MTABF

P.O. Box # 656
Baldwin Place, NY 10505
Phone: 845.543.7415
GUIDE TO ELIGIBILITY & ENROLLMENT

WHO ARE COVERED MEMBERS?
Members covered by the Benefit Fund are:

  • All employees of the Board of Education of Mahopac covered by the collective bargaining agreement between the Board of Education of Mahopac and for whom contributions are payable to the MTA Benefit Fund; and

  • Any other employees of the Board of Education of Mahopac who may be deemed eligible by the Board of Trustees, and for whom contributions are payable to the MTA Benefit Fund

WHO IS ELIGIBLE?

  • In general, subject to the requirements pertaining to the definition of covered member, employees in covered categories are eligible for benefits as long as they remain employees of Mahopac Public Schools and contributions are made on their behalf by the Board of Education to the MTA Benefit Fund.

  • Teachers who work .50, full time UPSEU & those titled full time managerial confidential

  • Legal spouses & dependents of any of the above mentioned groups.

  • Retired members of the above mentioned groups who elect to pay into the Fund.

ENROLLMENT:

  • Each covered member must complete and file an Enrollment Form with the Fund in order to receive any benefits from the Fund. If your marital status changes or if you acquire additional dependents, notify the Trustees and submit a new Enrollment Form

  • In Addition:

    1. When any change occurs in your status - marriage, divorce, separation, birth or adoption of a child or death of a dependent, please notify the Trustees. It is important and to your advantage that you keep the Fund Office up-to-date on your current status so that claims can be processed efficiently, consistent with our policy of prompt payment.

    2. The Fund should be notified promptly of any change of name and/or address.

    3. Use the Change in Status Form to notify the MTABF

INFORMATION REQUIRED FOR CLAIM FORMS CORRESPONDENCE:

  • All claims received by the MTA Benefit Fund (and all correspondence addressed to the Fund) must contain the following essential information:

Name of Member
School or Building Assignment
Position
Bargaining Unit
Social security number

  • An incomplete form will be returned to the member for further information and may cause a delay in the benefit payment.

  • All yearly maximums that apply to benefits are tied to the position in the district. Any staff person entering after the start of the school year will be granted the remainder of benefits set forth for that position. For a new position created after the opening of the school year, benefits will be prorated.

STATUTORY CONTINUATION OF COVERAGE (COBRA):

  • The Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA, as amended by the Omnibus Budget Reconciliation Act of 1989 (COBRA '89) allows you to extend health care coverage for yourself and your family under certain circumstances, which would normally cause coverage to end. COBRA continuation consists of those benefits mandated by COBRA to be continued to you and your dependents through the Mahopac Teachers Association Benefit Fund. You or your dependents will be required to make the necessary payments for the following benefits:
    • Excess Major Medical Insurance
    • Major Medical Deductible Reimbursement
    • Dental Benefits Plan
    • Hearing Aid Benefit Plan
    • Optical Benefit Plan.

  • You do not have to show evidence of good health in order to continue coverage. However, you must make all of the payments from the date of the event that qualifies you to continue coverage. Future payments are payable in advance by the first of each month.

  • You have the right to extend coverage for yourself, your spouse and your eligible dependents for up to 18 months if coverage ends because:
    • Your employment ends for any reason other than gross misconduct,
    • You are no longer eligible for coverage, or
    • You are on leave of absence without pay.

  • If you notify the Fund within 60 days from the date that Social Security determines that you or one of your dependents are disabled, you can continue COBRA coverage for that person beyond the 18th month at an increased cost. The disabled person's coverage may be continued for up to a total of 29 months from the date of the event that would have originally caused coverage to end. The covered person is required to make the necessary payment for the 19th through 29th month.

  • Your spouse has the right to this continuation coverage for up to 36 months if his or her coverage under the Fund would otherwise end because:
    • You are legally divorced or separated,
    • You become entitled to Medicare, or
    • You die.

  • Your eligible dependent children have the right to this continuation coverage for up to 36 months if their coverage under the Fund would otherwise end because:
    • They are no longer considered dependents,
    • You and your spouse become legally divorced or legally separated,
    • You become entitled to Medicare, or
    • You die.

  • A child who is born to, or placed for adoption with you during a period of COBRA coverage will be eligible to become a qualified beneficiary. These qualified beneficiaries can be added to COBRA coverage upon proper notification to the Fund Administrator of the birth or adoption.

NOTIFICATION:

  • It is your responsibility to inform the Fund in writing of a divorce, legal separation, or a child losing dependent status within 60 days of the date of the event that would cause loss of coverage. Use the Change in Status Form to make this notification.

  • Once the Fund is notified of an event that affects your coverage or your dependents coverage, you will be notified that you have the right to choose continuation coverage. To continue coverage, you must let the Fund know no later than 60 days after the date you or your dependent would lose coverage or from the date you receive notice from us of your right to elect continuation coverage. If you do not choose it, your health related benefits through the Fund will end. If you reject this continuation coverage, your spouse and dependent children will be given the opportunity to continue coverage independently from you.

  • The time periods during which coverage is extended may be shortened if:
    • Mahopac Teachers Association Benefit Fund no longer provides health related benefits for any participants or dependents,
    • The person electing coverage does not make the required payment within 30 days of the date it is due,
    • The person electing coverage becomes covered by another group health plan. (You may continue COBRA coverage if the other plan does not cover pre-existing conditions.)
    • The person electing coverage is widowed or divorced, subsequently remarries and is covered under the new spouse's group health plan, or
    • The person electing coverage becomes entitled to Medicare.

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