Eligibility for your Spouse and Children

Your spouse and eligible dependent children may be covered under the Plan. Eligible dependent children (married or unmarried) include:

• Children under age 26, including natural children, stepchildren, legally adopted children, children placed with you for adoption, or children in a domestic partner relationship
• Children as described above, age 26 or older, who have a mental or physical incapacity that began prior to age 26 that prevents them from engaging in any self-sustaining employment, have the same principal place of residence as you for the full year, are members of your household, and are dependent upon you for over one-half of their support.
• Unmarried children for whom you are the court-appointed guardian up to age 19. Note: unmarried children for whom you are the court-appointed guardian are eligible to continue their coverage after age 19 until age 23 if they are full-time students.

Eligibility for Domestic Partner

You can cover your domestic partner through the Health & Welfare Plan. Domestic partners are two adults of the opposite sex or the same sex who are engaged in a spouse-like relationship characterized by cohabitation, mutual caring, and dependency.

An “Affidavit of Domestic Partnership” must be submitted to the Health & Welfare Plan for your partner to receive benefits.

Under certain circumstances, the Participant may consider taxable income coverage for a domestic partner or children in a domestic partner relationship. Participants receiving coverage for their domestic partners will receive an annual income statement indicating the value of this coverage for tax purposes. Taxes are withheld through payroll deduction. Some states may consider coverage of a same-sex spouse to be taxable income.

Eligibility for Domestic Partners

The plan considers your domestic partner eligible for coverage if you:

• share a permanent residence and intend to do so indefinitely.
• are no less than 18 years of age.
• are jointly responsible for each other’s common welfare and living expenses and are financially interdependent.
• have registered a declaration of domestic partnership with the appropriate government offices.

Eligibility While on Leave

If you’re not working, but still eligible for Health & Welfare Plan coverage under your collective bargaining agreement, you can continue coverage by making monthly payments.

Payments are due on the first of the month. It’s your responsibility to make payments on time. The Plan does not send notices of late payments or invoices. If you do not make your payments on time, your coverage under the Plan will end. You have the option of deducting payments from your bank account. Contact the Plan Office for more information.

If you are on a leave of absence for military duty, you may continue medical, dental, prescription drug, and vision benefits coverage for you and your covered dependents. Please see “if you enter Military Service” for more information.

The Family and Medical Leave Act (FMLA)

If you take leave for a serious illness, the birth of a child, or caring for a seriously ill parent or spouse, you may qualify for leave under the Family and Medical Leave Act (FMLA) for up to 12 weeks. You may also be entitled to up to 12 weeks of leave for a situation that arises in connection with the active military service of a child, spouse, or parent. You may qualify for up to 26 weeks of leave during a single year under FMLA if you are caring for a child, spouse, parent, or next of kin who is a member of the Armed Forces and is undergoing medical treatment as a result of a severe injury or illness. Please get in touch with METRO to apply for FMLA leave.

As long as you are eligible and continue paying your Health & Welfare Plan monthly premium payments, METRO will continue paying its share of your coverage.

Retiree Coverage

If you participate in the Health & Welfare Plan and retire under the Transit Employees’ Retirement Plan, you are eligible for life insurance, medical coverage, and the voluntary retiree dental plan. If you do not choose to continue medical coverage, you can re-enroll later if you have a life-changing event or during the next Open Enrollment. If you were hired on or after January 1, 2010, you are not eligible for retiree medical coverage.

Your monthly Health and Welfare premium payments will be deducted from your pension check.

Retirees may change health plans when they retire and during the regular Open Enrollment Period.

If you Work Part-Time

All part-time employees (except re-hired retired employees) receive long-term disability and life insurance. Part-time employees can choose to pay and participate in the Health & Welfare Plan program for medical, vision, and dental coverage.

When Coverage Ends

Your coverage under the Plan will end at the end of the month in which one of the following occurs:

• you stop working as a Local 689 employee of METRO for reasons other than retirement
• you are no longer eligible under the terms of a collective bargaining agreement
• you do not make your monthly payments (if required) on time
• the Plan is terminated or modified to end your coverage.

When your coverage ends, coverage for your dependents ends unless the cause of your termination of coverage is your death. (See the “If You Die While a Participant” section on the Life Events Page).

Your spouse’s coverage ends if you divorce or your marriage is annulled. If you are separated but still legally married, your spouse is still covered. Your domestic partner loses coverage when your relationship no longer meets the domestic partner relationship criteria.

Coverage for your dependent children ends on the last day of the month when they no longer meet the Plan’s definition of dependent.