- EWTF automatically considers your spouse to be your “Personal Representative” unless you submit a form naming another person as your Personal Representative. A “Personal Representative” is allowed to exercise your rights on your behalf.
- All Dependent’s Social Security Number (SSN) must be on file with the Fund Office. This is a requirement of the Medicare Secondary Payor law. Failure to submit a copy of the SSN for your spouse within six months from the date of marriage or the date added to the coverage will result in termination of your spouse’s coverage.
- Coverage for an adopted child will begin when the child is officially placed for adoption—not when the adoption becomes final. Limitations on pre-existing conditions of your adopted child are not permitted. Please notify the Fund Office at 301-731-1050 or at 1-800-929-3983 if you intend to adopt a child. You will receive additional information about the procedures necessary to allow your child to be covered under the Plan. Failure to submit a copy of the adopted child’s social security number within six months will result in termination of your adopted child’s coverage.
- Coverage for your spouse under the EWTF will end at the end of the month that you begin living separate and apart, legally separate or divorce. However, your spouse may elect to continue coverage through COBRA. Your spouse must apply for COBRA within 60 days of your divorce or separation in order to qualify for coverage.
Your benefits are designed to adapt to your needs at different stages of your life. This section describes how your coverage is affected when different changes occur.
The following Life Events can affect your coverage or the coverage of your dependents. Contact the Fund Office as soon as possible when you experience, or expect to experience, any of the following:
- Change in your address;
- Legal separation or divorce;
- Birth, adoption or legal guardianship of a child;
- Loss of your child’s eligibility;
- Loss of your eligibility;
- Taking a leave of absence (including FMLA);
- Entering military service;
- Medicare eligibility (due to age or disability); or
What You Need To Do
- In general, you should notify the Fund Office at 301-731-1050 or at 1-800-929-3983 as soon as possible when you experience a life event.
- If you move, call or write to the Fund Office with your new address. Only you as the participant can make this change.
- If you’re adding a dependent, if you or your dependent become covered under another plan, or if there is any change to your other insurance coverage, call or e-mail the Fund Office at firstname.lastname@example.org to request the proper form you must complete and submit to the Fund. If more information is required after you submit the completed form, the Fund Office will contact you in writing.
If You Take a Leave of Absence (FMLA)
The Family and Medical Leave Act (FMLA) allows you to take up to 12 weeks of unpaid leave from employment during any 12-month period (26 weeks if the reason is to care for a spouse, child or parent who is a covered service member with a serious injury or illness) due to:
- The birth, adoption, or placement of a child with you for adoption;
- The need to provide care for a spouse, child, or parent who is seriously ill;
- Your own serious illness;
- Any “qualifying exigency” arising out of the fact that you, as a covered military member, are on active duty or call to active duty status, in support of a contingency operation (e.g., attending certain military events and related activities, making appropriate financial and legal arrangements, certain child care and related activities, attending counseling, certain post-deployment activities and issues arising from short notice deployment); or
- The need to care for a spouse, child or parent who is a covered service member with a serious injury or illness.
During your leave, you may arrange for your employer to continue all of your medical coverage and other benefits offered through the Plan. You are generally eligible for leave under the FMLA if you:
- Have worked for a covered employer for at least 12 months;
- Have worked at least 1,250 hours over the previous 12 months; and
- Work at a location where at least 50 employees are employed by the employer within 75 miles.
The Fund will maintain your eligibility status until the end of your leave, provided the contributing employer properly grants the leave under the FMLA and the contributing employer makes the required notification and payment to the Fund.
If You Enter Active Military Service
This Plan complies with the Uniformed Service Employment and Reemployment Rights Act (USERRA). Therefore, if you, as an eligible employee, go into active military service, including Reserve and National Guard Duty, the Fund provides you with the right to elect continuous health coverage for you and your eligible dependent(s) for up to 24 months, beginning on the date your absence begins from employment due to military service.
After 31 days, you must pay the cost of the coverage unless your employer elects to pay for your coverage in accordance with its military leave policy. The cost that you must pay to continue benefits will be determined in accordance with the provisions of USERRA by the same method that the Fund uses to determine the cost of COBRA continuation coverage.
You must notify your employer or the Fund office that you will be absent from employment due to military service unless you cannot give notice because of military necessity or unless, under all relevant circumstances, notice is impossible or unreasonable. You also must contact the Fund office and elect continuation coverage for yourself or your eligible dependent(s) under the provisions of USERRA within 60 days after your military service begins. Payment of the USERRA premium, retroactive to the date on which coverage under the Plan terminated, must be made within 45 days after the date of election of your USERRA coverage. Ongoing payments must be made by the last day of the month for which coverage is to be provided. You will not be billed; it is your responsibility to remit payments to the Fund Office. Late payments can result in termination of coverage.
Any period of leave of absence under the provisions of USERRA will not be counted as a break in coverage for purposes of determining your eligibility for benefits. Questions regarding your entitlement for leave under USERRA and Continuation Coverage should be referred to the Fund Office.
Reinstatement of Coverage after Completion of Military Service
In order to have coverage reinstated by the Plan after active military service, you must apply for reinstatement in accordance with USERRA. If your period of service in the uniformed services was less than 31 days, you must report to your employer for reemployment by the first day of the first full regularly scheduled work period after the expiration of eight hours after a period allowing for your safe transportation from the place of service to your residence.
If your period of service in the uniformed services was for 31 days or more but less than 181 days, you must submit an application for reemployment not later than 14 days after the completion of your period of service.
If your period of service was for more than 180 days, you must submit your application for reemployment with your employer within 90 days of release of service.
If you have been hospitalized, or are convalescing from an illness or injury incurred or aggravated during your tour of duty in the uniformed services, you have until your recovery from that illness or injury to submit an application for reemployment. However, that period of recovery may not exceed two years.
Please contact the Fund Office at 301-731-1050 or at 1-800-929-3983 for further questions regarding your entitlement to reinstatement of coverage after active military service.
If You Want to Dis-enroll
In general, the Plan’s rules regarding eligibility govern whether you and your dependents have coverage under the Plan. However, if an otherwise eligible participant or dependent wants to dis-enroll from coverage, they may do so. Once voluntarily dropped, an otherwise eligible dependent cannot be reenrolled unless s/he experiences a special enrollment event or the Fund otherwise is legally obligated to permit reenrollment.
To dis-enroll from coverage, contact the Fund Office to request the Fund’s disenrollment form, or download and print the form from the Plan’s website at www.ewtf.org. Please note that no claims will be paid for any services received on or after the date on which the coverage terminates. This includes services received after the termination date for an injury or illness that occurred before the effective date of disenrollment.