Adding a Dependent or Requesting Age Extension

If you are adding a dependent to you coverage or think that your dependent might qualify for age extension benefits, telephone the Fund at 631-319-4099 and request a Statement of Dependency form.  Remember that you must file a new enrollment card whenever you are making a change to your list of covered dependents.

Changes to filed Dependents

Divorce In the event of a divorce, you are required to provide a divorce decree* to the Fund immediately upon the issuance of the decree. (The decree becomes legal once it has been entered by the County Clerk.  The page showing the entered date must be included with your submission.)  Any expenses that the Fund has incurred for a dependent no longer covered (coverage is terminated upon the date of the event) due to the member’s failure to provide the required documentation  is the responsibility of the member.  Failure to compensate the Fund for those expenses will result in a suspension of all Fund benefits until such time as payment has been received.  All time limitations and exclusion apply.   The Fund can not add a new spouse to your coverage until such time as the previous spouse has been legally removed from your coverage. The Fund can not remove a spouse from coverage without having received a divorce decree or a signed and notarized waiver releasing the Fund from it’s obligation to provide benefits. It is the member’s responsibility to reimburse the Fund for any expenses it has incurred due to ineligibility.  Failure to reimburse the Fund will result in a suspension of benefits until such time as reimbursement is made.

Appealing a Decision of the Fund

Every now and then you get the unpleasant news that an expense you had was denied. You’ve called the Fund office and still have not been able to work it out.  Is there any avenue left for you to take? Sometimes, the answer is yes. First you need to answer a few questions:

1.  Is the benefit normally covered?
2. Am I sure there are no exclusions that apply?
3. Did I meet all of the requirements to be eligible and if not, were my circumstances unique?
4. Did I receive the denial less than 180 days ago?

If the answers to all of these questions are yes, then you may want to consider sending in a letter of appeal. Now, you need to do your homework.   Make sure that what you are putting in writing is factual.   Attach supporting documentation attesting to those facts.   If it’s a dental appeal, have your dentist help you by supplying you with a written narrative explaining why your situation is unique . If all is in order your appeal will be reviewed by the Funds’ Trustees at their next quarterly meeting.   Your request needs to be timely, so make sure that you’ve included everything that you think might be helpful. The Trustees can only entertain the facts surrounding your particular situation.  Many times the Fund receives a letter that simply states “I’m appealing the denial of ……”.  Well, logically thinking  – what could you do with this?  Be precise and lay out your case so that the Trustees can clearly see your point.  The Trustees can’t help you if your only basis for the appeal is what you think should have happened. Don’t confuse your request for new benefits with an appeal for denied benefits. The Trustees periodically review your plan of benefits, and when circumstances are right to add something new, it’s done in a manner consistent with fairness for all. A forward-looking effective date is the first thing established so that all members of the Fund will have equal access. (To submit at appeal please send it to the address listed here)