Continuation of coverage (COBRA) for in-service members

What do I do when my coverage terminates?

Depending upon your situation, there are many different ways to continue your coverage. They are as follows:

Regularly appointed pedagogues and paraprofessionals

1. Special Leave of Absence Coverage (SLOAC)

SLOAC is available when on a medically approved Leave of Absence for Restoration of Health (personal illness or pregnancy related leave) which commences immediately following cessation of in-service status.

When a member is off payroll due to illness or accident, the member may be eligible to have his or her City basic health insurance and Welfare Fund benefits continued for up to four (4) months through the Department of Education's Special Leave of Absence Coverage (SLOAC). As an additional benefit, the Welfare Fund will continue that coverage for up to eight (8) additional months.

Paraprofessionals

In addition, continuation of coverage, as stated above, is available to a paraprofessional who is on an approved leave while receiving Workers’ Compensation. You must submit the “Application for Leave of Absence for Employees in Paraprofessional Titles,” issued by the Department of Education with “Approval” indicated in the appropriate section by the Medical Director for those on authorized sick leave without pay.

All others

Other members may be eligible for continuation of Medical and Welfare Fund benefits for a period not to exceed one (1) year if the member:

receives an official leave for restoration of health (personal illness or pregnancy related leave) from the Department of Education which commences immediately following cessation of in-service status and
is eligible to receive SLOAC through the Department of Education.

2. The Family and Medical Leave Act (FMLA)

The Federal Family and Medical Leave Act of 1993 (FMLA) entitles eligible City employees, after twelve (12) months of employment, up to twelve (12) weeks of Family leave in a twelve (12) month period for the following reasons:

For the serious illness of the member, or
The birth or adoption of a child during the first twelve (12) months or for pre-natal care, or
To care for a serious health condition of a covered family member.

The FMLA also recognizes the following types of leave related to military service:

An eligible employee may take up to 12 work weeks of FMLA leave in a 12-month period, for any “qualifying exigency” arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty or called to active duty status as a member of the National Guard or Reserves in support of a contingency operation. A “qualifying exigency” could be, but is not limited to, short-notice deployment, military events and related activities, child care and school activities, financial and legal arrangements, counseling, rest and recuperation, post deployment activities and any additional activities agreed to by the employer and employee.
An eligible employee who is the spouse, son, daughter, parent or next of kin of a current member of the Armed Forces, including the National Guard or Reserves, with a serious injury or illness may take up to 26 workweeks of FMLA leave during a single 12 month period, to care for the service member.

Members using this leave may be able to continue their City health coverage through the FMLA provisions for unpaid leave.

Members should contact their payroll or personnel office for details. Upon submission to the Fund of documentation issued by the Department of Education verifying FMLA status, the Fund will provide Welfare Fund benefits during the FMLA period.

3. Layoff

Under the terms of the applicable Collective Bargaining Agreement, members may be eligible for ninety (90) days of basic health insurance and UFT Welfare Fund coverage, excluding Disability coverage.

4. COBRA

The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, requires that the City and UFT Welfare Fund offer members and their families, the opportunity to purchase continuation of certain health and Welfare Fund benefits at 102% of the group rate (or 150% of the group rate for the 19th through the 29th months in cases of total disability) whereby the coverage would otherwise terminate. The maximum period of coverage is either 18, 29 or 36 months, depending on the reason for termination.

The election of City (Medical/Hospital) COBRA does not enroll you in UFT Welfare Fund COBRA. A separate UFT Welfare Fund COBRA application is required which you can obtain by phoning the COBRA unit at 212-539-0560.

Read more detailed information below on COBRA and how it works.

5. Child care coverage

Who is eligible?

Members on approved Child Care Leave who are currently covered by the UFT Welfare Fund, on or after April 1, 2013, will be eligible to receive extended UFT Welfare Fund Benefits for up to a maximum of six (6) consecutive months.

Natural Childbirth: To be eligible, your child must be less than one (1) year of age, and your Child Care Leave must begin within one (1) year of the birth.

Adoption of Child: to be eligible your child must be less than five (5) years of age and your child care leave must begin within one year of the adoption.

This coverage is available one time per birth/adoption, per family unit.

What am I eligible for?

Approved members/dependents are entitled to all benefits except disability.

How do I apply?

The Child Care Coverage Request form is available here, or by calling the Forms Hotline at 212-539-0539.

When submitting, you must attach a copy of your approved Leave of Absence for Child Care and a UFT Welfare Fund Change of Status form to add the child to your coverage.

What does my dependent do if he/she loses coverage?

1. Dependent survivor coverage

Dependent coverage terminates when a member’s eligibility ends for any reason other than death, or on the date when the dependent no longer meets the definition of eligible dependent, whichever occurs first. In cases of the member’s death, the Welfare Fund extends dependent coverage three (3) months following the month in which the member died.

2. COBRA

The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, requires that the City and UFT Welfare Fund offer members and their families the opportunity to purchase continuation of certain health and Welfare Fund benefits at 102% of the group rate (or 150% of the group rate for the 19th through the 29th months in cases of total disability) whereby the coverage would otherwise terminate. The maximum period of coverage is for 36 months.

COBRA provides continuation of Fund coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed below. COBRA continuation coverage must be offered to each person who is a "qualified beneficiary" (QB). A qualified beneficiary is someone who will lose coverage under the Fund because of a qualifying event.

Depending on the type of qualifying event, employees, their spouse/domestic partner*, and dependent children of employees may be qualified beneficiaries. Qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

*The law does not require that COBRA continuation coverage be extended to domestic partners. However, the Fund Board of Trustees has determined that such COBRA continuation coverage will be offered to registered domestic partners of Fund members.

When am I eligible for COBRA?

Covered members are eligible for continuation under COBRA if Welfare Fund coverage was terminated due to the following qualifying events:

a reduction in hours of employment; or
the termination of employment including deferred payability and retirement.

Termination of employment includes non-covered unpaid leaves of absence of any kind and cannot be due to gross misconduct.

Spouses/domestic partners¹ of covered members have the right to continue coverage if coverage is lost for any of the following qualifying events:

death of the member; or
termination of the member's employment for any reason other than his or her gross misconduct; or
loss of coverage due to a reduction in the member's hours of employment; or
divorce or legal separation from the member; or
termination of the domestic partnership with the member.

¹ The law does not require that COBRA continuation coverage be extended to domestic partners. However, the Fund Board of Trustees has determined that such COBRA continuation coverage will be offered to registered domestic partners of Fund members.

Dependents of members have the right to continue coverage if coverage is lost for any of the following qualifying events:

death of the parent-member; or
the termination of a parent-member's employment for any reason other than his or her gross misconduct; or
loss of coverage due to a reduction in the parent-member's hours of employment; or
the dependent ceases to be a “dependent child” under the Fund’s rule of eligibility.

Qualified Beneficiary (QB): Individuals entitled to COBRA coverage on their own are called qualified beneficiaries (QB). Individuals who may be qualified beneficiaries are: the covered member, the spouse/domestic partner of the covered member and the dependent child(ren) of a covered member. In order to be a QB, an individual must be covered under the UFT Welfare Fund on the day before the event that causes the loss of coverage. The Health Insurance Portability and Accountability Act (HIPAA) amended this requirement to allow a child who is born to or adopted by the covered employee, while on COBRA, to become a Qualified Beneficiary.

Notes: Individuals covered under another employer sponsored group health plan prior to their COBRA start date are still eligible to purchase UFT Welfare Fund COBRA. However, individuals who become covered under another employer sponsored group health plan while on UFT Welfare Fund COBRA may not be eligible to continue the UFT Welfare Fund COBRA (except for the period that the new health plan excludes pre-existing conditions).

The Fund offers Medicare eligible enrollees and/or their Medicare eligible dependent(s) continuation benefits similar to COBRA if a COBRA event should occur.

What are the periods of continued coverage?

Continuation of coverage is available for a maximum duration of eighteen (18) months for the former member and their eligible dependents as a result of:

termination of employment; or
reduction of hours of employment; or
loss/reduction of Fund benefits due to deferred payability and retirement.

Continuation of coverage is also available for a maximum duration of thirty-six (36) months for the member’s eligible dependents as a result of:

death of member; or
divorce; or
legal separation; or
termination of a domestic partnership; or
dependents who cease to be a “dependent child” under the Fund’s rules of eligibility.

COBRA premiums for both eighteen (18) and thirty-six (36) month periods are calculated at 102% of the employer’s cost for coverage to the plan at the group rate.

New York State Insurance Law Extension of Continuation Coverage

Effective July 1, 2009, the New York State Insurance Law was amended to require insured group health plans to offer continuation coverage for up to 36 months, rather than the federally required maximum of 18 months. While the UFT Welfare Fund is not subject to this law, the Welfare Fund will provide the same coverage extension up to 36 months. Premiums for the extension months will also be charged at 102% of the group rate.

What is the “Disability Extension beyond the 18-month Period of Continuation Coverage”?

If you or anyone in your family covered under the Fund is determined by the Social Security Administration (SSA) to be disabled prior to the COBRA event date and/or at any time during the first 60 days of COBRA continuation coverage, and you notify the Fund in a timely fashion, you and your entire family can receive up to an additional eleven (11) months of COBRA continuation coverage, for a maximum of twenty-nine (29) months. You must make sure that the Fund is notified of the Social Security Administration's determination by sending a copy of the Determination letter within sixty (60) days of the date of the determination and before the end of the eighteen (18) month period of COBRA continuation coverage. This notice should be sent to the UFT Welfare Fund at 52 Broadway, New York, New York 10004, Attention: COBRA.

What is the “Second Qualifying Event Extension of the 18-month Period of Continuation Coverage”?

If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse/domestic partner and dependent children in your family can get up to an additional eighteen (18) months of of COBRA continuation coverage, up to a maximum of thirty-six (36) months.

This extension is available to the spouse/domestic partner and dependent children if the former employee dies, enrolls in Medicare (Part A, Part B, or both), or gets divorced or legally separated. The extension is also available to a child when that child stops being eligible under the Fund as a dependent child. In all of these cases, you must make sure that the Fund is notified of the second qualifying event within sixty (60) days of the second qualifying event. This notice must be sent to the UFT Welfare Fund at 52 Broadway, New York, New York 10004, Attention: COBRA.

In the event of death, a photocopy of the death certificate must be provided.
In the event of enrollment in Medicare, you must send a copy of the Medicare card.
In the event of divorce, you must send a copy of the divorce judgment.
In the event of legal separation, you must send a copy of the Court Order of Separation.
In the event of the dissolution of a domestic partnership, you must send a copy of the “Affidavit of Domestic Partnership Termination.”

Continuation of coverage can never exceed thirty-six (36) months in total, regardless of the number of events that relate to a loss of coverage. Coverage during the continuation period will terminate if the COBRA participant fails to make timely payments or if the COBRA participant becomes covered under another employer sponsored group health plan while on the UFT Welfare Fund COBRA (unless the new plan contains a pre-existing condition exclusion).

What are my notification responsibilities?

Under the law, the member, retiree or eligible dependent has the responsibility to notify either their payroll secretary or the Department of Education’s HR Connect (In-Service), or City of NY Health Benefits Program (Retirees) and the Welfare Fund within sixty (60) days of an address change, death, divorce, legal separation, termination of domestic partnership or a child losing dependent status.

A Qualified Beneficiary who is totally disabled (as determined by the SSA) and eligible for the disability extension, must submit to the Fund a copy of the SSA disability determination letter. This notice must be submitted within sixty (60) days of the SSA determination and before the end of the eighteen (18) month COBRA continuation period. If the SSA later determines that the Qualified Beneficiary is no longer disabled, then the Qualified Beneficiary must also notify the Fund, within thirty (30) days of this change.

When a qualifying event (such as a member's death, termination of employment, or reduction of hours) occurs, you and your eligible dependents will be notified by the Department of Education’s HR Connect (In-Service), or City of NY Health Benefits Program (Retirees) of your option to choose continuation coverage.

How do I elect City COBRA coverage?

To elect City COBRA continuation of health coverage, the COBRA eligible person must complete a "COBRA Continuation of Coverage Application." This application is available through the payroll secretary, the Department of Education’s HR Connect (In-Service), City of NY Health Benefits Program (Retirees), or the New York City Office of Labor Relations website: www.nyc.gov/olr.

What should I do if I am interested in electing the UFT Welfare Fund COBRA?

To elect UFT Welfare Fund COBRA you must:

Contact the Fund office directly at 212-539-0560 for necessary forms, available options and costs, or

make a copy of your City application and send it directly to the Welfare Fund Office. If you do not elect City COBRA but you would like to purchase Welfare Fund COBRA, contact the Fund office.

Upon notification, a Welfare Fund COBRA application will be mailed to you so that you may enroll in the UFT Welfare Fund COBRA benefit plan.

Eligible persons choosing to elect COBRA coverage must do so within sixty (60) days of the qualifying event or of the date on which they receive notification of their rights, whichever is later.

When are my premium payments due?

The initial premium is due within forty-five (45) days of your COBRA election. Thereafter, premiums are due on the first of the month with a thirty (30) day grace period. Since there cannot be a gap in the coverage period, coverage and premiums are retroactive to the COBRA qualifying event date. Subsequent premium payments are applied to the earliest unpaid months.

When can I change my benefits selected under COBRA?

COBRA participants are entitled to change the selection of COBRA benefits during the City’s Fall Open Enrollment Period as designated for in-service members.

The following language is required by the Federal Patient Protection Affordable Care Act: The Fund cannot represent whether or not “stand-alone” prescription drug, dental, vision and other supplemental benefits it provides are available through health insurance exchanges.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at Healthcare.gov.

Whom can I call if I have any questions about COBRA?

If you have questions about your COBRA continuation coverage, you should contact the Fund or you may contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.

3. Extension of coverage for unmarried children 29 years of age or under

New York State Insurance Law allows unmarried children to be covered by the member’s insured health plan, if they so choose, by paying the premium cost of the coverage until the unmarried child reaches his/her 30th birthday. Welfare Fund coverage for umarried children 29 years of age or under will coordinate with coverage afforded said children under the New York City health plans.

What are the eligibility requirements?

Member must have Welfare Fund coverage.
Child must be unmarried.
Child must be under age 30.
Child must live, work or reside in NY State or the health insurance company's service area.
Child may not be insured or eligible for comprehensive health insurance through his/her employer.

When will the Welfare Fund Age 29 Young Adult Coverage start?

The first month following receipt of your completed application or first payment.

When will the Welfare Fund Age 29 Young Adult Coverage end?

When the child loses any of the eligibility requirements listed above.
When premium payments are not received.