Employees: Eligibility for eligible employees commences on the 1st day of the month following completion of 60 consecutive days of full-time service in position within the SCCEA bargaining unit, provided necessary enrollment cards are completed and filed at the Fund Office. Dependents become eligible at the same time the employee does.
However, if the required enrollment card is not submitted within 60 days following the completion of 60 consecutive days of full time service, eligibility for eligible employees and dependents will commence on the 1st day of the month following receipt of the enrollment card. Transferred and/or promoted employees are eligible immediately.
Retirees: Eligible employees who are granted retirement by the NYSERS within 30 days of the last date upon which he/she was in full pay status shall be entitled to Fund benefits as a retiree with no waiting period.
All other retirees (e.g. employees who vested retirement rights and left service and employees who were out of pay status awaiting the granting of an application of disability retirement) become eligible on the 1st day of the month following 60 days from the date written notification of the granting of retirement benefits is received by the Fund.
Filing of Claims: All claims for Welfare Fund benefits must be submitted on appropriate claim forms. Claim forms can be obtained by calling the fund office at 231-3983 and may be available at personnel offices. All claims must be accompanied by any information or proof requested by the Fund Office which is reasonably required to process the claim.
Termination of Benefits: Benefits for eligible employees cease at the end of the calendar month in which the eligible employee ceases to be an eligible participant in the plan. Benefits for retirees cease at the end of the calendar month in which they lose status as an eligible retiree under the plan or the retiree dies, whichever first occurs. Benefits cease for dependents at the time benefits cease for the eligible retiree or when the dependents cease to fulfill the definition of an eligible dependent whichever first occurs.
Coordination of Benefits: Coordination of benefits provides that each Welfare Fund Benefit is coordinated with any other plan under which an individual is covered so that the total benefits available will not exceed 100% of the reasonable and customary charges or the actual charges, whichever is less. A person may not have coverage as both a retiree and as a covered dependent. The plan covering the retiree directly is the primary plan. If a dependent child is covered under another plan, the plan that insures the father pays first however, if the parents are divorced or legally separated, the plan of the parent with custody pays benefits first.