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Who is Eligible for Benefits?
Termination of Coverage
Coverage While on Industrial Accident
One-Year Limitation for Submitting Claims
How Do We Use Health Information?
Information We Share
Board of Trustees' Statement
Plan Amendment, Modification or Termination
Reminder - Do you participate in a flexible spending plan?
The Board of Trustees of the Commonwealth of Massachusetts/National Association of Government Employees (NAGE) Health and Welfare Trust Fund (Fund) is pleased to provide you and your eligible dependents with these benefits.
- The Dental Assistance Program
- The Optical Assistance Program, Davis Vision.
- The Dependent Care Assistance Program, which provides reimbursement for eligible work-related dependent care expenses for your eligible dependents
- Assistance Program
- The Hearing Aid Assistance Program, which provides reimbursement toward the cost of hearing aid devices.
- A Death Benefit for each eligible employee, spouse and dependent child, payable to the estate of the deceased.
If you have any questions about your benefits or your eligibility, please call the Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund Office at (617) 773-8947 or 1-800-641-0700.
COMMONWEALTH OF MASSACHUSETTS/NAGE FUND OFFICE
159 Burgin Parkway
Quincy, MA 02169-4213
FAX: (617) 773-8637
BOARD OF TRUSTEES
Department of Transportation
Appellate Tax Board
Executive Office of Health & Human Services
Department of Transportation
Department of Transportation
Office of Employee Relations
Human Resource Division
Massachusetts Water Resource Authority
Susan E. Montgomery-Gadbois
Department of Revenue
University of Massachusetts
Office of the Presidnet
Executive Office of Labor Relations Specialist Tewksbury Hospital/HR
TRUST FUND ATTORNEY
Thomas F. Gibson, Esq.
Law Office of Thomas F. Gibson
The Segal Company
TRUST FUND AUTIDTOR
Michael P. Ross
TRUST FUND ADMINISTRATOR
GENERAL INFORMATION APPLIES TO ALL COMMONWEALTH OF MASSACHUSETTS/NAGE HEALTH AND WELFARE TRUST FUND BENEFITS.
WHO IS ELIGIBLE FOR BENEFITS?
All full-time and regular part-time employees who work at least 18.75 hours of the work week are eligible, in accordance with the terms of the Collective Bargaining Agreements between the National Association of Government Employees (NAGE), or its affiliates, and the Commonwealth of Massachusetts, or another employer who has an employment relationship with NAGE.
You are eligible for benefits on your date of hire with your employer.
New employees are eligible for benefits after completion of six (6) consecutive months of employment. Presently, the Board of Trustees has voted to waive the six-month waiting period. The Board will revisit the employee eligibility period on an annual basis. Removal of the waiver will not affect existing members.
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.
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 19 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 children who are age 19 or older may also be eligible until they are 23 years of age if dependent upon you for support and maintenance while enrolled in school or college on a full time basis. Student verification must be submitted to the Commonwealth of Massachusetts/NAGE Fund Office each semester. 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.
Download Student Verification Form
Download Dependent Enrollment Form
Additional Dependent Eligibility Requirements
- In order for the Fund to consider a child an eligible dependent, the child must have the same principal place of abode as you for over half of the year, and must be dependent on you for over half of his or her support. Proof that the child is dependent upon you for over half of his or her support must be furnished to the Fund upon request.
The requirement that you provide over half of the child’s support and that the child has the same principal abode as you for over half of the year, will not apply if: (a) you and the child’s other parent are divorced or legally separated under a decree of divorce or separate maintenance, separated under a written separation agreement, or live apart at all times during the last six (6) months of the calendar year; (b) you and the child’s other parent provide over half of the child’s support; and (c) the child is in the custody of one or both parents for more than half of the calendar year.
- In order for the Fund to consider a child under your legal guardianship to be an eligible dependent, in addition to the requirements set forth in section 1 above, if the child is not related to you (in the manner described in Internal Revenue Code section 152(d)(2)(A) through (G)), the child must, for the entire year, share your principal place of abode and be a member of your household.
Your dependents’ coverage will become effective as soon as their eligibility information is provided to the Commonwealth of Massachusetts/NAGE Fund Office. You must submit a completed Enrollment Card to the Fund Office before your dependents can obtain benefits. 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.
TERMINATION OF COVERAGE
Your coverage and your dependent’s coverage under this Plan will terminate 30 days after the end of the month when you leave the employ of your employer.
The Federal COBRA law allows you and your family to receive dental, optical and hearing benefits from the Fund under certain circumstances. Once your coverage has terminated due to: (1) Employee’s termination of employment or a reduction in hours including leave of absence; (2) Employee’s death; (3) Employee’s dependent child reaches age 19 and is not a full-time student, or, if a full time student, has submitted student verification until the age of 23; (4) Employee’s dependent child has married; (5) Employee’s divorce or legal separation; (6) Employee’s entitlement to Medicare; you or your spouse or dependent have the right to continue coverage on a self-pay basis.
For the following qualifying events ( divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator no later than 60 days after the later of: the date of the qualifying event or the date coverage would be lost under the Plan as a result of the qualifying event.
If during the initial 18 month period of COBRA continuation coverage you or anyone in your family, who was covered under the Plan at the time of the employee’s qualifying event of the termination of employment or reduction in hours of employment, is determined by the Social Security Administration (SSA) to be disabled, the disabled individual may be entitled to receive up to an additional 11 months of COBRA continuation coverage for a total maximum of 29 months. You must notify the Plan Administrator of a disability determination by the Social Security Administration (SSA) within 60 days after the later of: the date of the Social Security Administration determination; the date of the qualifying event; or the date on which the qualified beneficiary would lose Plan coverage due to the qualifying event; and before the end of the 18-month period of continuation coverage, if you want to extend your COBRA coverage to a total maximum of 29 months. If the qualified beneficiary is determined to be no longer disabled, you must notify the Plan of the fact within 30 days after SSA’s determination.
You must also notify the Plan Administrator within 60 days after a second qualifying event occurs if you want to extend your COBRA continuation coverage.
In order to provide these notices, you must complete and submit a notification form to the Plan Administrator. Please contact the Plan Administrator to obtain the notification form and the address where you must submit it. Additional documentation of the qualifying event may also be required (i.e. copy of the divorce decree, court order granting legal separation, birth certificate or other documentation.) The Plan Administrator may reject an incomplete notice from you if the notice does not contain sufficient information to allow the Plan Administrator to identify and determine any of the following: (1) the name of the Plan; (2) the covered employee and qualified beneficiaries; (3) the qualifying event or disability determination; or (4) the date of the qualifying event or disability determination. If you do not notify the Plan of your qualifying event in a timely manner as in accordance with the Plan’s procedures, COBRA coverage will be denied. Please contact the Commonwealth of Massachusetts/NAGE Fund Office at 617-773-8947, 1-800-641-0700 or by writing to 159 Burgin Parkway, Quincy, MA 02169-4213.
COVERAGE WHILE ON INDUSTRIAL ACCIDENT
If you are on Industrial Accident Leave with the Commonwealth, and your COBRA continuation coverage under the Fund terminates, you may elect to continue Fund coverage on a self-pay basis for the term of your Industrial Accident Leave. Please contact the Fund Office for details.
ONE-YEAR LIMITATION FOR SUBMITTING CLAIMS
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, included with this information packet.
The Commonwealth of Massachusetts/NAGE Health and Welfare Trust Fund (Fund) takes your privacy seriously. We want to tell you about our privacy practices to protect your personal health information. Use and disclosure of your personal health information is regulated by federal law, the Health Insurance Portability and Accountability Act (“HIPAA”). You may find further information regarding privacy rules under HIPAA at 45 Code of Federal Regulations Parts 160 and 164. HIPAA’s regulations supercede any discrepancies with the information provided in this notice.
How Do We Use Health Information?
The Fund uses your health information to pay Delta Dental Plan of Massachusetts and Davis Vision who provide you with dental and optical care or service, and to conduct normal business known as dental and optical care operations. Examples of how we use your information include:
- Payment – The Fund reimburses Delta Dental Plan of Massachusetts who pay claims submitted by dentists and Davis Vision who treat you. We may also discuss your treatment plan with your dentist or optical provider to provide prior authorization for certain services.
- Dental Care/Optical Care Operations – Health information is used for quality improvement, and for customer service.
We comply with all applicable state and federal laws, including any laws that impact our ability to use your health information for payment and operations.
We may also use information to:
- Recommend treatment alternatives
- Tell you about benefits and services
- Communicate with family or friends involved in your care
- Communicate with other healthcare providers or Business Associates for treatment, payment or health care operations. Business Associates must follow our privacy rules.
Information We Share
There are limited times when we are permitted or required to disclose health information without your signed permission. These situations are listed below:
- To protect victims of abuse or neglect for federal and state health oversight activities such as fraud investigations
- For judicial or administrative proceedings
- If required by law or for law enforcement
- To coroners, medical examiners and funeral directors
- For specialized government functions such as national security and intelligence
- To Worker’s Compensation if you are injured at work
- To a correctional institution if you are an inmate
All other uses and disclosures, not previously described, may only be made with your signed authorization. You may revoke your authorization at any time.
The Fund is required by law to :
- Maintain the privacy of your health information
- Provide this notice of our duties and privacy practices
- Abide by the terms of the notice currently in effect
- We reserve the right to change privacy practices, and make the new practices effective for all the information we maintain. Revised notices will be available to you.
You have the right to:
- Request that we restrict how we use or disclose your health information. We may not be able to comply with all requests
- Request that we use a specific telephone number or address to communicate with you
- Inspect and copy your health information (fees will apply)*
- Request additions or corrections to your health information*
- Receive an accounting of how your health information was disclosed (excludes disclosures for treatment, payment, healthcare operations and some required disclosures, as well as disclosures that you authorize)*
- Obtain a paper copy of this notice even if you received it electronically
Request followed by an asterisk (*) must be in writing.
We do not give your financial information to any person or persons not affiliated with the Fund. It is important to the Fund that you understand what financial information is gathered and how it is used to administer your benefits.
- Financial Information – In order to provide your dental and optical services, we may gather financial information about you from you, your employer or your dentist or optical provider; with respect to claims, co-payments, and premium payments.
- Security – In compliance with state and federal safeguard standards, electronic, procedural and physical safeguards are in place to limit the collection and use of non-public information to the minimum necessary to provide you with quality products and services. Access to this information is limited to a “need to know” basis for the Commonwealth of Massachusetts/NAGE Fund Office employees to perform their jobs. This applies to you whether you are a former or current member.
If you would like to exercise your rights, or feel your privacy rights have been violated please contact Johanna McNally, Privacy Officer at the Commonwealth of Massachusetts/NAGE Fund Office at 1-800-641-0700 or (617) 773-8947 or by mail at: The Commonwealth of Massachusetts/NAGE Fund Office, 159 Burgin Parkway, Quincy, MA 02169-4213.
All complaints will be investigated and you will not suffer retaliation for filing a complaint. You may also file a complaint regarding health information with the Secretary of Health and Human Services in Washington, D.C.
BOARD OF TRUSTEES’ STATEMENT
Plan members may select the benefit options that best serves their needs, and may select the provider who alone is responsible for the delivery of quality care. The Trustees have selected Delta Dental Plan of Massachusetts and Davis Vision to provide contracted panels of dental and vision providers, respectively, throughout the area. Delta Dental Plan of Massachusetts and Davis Vision represent that they have selected these providers based on their demonstrated commitment to providing and maintaining the highest quality of care. Delta Dental Plan of Massachusetts and Davis Vision and the providers in their networks are independent and separate entities, not affiliated with or under the control of the Board of Trustees of the Fund. The Trustees cannot take responsibility for the quality of care or treatment decisions received through Delta Dental Plan of Massachusetts and Davis Vision or their providers, nor will the Trustees interfere in the professional relationship between a member and his or her provider.
Plan Amendment, Modification or Termination
The Board of Trustees, by a majority vote, may amend, modify, or terminate all or part of each plan, whenever, in their judgment, conditions so warrant, upon reasonable notice. No benefits or rules described in this booklet are guaranteed (vested) for any employee or eligible dependent.
If your claim is denied or partially denied, you will receive written notification along with the specific reason for the denial. Provided that you have exhausted all appeals available under the dental and vision plans, you may appeal any denial directly to the Board of Trustees of the Commonwealth of Massachusetts/NAGE Trust Fund, c/o the Commonwealth of Massachusetts/NAGE Fund Office, 159 Burgin Parkway, Quincy, MA 02169-4213 provided you do so within sixty (60) days of the date of the denial notice.
The Fund’s Board of Trustees, or the Fund Administrator acting on its behalf, has the final discretionary authority to determine any questions arising in connection with the administration, interpretation and application of any or all these plans, including any question regarding eligibility for benefits and the right to participate in a plan. Either the Board’s or the Administrator’s determination concerning the administration, application and interpretation of the plans shall be conclusive and binding on all persons subject to the provisions of these plans.
It is illegal for a Fund member to willfully and knowingly misrepresent any fact for the purpose of securing benefits under any of the Fund’s plans. Any member found by the Board of Trustees to have committed such a misrepresentation may immediately become ineligible for benefits, and will be required to reimburse the Fund for any benefits so obtained. The Trust Fund will cooperate with law enforcement agencies investigating and prosecuting criminal complaints, including fraud or larceny.
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 dental benefits not covered by your dental plan and eyeglasses and contact lenses not covered by your vision plan are eligible expenses under a Flexible Spending Plan. 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.
THE INFORMATION ON THIS WEB SITE IS TO BE USED FOR REFERENCE ONLY