Yes, if you get married, you can add your wife and her children to the Plan. You need to notify the Health & Welfare Plan Office about your marriage and new dependents within 90 days of your marriage. You also need to provide the Plan Office with the necessary documentation. For more information, see the “If You Get Married or Add a Life Partner and “If You Acquire a Child Through Marriage” sections on the Life Events page.

Yes, your newborn child will be covered by the Plan from the date of birth, as long as you enroll the child within 30 days from the date of birth. If you enroll the child between 31 and 90 days after the date of birth, coverage for the newborn child begins on the first of the following month. If you miss this 90-day period, you will not be able to enroll your newborn child until the next Open Enrollment Period. You will need to provide the Plan with the necessary documentation. For more information, visit the “If You Have a Baby” section on the Life Events page.

Yes, as long as the newborn child is your natural child, your legally adopted child, or you are the child’s legal guardian. If your girlfriend is covered under the Plan as your domestic partner, your child may also be added to the Plan. You’ll need to show documents of proof to the Health & Welfare Plan Office. For more information on dependent eligibility, see Eligibility for Your Spouse and Children.

For various legitimate reasons, some members may have difficulty providing necessary documentation. In this case, it is important that you apply for coverage within the time periods outlined for each plan. Only then will the merits of your unique situation be considered. Contact the Health and Welfare office for more information.

You do not need to come into the Health and Welfare Office for every change. Open Enrollment forms and election forms may be mailed to the office. If documentation is required, however, (e.g., birth certificate, social security cards, proof of other coverage) you may need to supply those documents directly to the office for authentication purposes.

Your spouse’s coverage ends if you get divorced or if your marriage is annulled. If you are separated but still legally married, your spouse is still covered. You can remover him or her during the annual open enrollment. Your domestic partner loses coverage when your relationship no longer meets the criteria for a domestic partner relationship.

If you and your spouse are divorced, you should notify the Health & Welfare Plan Office immediately. If you fail to remove your divorced spouse from the Plan, you could be liable for any expenses claimed by your former spouse after the date of the divorce. For more information, see the Life Events page.

If you are not working, but you are still eligible for Plan coverage under the collective bargaining agreement, you may continue your coverage under the Plan by making monthly payments to the Plan during your period(s) of leave. You must notify the Health and Welfare office when you return to work.

If you are out on Workers’ Compensation, you must also make your monthly payments directly to the Health & Welfare Plan because they are not deducted from your paycheck or from your Workers’ Compensation benefits.

Payments are due on the first of the month. It is your responsibility to make your Health & Welfare payments on time. The Plan does not send notices of delinquent payments, nor will it send you a bill. If you do not make your payments on time, your coverage under the Plan will end. Consider permitting the Plan to deduct payments from your bank account. Contact the Plan for more information.

Coverage will retroactively end as of the monthly premium payment due date if the required monthly premium payment is not paid within 30 days from the due date (e.g., if the monthly premium payment for September, which is due on September 1, is not paid by September 30th, coverage would be terminated as of September 1). If coverage is terminated due to non-payment of the required monthly premium payment, you may again become covered (on a prospective basis) by sending in the required monthly premium payment for future coverage. Your coverage will re-start as of the first day of the month following receipt of the required monthly premium payment. You will not be permitted to retroactively reinstate coverage for any period of coverage that terminated due to non-payment of the required monthly premium payment.

If you are on a leave of absence for military duty, you are permitted to continue medical, dental, prescription drug, and vision benefit coverage under this Plan for you and your covered dependents in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). Please see the “If You Enter Military Service” section on the Life Events page for more information.

If your coverage ends due to termination of your employment with METRO, you may be eligible for COBRA for you and your family. Although METRO will notify the Health & Welfare Plan of your termination, you are also encouraged to inform the Health & Welfare Plan to avoid any delay.

If you lose Plan coverage due to the termination of your employment or any other reason, you may want to look into purchasing health coverage through a Health Insurance Marketplace.

• Washington, DC Marketplace: DC HealthLink
• Maryland Marketplace: Maryland Health Connection
• Virginia Marketplace: HealthCare.gov
• Federal Health Marketplace

If you are on military leave for 31 days or less, you and your family will continue to receive health care coverage for up to 31 days. Coverage continues until the end of the month, after the month in which you are deployed.

If you are on military leave for more than 31 days, the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) allows you to continue medical, prescription drug, vision, and dental coverage for you and your family at your own expense for up to 36 months. This continu­ation right is similar to COBRA. Your dependent(s) may also be eligible for health care coverage under TRICARE, the military health plan. For more information on your benefits if you go on military leave, visit the “If You Enter Military Service” on the Life Events page.

If you are a METRO employee and a participant in the Plan, but you leave your METRO employment, lose your eligibility for Plan coverage, and then return to work for METRO at a later date, you will be treated a s a new METRO employee.

You will be asked to complete enrollment forms. Before the end of your probation period, you will receive information from the Health & Welfare Plan about the benefit choices available to you. You must return those forms to the Health & Welfare Plan by the date indicated. Full-time employees who do not make a selection will automatically be enrolled for single coverage in the default HMO (Kaiser), and the Cigna Dental HMO.

If you transfer from a full-time to a part-time position, you will have to pay more out-of-pocket to continue your medical coverage. Medical, vision and dental coverage are not mandatory for part-time employees. You have the option to discontinue your coverage if you become a part-time employee. You will return to the Plan as soon as The Health and Welfare office is notified of your return to full-time status.

Part-time employees can choose to pay monthly for coverage through the Health & Welfare Plan. All part-time employees (except for New Service Agreement employees and re-hired retired employees) receive long-term disability and life insurance coverage. For more information, visit the Enrollment page.

Yes, if you are a full-time METRO employee or working under the supplemental collective bargaining agreement (the “New Service Agreement”), you may be eligible to opt out of coverage and receive a cash payment amount. You will need to provide proof that you have coverage from a source other than METRO. For more information on opting out of coverage, visit the “Election of Cash Payment/Waiver of Coverage” section on the Enrollment page.

You cannot add your boyfriend or girlfriend to the Plan unless they legally qualify as your domestic partner. To qualify as your domestic partner, they must meet criteria set forth by the Health & Welfare Plan and submit an “Affidavit of Domestic Partnership” to the Plan to receive benefits. For more information, visit Eligibility for Domestic Partners.

No, you can only add your spouse or eligible dependent children to the Plan. For more information, see the Eligibility section.

No. The parents need to decide which one of them will cover the child. In cases involving a Qualified Medical Child Support Order (QMCSO), the county Child Services Agency may need to be informed. See the Enrolling for Coverage page for more information.

The 2012 collective bargaining agreement permits employees to receive a credit of up to $1,200 if their spouse opts out of the Transit Employees’ Health & Welfare Plan’s health insurance program. It can only be used as a credit against medical and dental benefit expenses incurred as a Participant in the Plan. You must elect the spousal credit option each year.

Up to $100 per month will be applied to reduce the cost of your medical and dental insurance. It cannot be applied to reduce the cost of any supplemental life insurance you may have elected or of any other voluntary benefit.

Example

Your plan requires a monthly contribution of $80 toward single coverage and $208 toward family coverage. Here is how the credit will work:

• For a family with only employee and spouse coverage, the spousal credit would change your plan from family to single (from $208 to $80) and the credit would further reduce the monthly contribution for single coverage ($80) to zero.
• For a family with employee, spouse and children coverage, the spousal credit would not change your family plan coverage ($208), but it would reduce the $208 amount you pay to $108 (the maximum credit of $100 per month).

This credit is available to employees and retirees, but cannot be combined with the employee opt-out payment. This credit is available only if the employee or retiree remains covered in the Transit Employees Health and Welfare program.

You can only elect the spousal credit option during the annual open enrollment period, usually in November of each year. It will be effective for your premiums for the following January 1st. Download the Spousal Credit form here.

If you have more questions, please contact the Health and Welfare Plan Office.

Each November, you have the option to change your benefit plan, add or remove dependents or add or change your supplemental life insurance option. You will receive an Enrollment Guide and a Statement of Benefits to help you make your benefits choices. This is the only time of the year you can make changes to your benefits choices, unless you experience a change in status.

To make changes, you’ll need to complete an Enrollment Form and submit it to the Plan Office. Your changes will be effective the following January 1. For more information, see the Enrollment section of the Open Enrollment page.

To change doctors you should call your health care provider (e.g., CareFirst, Kaiser etc.) or visit them online.

In some cases, your medical coverage can be used for medical care outside of the United States. It is best to contact your medical plan and your prescription plan well in advance of your scheduled travel.

No. Medical and dental coverage are offered together. You must elect a medical plan and dental plan or opt out of both medical and dental coverage.

On the other hand, retirees can elect medical and dental coverage together, or just medical coverage.

Only you are eligible for life insurance under the Plan. However, you can name anyone to be the beneficiary of your Life Insurance Plan. That person(s) name must be on file with the Plan to be valid. For more information, visit the Life and Accident Insurance section.

For now, if you want to change the beneficiary(s) on your life or supplemental life insurance, you need to fill out a Change of Beneficiary Form and submit it to the Health & Welfare Plan. For more information, visit the Designating a Beneficiary page.

If you are on Workers’ Compensation, you must make monthly premium payments, at the rate paid by active employees, to stay covered under the Plan. Payments are not deducted from your Workers’ Compensation check, so it is your responsibility to send timely payments directly to the Plan.

While you are collecting Workers’ Compensation, you are not eligible to receive short-term disability benefits from the Plan. However, you are eligible to apply for long-term disability benefits six months after your injury. Any long-term disability benefit you receive will be reduced by your Workers’ Compensation and other forms of income. For many reasons, it is to your advantage to apply for long-term disability benefits. Call the Health & Welfare Plan office if you have any questions.

If you suffer a work-related injury, you are not eligible for short-term disability benefits. However, if you suffer a work-related injury and are denied Workers’ Compensation, you are eligible to apply for the Weekly Disability Subrogation Agreement. You can also apply for long-term disability benefits six months after your injury. For more information, see the “If You Become Disabled” section on the Life Events page.

If you were hired before January 1, 2010 and you retire, you can choose to continue your medical benefits (including prescription drug coverage) under the Plan. You are also eligible for life insurance and voluntary retiree dental coverage through Delta Dental.

When you retire, you are no longer eligible for short-term disability (STD), long-term disability (LTD) or accidental death and dismemberment (ADD) coverage.

You need to make monthly premium payments to receive coverage when you retire. In most cases, your premium payments are automatically deducted from your pension check. For more information on medical coverage after retirement, see “If You Retire” on the Life Events page.

When you or your spouse becomes eligible for Medi­care, you should enroll in Medicare Parts A and B. For most people, enrollment in Medicare Part A is automatic (there is no premium) when you start receiving benefits from Social Security. You should sign up for Medicare Part B with the Social Security office three months before turning 65. Your monthly premium to Medicare for Part B will be deducted from your Social Security check.

When you become eligible, you are not required to enroll in Medicare Part B, but benefits will be paid by the Plan as if you are enrolled. This means that, if you do not enroll, you or your spouse will have higher expenses because you will be responsible for paying for the benefits Medicare Part B would have covered. After you submit evidence of your Part B enrollment for yourself or your dependent, your HEALTH & WELFARE Plan premium will be reduced. For more information, visit the “If You Become Eligible for Medicare” section on the Life Events page.

The Health & Welfare Plan Office is open Monday through Friday, from 8:30 AM to 5:00 PM.

Our address is:
Transit Employees’ Health & Welfare Plan
2701 Whitney Place, Suite 100
Forestville, Maryland 20747
Phone: 301-568-2294

Directions to the Transit Employees’ Health & Welfare Plan Office
The office of the Transit Employees’ Health & Welfare Plan Office is located just inside the beltway on the first floor of the ATU Local 689 union building in Forestville, MD. From the Beltway, take exit 11-B (Route 4, Pennsylvania Ave) toward Washington DC. The second traffic light is Donnell Drive. Turn right (north) on Donnell Drive. At the end of Donnell Drive, turn left onto Marlboro Pike. Immediately after turning onto Marlboro Pike, make a right onto Whitney Place. The union office building will be on the left and the Health & Welfare Plan Office is to the left of the main entrance.

If you are looking for a state or federal tax form, you can go to the IRS website for federal forms or your state site (DC, Maryland or Virginia, for example) for the state forms.

For Transit Employees’ Health & Welfare Plan forms, visit the Forms and Documents page.

You should first contact the customer service number on the back of your benefit card to discuss the reasons for denial. If the problem cannot be resolved at this level then contact the Health and Welfare office.

Several factors determine the rates you pay.

• Actual experience. Each year, all of our carriers for medical, prescription drug and life insurance look back at our actual claim experience to determine the next year’s rates. With assistance from our Plan consultants and actuaries, actual monthly rates are developed and the Trustees then approve and adopt the rates.
• The collective bargaining agreement. The collective bargaining agreement determines how much is paid by the authority and how much is paid by you, the member.

Active employees. Unless you elect a monthly deduction, your monthly rate will be broken into four monthly installments. On months with five pay periods, a deduction holiday will occur on the pay date for the fifth pay period. As long as you stay current, you will normally have four deduction holidays each year.

Retirees. Retirees pay their monthly premiums with deductions from their pension checks. Retiree deductions are taken at the end of the coverage month. For example, the pension check you receive at the beginning of May pays for your health care coverage for April.

Others. Several categories of people are on self-pay. They may be those on extended leave, Workers’ Compensation, disability or those receiving survivor benefits. They can send checks or elect automatic debits.

This is a point of common confusion. We go by pay periods, which end on Saturdays. So, look for months with five Saturdays, and then count forward 11 days. That will be your deduction holiday. For example, April 2017 has five Saturdays with the fifth Saturday falling on April 29, 2017. The pay date for that pay period end date is May 10th.

In 2017, the deduction holidays fall on the following dates:

• January 11, 2017
• May 10, 2017
• August 9, 2017
• October 11, 2017

The good news is that you pay ahead while you are working. So your premium for the coverage month is normally paid by the beginning of the coverage month.

An example may help. You pay your premium in four monthly installments. Using April 2017 as an example, the fourth pay period ends on April 22nd. That pays your share of the premium for May 2017. If, for example, you should be out for the month of May without pay for any reason, your insurance will be paid for May. But, when you return to work, we will begin to catch you up. We limit the amount of the recovery to twice your normal weekly amount. Generally, that means that for each week you fall behind, your regular deduction amount will be doubled until you are caught up.

For those on Short-Term Disability (STD), we will take deductions from your short-term disability check if there is enough to pay your premium. It is not uncommon for people on STD to fall behind in their Health and Welfare Plan premiums.

For those on Long-Term Disability (LTD), members can elect monthly deductions. Generally, those are taken at the end of the coverage month. Members who return to work from STD or LTD frequently find that they have some catch-up contributions to make for a month or so.