be noted that the Educational Fund does not provide benefits for your eligible dependents, except for the ACT/SAT Preparation Courses benefit. The Legal Services Fund provides for spouse and/or dependent coverage under specific benefits. Please refer to the Educational and the Legal Services Funds sections for specific information.

Enrollment Is Necessary For Coverage

In order to receive benefits, employees must have completed and signed the white SSEU Local 371 Benefit Funds Enrollment Card, and the card must have been returned to the Funds’ office (by a Union official whenever possible). For your convenience, Enrollment Cards are often available through the Union delegate at your work location and on our website https://mightyunionfunds.org in Forms section. The information on the Enrollment Card is entered immediately in the Funds’ enrollment files, and an Express Scripts Prescription Drug Card is mailed to the member. While waiting to receive a Prescription Drug Card, the member may have prescriptions filled at a participating pharmacy by providing his/her Social Security number, the Welfare Fund’s Group Number, “SSEU 371,” and the name of the drug plan’s administrator, “Express Scripts, Inc.” to the pharmacist.

New employees who have not yet completed the Enrollment Card should keep receipts  for covered services rendered since their date of hire, e.g., dental, optical, prescription drug, etc, so that they may file claims for reimbursement once their enrollment data is on file at the Fund Office. Covered members who have any questions regarding their eligibility status should call the Enrollment section at (212) 777-9000, Ext. 3064 or 3089.

You must complete and sign a new enrollment card if there are any changes in your marital status, your eligible dependents, your address or your beneficiary (beneficiaries), etc. Keeping the Fund informed of your current status assures the efficient processing of your claims and the prompt receipt of your benefits.

Termination of Coverage

Covered members remain eligible for benefits until the end of the month in which they were last on active pay status. However, under the terms of the contract between the Welfare Fund and the life insurance carrier, you have the privilege of converting to a direct payment life insurance plan within 31 days after your Welfare Fund coverage terminates. This conversion privilege is described in the section on life insurance.