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What are the Trust Fund Benefits?

The Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund offers a Dental and Optical benefit, a Hearing Aid Assistance Program, a Dependent Care Assistance Plan and a Death Benefit.

What is the waiting period for Trust Fund Benefits?

New employees are eligible for benefits immediately upon the first day of employment. This benefit, resulting from a vote by the Board of Trustees, replaces the six-month waiting period previously in effect.

Are my dependents eligible for benefits?

Your eligible dependents may include your lawful spouse. Your eligible dependents may also include your unmarried natural or adopted children, children legally placed for adoption with you, foster children, stepchildren, or a child under your legal guardianship, from birth to 26 years of age, none of whom are eligible under the Commonwealth of Massachusetts/National Association of Government Employees (NAGE) Health and Welfare Plan (Plan) as employees. Your unmarried dependent children must also meet the additional dependent eligibility requirements below.

Trust Fund coverage for an unmarried child who meets the dependent eligibility requirements, below, who is incapable of self-sustaining employment because of mental retardation or physical handicap and whose incapacity began prior to the limiting age shown above, may continue so long as: (a) your coverage remains in force and (b) such incapacity continues. Proof of such incapacity must be submitted to the Commonwealth of Massachusetts/NAGE Fund Office with-in 31 days of the date the dependent’s coverage would otherwise terminate. Proof of continuing disability may be required from time to time.

How do I add my dependents to my plan?

To add eligible dependents to your plan you must complete and return an Enrollment Form. You must provide proof of your dependents’ status, which includes a marriage certificate, birth certificate, full time school registration documents, tax documents, adoption papers or legal foster child documents. If an enrollment form is not submitted, you will be enrolled with individual coverage only.

Download Dependent Enrollment Form

Download Student Verification Form

What Delta Plan am I enrolled in?

All members are enrolled in the Delta Dental PPO Plus Premier Plan.

The Delta Dental PPO Plus Premier Plan combines two of Delta dentals networks – the Delta Dental PPO network of participating providers, and the Delta Dental Premier network of participating providers – giving you access to dentists that participate in both.

What is the difference between the two dental networks?

  • The Delta Dental Premier network is a large network of dentist, with approximately 96% of dentist in Massachusetts. Savings are created through Delta-negotiated dentists’ fees.

Download Delta Premier Benefit schedule

  • The Delta Dental PPO network is a smaller network of dentists who have agreed to fees that are up to 25% - 30% less than what dentists normally charge. Approximately 20% of dentists who participate with Delta Premier in Massachusetts also participate with Delta Dental PPO. Most often, the Delta Dental PPO network will result in greater out-of-pocket savings for you, as compared to the Delta Dental Premier network.

What if I receive dental services from a dentist who does not contract with Delta Dental?

  • You will still be eligible for coverage, but without the benefit of the Delta discount. You will be balanced billed for the difference between the dentist’s charge and the maximum payment allowed by the Fund.

Can I coordinate dental benefits?

If you or your dependent is entitled to benefits under any other plan which will pay part or all of the expenses incurred for any benefits received or services rendered under this Plan the amount of benefits payable under this Plan and any other plan will be coordinated so that the aggregate amount paid will not exceed 100% of the expense incurred. However, in no event will the amount of benefits paid under the Plan exceed the amount, which would have been paid if there were no other plans involved.

The Plan that provides benefits first is known as the primary plan. The primary plan is responsible for providing benefits to the full extent of their coverage. The plan that provides benefits next is the secondary plan. It provides benefits towards any remaining balance of covered services as long as the payment, when added to the primary plan’s payment, it not more than the total amount of the covered benefit expenses.

If you and your spouse each have dental insurance, claims for your eligible dependent children are paid based on the “Birthday Rule”. Which ever parents’ birthday month is the earliest in the year that insurance plan is considered the primary carrier and the dental claims are submitted to that insurance company first. Any remaining balance is then submitted to the secondary insurance company.

How often can I use the Optical Plan?

Members and their dependents are eligible every twenty four (24) months for an optical benefit. Twelve (12) months for dependents less than nineteen years of age. The eligibility period starts from the date of your last optical service.

How do I find out if I am eligible for an Optical Benefit?

All member eligibility is verified by Davis Vision. You can contact Davis Vision at 1-800-999-5431 or at www.davisvision.com You will be asked for an identification number which is your social security number and a pass word which is the first five (5) letters of your last name.

How does the Optical Assistance Open Plan work?

With the Optical Assistance Open Panel Plan you may receive services from any vision care provider you choose. You must pay for your services up front and submit for reimbursement. The Maximum Reimbursements are as follows:

Eye Examination Up to $50.00
Eye glasses Up to $200.00 for one pair of eyeglasses, lenses and frames
Contact Lenses Up to $200.00 for eye exam and contact lenses

Download Davis Vision Open Plan Reimbursement Claim Form

Download Davis Vision Closed Plan Summary Plan Description

DO YOU PARTICIPATE IN A FLEXIBLE SPENDING PLAN?

A Flexible Spending Plan is a program that allows you to have a designated dollar amount of your paycheck put aside and held in an account until you need to use it for out-of-pocket healthcare expenses. The money is deducted before taxes are paid, allowing you to apply 100 percent of the money you earn and put aside toward eligible expenses.

The out-of-pocket cost for vision care is an eligible expense under a Flexible Spending Plan, including eyeglasses, contact lenses and their upkeep, prescription sunglasses, non-prescription reading glasses, laser eye surgery and examination fees. For additional information call The Group Insurance Commission Health Care Spending Account Administrator at 1-866-862-2422 or visit the Group Insurance Commission web site at the link below.

www.mass.gov/gic/hcsa.htm

How much is the reimbursement for the Dependent Care Assistance Program?

The annual maximum reimbursement for the dependent care services is $1000.00 per member. All claims for services each calendar year must be post marked not later than the following January 31 st. No reimbursement will be issued retroactively for any claim received by the Commonwealth of Massachusetts/NAGE Fund Office after that date.

Is Kindergarten covered under the Dependent Care Assistance Program?

Kindergarten is not a covered Dependent Care expense. The following are some examples of expenses that do not qualify for reimbursement under the Dependent Care Assistance Program:

  • Kindergarten
  • Entertainment– after school sports, dance lessons
  • Education or Enrichment – summer school, computer classes, tutoring or music classes
  • Food clothing, transportation, overnight camp and field trips

What is the Hearing Aid Assistance Program?

The Hearing Aid Assistance Program provides a maximum reimbursement of $1000.00 every three (3) years for the cost of a hearing aid device. Reimbursement is provided for a hearing aid device only. There is no coverage for a hearing test.

How do you file claims for reimbursement?

The Trust Fund is your secondary insurance for a hearing aid device. You must submit your claim to your health insurance carrier through the Commonwealth of Massachusetts Group Insurance Commission for coverage first. Then submit your paid receipt for your hearing aid device to the Fund Office with the completed claim form for the Hearing Aid Assistance Program.

The Commonwealth of Massachusetts/NAGE Fund Office will not process any claims until all payments have been received from your health insurance carrier. You must submit an itemized statement of services as well as the Explanation of Benefits (EOB) from your health insurance carrier. The following information must be provided: name of patient, name of insured member, name and address of the provider, date of service, a list of the itemized services provided and each associated charge, with written confirmation of payment for the services.

Download Hearing Aid Claim Form

How does the Death Benefit work?

There is a $1,000 death benefit available for each eligible employee, spouse and dependent child. This benefit will be paid directly to the estate of the deceased, provided a copy of a death certificate is submitted.


WHO IS ELIGIBLE?
A Death Benefit will only be paid for members or eligible dependents that are eligible for Trust Fund benefits at the time of death.

FILING A CLAIM
A completed Death Benefit Claim Form must be submitted to the Commonwealth of Massachusetts/NAGE Fund Office with a copy of the death certificate. If a copy of the Death Certificate is not included, the claim will not be processed.

Download Death Benefit Claim Form

Can I add a same sex spouse to my plan for benefits?

You can add your legally married same-gender spouse to the plan for Trust Fund coverage. Please contact the Fund Office at 1-800-641-0700 or fundoffice@nage.org for additional information.

How much time do I have to submit any of my claims for Trust Fund benefits?

The Plan will not accept claims submitted later than one year after the service occurred. Contact the Commonwealth of Massachusetts/NAGE Fund Office for additional information at 1-800-641-0700. See separate rules regarding the submission of claims for the Dependent Care Assistance Program.

How long do my benefits continue when I leave state service?

If you are on an unpaid leave of absence, you will be covered for one (1) month after the end of the month during which your leave of absence begins. After the one (1) month period, you will have the option to elect COBRA Continuation Coverage. Upon your return to active employment, your benefits will be reinstated immediately.

If I am out of work but continue to pay my union dues am I eligible for benefits?

No. If you are on an unpaid leave of absence, paying your union dues does not entitle you to Trust Fund benefits. If you are on an unpaid leave of absence, you will be covered for one (1) month after the end of the month during which your leave of absence begins. After the one (1) month period, you will have the option to elect COBRA Continuation Coverage. Upon your return to active employment, you benefits will be reinstated immediately.

How much does COBRA cost?

The current COBRA premiums are:

Individual - $19.00 per month

Family - $47.00 per month