What is the Fund?
The Suffolk County Superior Officers Association Benefit Fund (Fund or Benefit Fund) is a legal entity separate and distinct from the Suffolk County Superior Officers Association (Association) and was established as a result of collective bargaining between the Association and the County of Suffolk, New York (Employer).
How does the Fund obtain money to operate its plan of benefits?
The source of contributions to the Fund is the employer, the County of Suffolk. Contributions are provided at the annual rate, pro-rated monthly on behalf of each active covered employee. There is no requirement that active employees contribute to the Fund in order to be eligible for the benefits provided. Also, members and their dependents about to lose coverage under certain conditions can elect to continue coverage by paying the Fund directly under COBRA, which is explained in more detail in the section of this booklet entitled “Continuation Coverage Under COBRA.” In accordance with the Agreement and Declaration of Trust and the various governing agreements, the contributions to the Benefit Fund are used to provide benefits for covered employees and eligible dependents and to finance the cost of administration.
Who is responsible for the Fund’s operations?
The Fund is governed by a joint Board of Trustees comprised of eight members; four of whom are designated by the Association and four of whom are designated by the employer, in accordance with the Agreement and Declaration of Trust by which the Benefit Fund was created.
The board of trustees employs a staff who are responsible for the daily function and operation of the Fund, the foremost of which is the processing of claims for benefits. This booklet describes how claims should be presented for payment and the eligibility requirements for same. Decisions by the Administrator and of the staff are subject to appeal in writing to the Board of Trustees. The procedure describing appeal is set forth in this booklet.
All of the benefits provided by the Suffolk County Superior Officers Association Benefit Fund are self-insured . There are no insurance carriers underwriting the benefits provided by the Fund.
The Fund is mandated to submit its books to audit by certified public accountants on an annual basis. A copy of the financial status of the Fund is mailed to every member upon completion of our annual audit.
An annual report is also filed with the New York State Department of Insurance. The State Insurance Department and the Suffolk County Comptroller may also conduct audits at periodic intervals. Copies of their findings are on file in the Fund Office.
Does the Fund Operate Under ERISA?
The Fund is not subject to the provisions of the Employee Retirement Income Security Act of 1974.
Who is Covered?
All employees of Suffolk County covered by the Collective Bargaining Agreement between the County of Suffolk and the Suffolk County Police Superior Officers Association are covered employees under the Fund. Employees of Suffolk County for whom contributions are paid to the Benefit Fund, employees of the Superior Officers Association and employees of the Superior Officers Association Benefit Fund deemed eligible by the Board of Trustees, are also covered under the Fund.
Dependents of covered members are covered for the dental, optical, and medical supplemental benefits under the plan. Dependents include:
Your spouse. If legally separated, your spouse is still eligible. If you are divorced or your marriage has been annulled, your former spouse is not eligible unless payment under COBRA continuation of coverage is maintained.
Your domestic partner. Your domestic partner who is a person, eighteen years of age or older, who is not related by blood to the member in a manner that would bar marriage in the State of New York and who is not legally married to another person, who has a close and committed personal relationship with the member, who lives with the member and has been living with same on a continuous basis, and who, together with the member has registered with the Fund as a domestic partner of the member and has not terminated the partnership.
- It is the member’s responsibility to notify the Fund in a divorce situation.
- Your Children Under age 26. This includes your natural children, legally adopted children, including children in a waiting period prior to finalization of adoption. Stepchildren and other children who reside permanently with you in your household who are chiefly dependent on you for support may also be eligible. A Statement of Dependency must be filed and approved by the Benefit Fund. Foster children are not eligible.
Disabled Dependents. Dependent coverage is also extended to any unmarried child, regardless of age, who is incapable of self-sustaining employment by reason of a mental or physical handicap and who becomes so prior to attainment of age 26 and who resides with and is wholly dependent on the covered member for financial support. You must submit proof of your dependent child’s incapacity to the Fund Office 31 days after the date he/she attains the age at which his/her coverage would otherwise terminate, or within 31 days after you are notified of his/her ineligibility whichever is later. Proof of the continued existence of such incapacity shall be furnished to the Fund Office from time to time at its request.
If your marital status changes, the status of any dependents change or you acquire additional dependents, you MUST notify the Fund Office immediately. The Fund reserves the right to request additional documentation verifying a bona fide relationship of any dependent member.
How do I Enroll and Update Information?
All new members must complete an enrollment form, which is available from the Fund office and attach applicable documentation (e.g. birth certificate, marriage certificate or domestic partner registration).
All members must notify the Fund office of a change in marital status, domestic partner status or dependent child status. The Fund reserves the right to request additional documentation verifying the bond fide relationship of any dependent to the member.
If you fail to timely notify the Fund office of a divorce or termination of a domestic partnership and your former spouse/domestic partner incurs claims paid for by the Fund, you will be held financially responsible for repayment of those claims to the Fund.
How to Decline Dental and Optical Coverage
Actively employed members may decline coverage of Fund benefits (dental and optical) for themselves and/or any enrolled dependents at any time by completing a Declination of Coverage form, which can be obtained by contacting the Fund office
Continuation of Benefit Coverage
1. Death of a Covered Member
A. In the Line of Duty
If a covered member dies in the line of duty, the member’s spouse shall continue to be eligible for Fund benefits at no cost until such time as the surviving spouse remarries. The covered member’s eligible dependents are also covered at no cost for so long as they meet the Fund’s definition of dependent.
B. Outside of the Line of Duty
If a covered active member dies outside of the line of duty, the member’s spouse and eligible dependents continue to be eligible for Fund benefits for 6 months at no cost, and after that as long as timely payment is made to the Fund for the cost of such continuation coverage, and the individual is also eligible under the rules of the plan.
2. Covered Member’s Employment Ends (for reasons other than gross misconduct) or is on leave of absence without pay.
Under these circumstances, the member, his/her spouse and eligible dependents continue to be eligible for Fund benefits for so long as timely payment is made to the Fund for the cost of such continuation coverage, and the individual is also eligible under the rules of the plan. See “continuation coverage under COBRA” section on page____ of this booklet.
3. Retirement of the Covered Member
A. No Cost Plan
Eligible members who retire and their dependents are automatically eligible for the following plans, at no cost, provided the retiree maintains membership in the Superior Officers Association:
i. Dental plan - $300.00 per family maximum per plan year (calendar year)
ii. Optical benefit - $135.00 every 24 months for covered eyewear.
B. Self-Pay Plan
Eligible members who retire may elect the following plan, and receive the benefits outlined below, provided they remit the required payment for same to the Fund, on a timely basis:
i. Dental, Optical (not including the Sunglass Benefit) and Medical Supplemental and Maternity as provided at the time of election to active members.
ii. For an additional cost, the retiree may purchase the legal services plan in addition to those benefits outlined in i. above.
IMPORTANT: Those electing this plan of benefits must do so within 60 days of retirement. This package is not available at any other time. If you do not elect the self-pay plan, or fail to remit the appropriate payment for same, then you will be automatically enrolled in the No Cost plan. If this should occur, you may not again elect the self-pay plan.
4. Continuation Coverage Under COBRA
Federal law requires that most group health plans, including the plan of the Suffolk County Superior Officers Association Benefit Fund, (the “Fund”) give employees (known as “members” in the case of the Fund) and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under an employer’s plan (in this case, the Fund’s plan of benefits under which the individual was covered). Depending on the type of qualifying event, “qualified beneficiaries” can include the employee/member covered under the Fund’s plan, the covered employee’s/member’s spouse, and the dependent children of the covered employee/member.
Continuation coverage is the same coverage that the Fund’s plan gives to other members or eligible dependents who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other members or eligible dependents covered under the Fund’s plan. Continuation coverage applies to the Fund’s dental, optical, supplemental medical, hearing aid and ophthamologic benefits.
The following language required by the federal health care law. The Fund cannot represent whether or not dental, vision and the other supplemental benefits it provides are available through the health care exchanges.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
How long will continuation coverage last?
In the case of a loss of Fund coverage due to end of employment or reduction in hours of employment with the County, coverage generally may be continued only for up to a total of 18 months. In the case of losses of coverage due to a member’s/ employee’s death, divorce or legal separation, the member’s/employee’s becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the Fund’s plan, coverage may be continued for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the member’s/employee's hours of employment with the District, and the member/employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the member/employee lasts until 36 months after the date of Medicare entitlement. This notice shows the maximum period of continuation coverage available to the qualified beneficiaries.
Continuation coverage will be terminated before the end of the maximum period if:
· any required premium for continuation coverage is not paid to the Fund in full and on time,
· a qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary,
· a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage, or
· the Fund ceases to provide any health-related benefits to its members.
Continuation coverage may also be terminated for any reason that the Fund would terminate the coverage of a member who is not receiving continuation coverage.
How can you extend the length of COBRA continuation coverage?
If you elect continuation coverage from the Fund, an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. You must notify the Fund of a disability or a second qualifying event in order to extend the period of continuation coverage. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage.
An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined by the Social Security Administration (SSA) to be disabled. The disability has to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must provide the Fund with a copy of an SSA disability determination letter within 60 days of the determination in order to extend the period of continuation coverage. Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, you must notify the Fund of that fact within 30 days after SSA’s determination.
Second Qualifying Event
An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second qualifying events may include the death of a covered member/employee, divorce or separation from the covered member/employee, the covered member’s/employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), or a dependent child’s ceasing to be eligible for coverage as a dependent under the Fund’s plan. These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Fund’s plan if the first qualifying event had not occurred. You must notify the Fund within 60 days after a second qualifying event occurs if you want to extend your continuation coverage.
How can you elect COBRA continuation coverage?
To elect continuation coverage, you must complete the Fund’s Continuation Coverage Election Form and furnish it according to the directions on the form. Each qualified beneficiary has a separate right to elect continuation coverage. For example, the member’s/employee’s spouse may elect continuation coverage even if the member/employee does not. Continuation coverage may be elected for only one, several, or for all dependent children who are qualified beneficiaries. A parent may elect to continue coverage on behalf of any dependent children. The member/employee or the member’s/employee's spouse can elect continuation coverage on behalf of all of the qualified beneficiaries.
In considering whether to elect continuation coverage, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your Fund’s health-related benefits coverage ends because same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you. Under the rules governing the portability provisions of the Health Insurance Portability and Accountability Act (“HIPAA”) there were limitations on plans imposing preexisting condition exclusions; however, such exclusions became prohibited beginning in 2014 under the Patient Protection and Affordable Care Act (“PPACA”).
How much does COBRA continuation coverage cost?
Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of continuation coverage due to a disability, 150 percent) of the cost to the Fund for coverage of a similarly situated Fund member or eligible dependent who is not receiving continuation coverage.
For more information
If you have any questions concerning COBRA continuation coverage, you should contact the Fund Administrator at (631) 654-0900.
For more information about your rights under COBRA and other laws affecting group health plans, contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)
Keep Your Plan Informed of Address Changes
In order to protect your and your family’s rights, you should keep the Fund informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Fund.
Fund Contact Information
Suffolk County Superior Officers Association Benefit Fund 2518 Montauk Highway Brookhaven, New York 11719-9501, telephone – (631) 654-0900.
5. Continuation Coverage Under the Family Medical Leave Act (FMLA)
If your employer has 50 or more employees, you may be eligible for leave under the Family and Medical Leave Act (FMLA). If you take a FMLA leave, your employer must continue to contribute to the Fund on your behalf and certain health-related benefits through the Fund must continue. However, if you do not return to work after your FMLA leave ends, you may be required to repay the amount your employer paid toward your coverage during your leave unless you do not return because of a serious health condition of yourself or a family member or other circumstances beyond your control.
If you do not return to work after the end of your FMLA leave, you may be eligible for COBRA continuation coverage.
Privacy of Protected Health Information Under the Health Insurance Portability and Accountability Act (“HIPAA”)
A federal law, the Health Insurance Portability and Accountability Act, (“HIPAA”), requires the Suffolk County Superior Officers Association Benefit Fund (“the Fund”) to protect the confidentiality of your private health information. A complete description of your rights under HIPAA can be found in the Fund’s privacy notice, which was distributed to all members of the Fund prior to April 14, 2004 and is distributed to all new members upon enrollment, a copy of which is available from the Fund office.
The Fund will not use or further disclose information that is protected by HIPAA (“protected health information”), except as necessary for treatment, payment, operations of the Fund, or as permitted or required by law. By law, the Fund has required all business associates to also observe the Fund’s privacy rules. In particular, the Fund will not, without authorization, use or disclose protected health information for employment-related actions and decisions.
Page Last Updated: Dec 27, 2020 (06:07:00)