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Health SPD


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Eligibility and Enrollment > When You Lose Eligibility > Other Extensions Of Coverage

Other Extensions Of Coverage

After you or your dependents lose eligibility for the Fund's health plans, there may be other options for extending coverage.

Full-Time Students
Your dependent child's medical and dental coverage may be extended after age 19 if your child is:

  • Under age 23;
  • Unmarried and dependent on you for full support;
  • A student at an accredited educational institution of higher learning; and
  • Deemed by that institution to be a full-time student.

When your child turns age 19, the Fund will send you a notification requesting that you submit:

  • A student verification form completed by the school's registrar's office (the form will be provided); and
  • Information about COBRA continuation coverage in case your dependent doesn't meet the criteria outlined above.
Total Disability
If, at the time coverage ends, you or a dependent - excluding same-sex domestic partners - is totally disabled, that person may receive extended benefits through the total disability extension offered by the Fund for the disabling condition only or through COBRA.

  • After completing and returning all required disability forms, including a physician's statement, and being deemed eligible for disability extension of coverage, a totally disabled participant or their dependent is entitled to medical benefits as follows:

A Disabled Writer:

  • After completing and returning all required disability forms, including a physician’s statement, and being deemed eligible for disability extension of coverage, the totally disabled writer and their covered dependents are entitled to full medical benefits for up to 6 months from the date coverage ends.
  • If at the end of the 6-month extension the writer is still disabled, he/she will be entitled to elect an additional 12 months of “comprehensive medical coverage” (out-patient medical and prescription benefits only) or COBRA. Dependents are not eligible for the 12-month comprehensive medical coverage extension; however, they will be offered COBRA and the COBRA entitlement will be offset by the 6-months of extended coverage they received.
  • If after the 1st 6-month extension of coverage the writer elects COBRA, the COBRA entitlement will be offset by the 6-month extension previously received. If the 12-month comprehensive medical coverage extension is elected, no COBRA will be offered at the termination of this extension.

A Disabled Spouse:

  • If at the time coverage ends, the covered spouse is totally disabled; the spouse will be entitled to elect 12 months of comprehensive medical coverage or COBRA. If the 12-month extension is elected, no COBRA will be offered at the termination of the 12-month extension.

A Disabled Child:

  • If at the time coverage ends, a dependent child is totally disabled; the child will be entitled to elect 12 months of comprehensive medical coverage or COBRA. If the 12-month extension is elected, no COBRA will be offered at the termination of the 12-month extension.
  • If a dependent child has been deemed “permanently disabled” by the Fund, the child will be entitled to lifetime coverage. This coverage will be in effect as long as the writer is covered under the Fund and claims will be paid based upon the plan of benefits the writer elects. If the writer loses coverage, the writer and the permanently disabled child will be offered COBRA. Should the writer regain earned coverage, the permanently disabled child’s coverage would resume

(For information about COBRA, see "COBRA Continuation Coverage".)

If you're the disabled participant and your disability occurs before age 60, your life insurance may be continued at no cost to you through your extension of coverage period.

Applicable disability forms are available from the Eligibility or Claims Department or click on the Forms section to download the forms from the website. (http://www.wgaplans.org/)

Active Survivor Coverage
If you die while covered under the Fund's health plans, your covered surviving spouse or same-sex domestic partner may be entitled to extended coverage under your health plan at no cost if, at the time of your death, you're an active participant under age 60 and you have:

  • Accumulated at least 68 quarters of eligibility; and
  • Been married or in a same-sex domestic partnership for at least two years.

Your survivor can elect either of the following options:

  • Five years of medical and dental coverage. Coverage will end if your surviving spouse remarries, if your same-sex domestic partner enters into a new domestic partnership, or if your spouse or partner becomes eligible for Medicare or another group health plan; or
  • Lifetime medical and dental coverage starting on the date you would have turned age 60. Coverage will end if your surviving spouse remarries or your same-sex domestic partner enters into a new domestic partnership. Once your spouse or partner becomes Medicare-eligible, the Fund's health plan will be secondary to Medicare. (See "Understanding Coordination of Benefits (COB)").

Alternatively, your surviving spouse may enroll for COBRA continuation coverage. This option is not available to same-sex domestic partners. (For information about COBRA, see "COBRA Continuation Coverage".)

Certified Retiree Survivor Coverage
If you're at least 60 years old when you die and you had accumulated at least 68 quarters of eligibility:

  • If you had been married or in a same-sex domestic partnership for at least two years, your survivor will receive the same Certified Retiree benefits he/she would have received had you retired and died immediately thereafter; or
  • If you had been married or in the same-sex domestic partner relationship for less than two years when you died, your survivor will receive this coverage for only six months
Important!

This extension of coverage, like all Fund benefits, is subject to amendment or termination by the Fund's Board of Trustees and does not entitle your surviving dependents to a guarantee or vested rights to the Fund's benefits program.



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