New Workers
In order to be eligible to enroll in the WELS VEBA Group Health Care Plan (WELS VEBA), a worker must meet all of the following criteria:
- Be an active worker in an eligible sponsoring organization
- Be hired or called, and compensated, to work at least 20 hours per week and for five or more consecutive months of the year
In order to enroll in WELS VEBA, new workers must complete the enrollment forms and have them postmarked by the 60th day of their start date. If these forms are not completed and postmarked within this time period, new workers will only be eligible to enroll during the Open Enrollment period or if special enrollment rules are met during the Plan Year. Please see the Special Enrollment Rules section below for further information.
If the eligibility and enrollment rules listed above are met, coverage will become effective on the latest of the following dates:
- Employment effective date
- Date after postmark
- Date of fax
- Date requested for coverage
Open Enrollment / Plan Election Periods
Open Enrollment periods, which provide members the opportunity to change deductible options and add eligible family members, are held solely on a discretionary basis as determined by the WELS VEBA Commission. There is no guarantee that an Open Enrollment period will be held each year.
Plan Election periods, which provide members the ability to change their deductible options (but not to add family members), are generally held in October-November each year with changes becoming effective January 1 of the following year.
Please note: There is no Open Enrollment period for the Supplemental Medicare Benefits provided under WELS VEBA.
Special Enrollment Rules
The following special enrollment rules exist within the Plan:
- Gaining a dependent through marriage, birth, adoption or placement for adoption
- Taking a new call or position to a new Sponsoring Organization
- Loss of other coverage (including Medicaid and Children's Health Insurance Program {CHIP})
If one of the above events occurs during the Plan Year, the worker must complete and postmark all of the necessary forms within 60 days of the event.
Please note: Other special eligibility rules may apply. Please either refer to your Plan Booklet or contact the Benefit Plans Office for further information.
Student Status
The child of an active WELS VEBA member (including natural child, adopted child, or stepchild), provided the member provides more than one-half the financial support of the child and the child was never married, will be considered to be a dependent if he/she meets the following conditions:
- The child is under age 19 and is the member's dependent for federal income tax purposes or due to a court order or divorce decree
-or-
- The child:
- Has attained age 19 but has not attained age 26
-and-
- Is physically attending and is earning credits as a full-time student in an educational institution. (The institution determines full-time status. Please contact the Benefit Plans Office for special rules for individuals on a medically necessary leave of absence.)
Please note that a member's child who has lost dependent status because he or she is no longer attending school may again become a dependent under WELS VEBA when the child returns to school as long as the student is under the age of 26. The effective date of coverage shall be the first day the student physically attends school as a full-time student.
Total Disability
Children who are totally disabled may be covered by WELS VEBA. In order to be considered totally disabled, a child must meet the following eligibility rules:
- The WELS VEBA member provides more than one-half of the financial support for the child because the child is incapable of self-sustaining employment by reason of mental retardation or physical handicap; and:
- The condition began before the child would otherwise lose dependent status under WELS VEBA; and
- The child has been continuously covered by WELS VEBA
Marriage
A dependent who marries loses dependent status as a child of a member. The former dependent retains WELS VEBA coverage through the end of the month in which the marriage occurs.
Dependents who lose dependent status for reasons other than marriage retain WELS VEBA coverage through the end of the calendar quarter.
Please note: Once a dependent child becomes married, the child will no longer be eligible to be a dependent under the member's coverage.
Surviving Spouse Benefit
The definition of a surviving spouse is as follows:
- The spouse of a worker who maintained family or employee + spouse coverage under WELS VEBA at the time of the worker's death.
WELS VEBA allows a surviving spouse to continue coverage on a self-pay basis.
The surviving spouse must complete the necessary enrollment forms to continue health coverage within 60 days of the end of the quarter in which the worker's death occurred.
The Plan will cover children who are dependents and were covered by WELS VEBA at the time of the worker's death. A child may remain covered by the Plan until the child is no longer a dependent. WELS VEBA will not cover new family members acquired by the surviving spouse.
When the surviving spouse is entitled to Medicare, the surviving spouse may continue Supplemental Medicare Benefits under WELS VEBA.
For further information regarding the surviving spouse benefit, please consult your Plan Booklet or contact the Benefit Plans Office.
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