WELFAREFU~D

May 28, 2013

Dear Retiree:

The UFT Welfare Fund's Medicare Part D Catastrophic Reimbursement benefit is described onpage 49 of the recently published 2013 Edition of The R,?d Apple for retirees and their families.This notice serves to supplement and clarify how the Fund processes claims for this benefit inlight ofrecent changes in the administration of the underlying Medicare Part D prescription drugprogram.

The Fund's Medicare Part D Catastrophic Reimbursement benefit was created to reimburseeligible retirees and their spouses/domestic partners, for the 5% catastrophic coinsurance costsnot covered by their underlying Medicare Part D prescription drug insurance coverage.

To qualify for the Fund's benefit, an eligible claimant must reach the "catastrophic stage" of theirMedicare Part D coverage, by incurring real and true out-of-pocket expenses, equal to the armualout-of-pocket spending threshold set each year by Medicare. The Fund's program does notconsider any subsidies, payments or other forms of "extra help" (including, but not limited to,Medicare's coverage gap discount program) received by a Medicare Part D enrollee, indetermining if he/she has reached the Medicare out-of-pocket threshold. In processing claims,the Fund will only consider the amount in the "You Paid" column of your Medicare Part plan'sExplanation of Benefits, in determining whether you have incurred the required amount of out­of-pocket costs to be eligible for catastrophic reimbursement benefits. If the "YouPaid" columndoes not equal the requisite Medicare out-of-pocket threshold, you will not qualify for Fundbenefits.

As always, the staffof the United Federation of Teachers Welfare Fund is available at(212) 539-0500, should you have any questions.

/571~ .~e~

Executive Director

Local 2 American Fe 'hers, NYSUT, AFL-(JO

TRUSTEES: Michael Mulgrew, Chair· Karen Alford· Michael Mendel. Thomas Murphy· Mona Romain

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Health and Welfare Benefitsfor Retirees

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United Federation of TeachersLocal 2 AFT, NYSUT, AFL-CIO

52 BroadwayNew York, NY 10004212-539-0500

TRUSTEESMichael Mulgrew, Chair

Karen AlfordMichael MendelThomas MurphyMona Romain

EXECUTIVE DIRECTORArthur B. Pepper

ASSISTANT DIRECTORSLorna E. BaptisteGeofrey Sorkin

COUNSELMirkin & Gordon, P.C.

The Atrium98 Cutter Mill Road

Great Neck, New York 11021

CERTIFIED PUBLIC ACCOUNTANTSBuchbinder Tunick & Co., LLPOne Penn Plaza, 53rd floorNew York, New York 10119

CONSULTANTS AND ACTUARIESThe Segal Company

333 West 34th StreetNew York, New York 10001-2402

Message fromMichael Mulgrew,President and Chair of the Trustees

Dear UFT Retiree,

Since 1965 our WelfareFund has provided accessto a variety of benefits tothousands of our membersand their dependents. I ampleased to send you this2013 edition of the Retiree Red Apple which describes thebenefits available to you and your family.

In spite of the economic climate throughout our country, weare especially proud to be able to not only preserve our ben-efits but improve them as well. Whether providing our newextended disability, child care, and optical benefits or increas-ing the Optional Rider reimbursement for our retirees, ourWelfare Fund continues to respond to the needs of all of ourmembers and their families.

Our Welfare Fund staff is always available to assist you withall of your health care needs. Additionally, we are constant-ly updating our website access which offers you valuablehealth-related information and can expedite your requests aswell. Please take a few moments to visit us at www.uftwf.organd familiarize yourself with this tool.

Finally, I reaffirm our commitment to you and your family to continue to protect and improve on the quality health bene-fits you deserve.

Fraternally,

Michael Mulgrew

TABLE OF CONTENTS

1 GENERAL INFORMATION17 DENTAL PLAN33 OPTICAL PLAN41 HEARING AID BENEFIT PLAN47 MEDICARE PART D

CATASTROPHIC REIMBURSEMENT51 OPTIONAL RIDER55 CONTINUATION OF COVERAGE63 LEGAL PLAN67 RETIREE PROGRAMS71 HEALTH & CANCER HELPLINE75 RESOURCES

RETIREDMEMBERS

General Information

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GENERAL INFORMATION

• Eligibility Rules

• Enrolling and Updating Information

• Coverage Rules

• Coordination of Benefits (COB) Information

• Special Coordination of Benefits (SCOB) Information

• Forms and Claim Submission Information

• General Questions and Answers

• Miscellaneous Information

IMPORTANT INFORMATION

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS:www.uftwf.org

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GENERAL INFORMATION

Who is covered?You are eligible to be covered by the UFT Welfare FundBenefits Plan for Retirees if all of the following criteria aremet:

1. You retired after June 30, 1970; and

2. You are receiving a pension check from a retirementsystem maintained by the City; and

3. You were covered by the UFT Welfare Fund immedi-ately prior to retirement of City employment; and

4. You are not currently employed by the City (or Cityrelated agency) or by the NYC Department of Educationin a position that entitles you to Welfare Fund benefits.

Please Note: For those members that retired prior to July 1,1970, please contact the Retired Teachers Chapter of theUnited Federation of Teachers (RTC-UFT) for further infor-mation.

Dependents – Dependents of eligible retirees as definedbelow, are eligible for certain benefits. Please refer to thespecific section for each benefit for eligibility.

1. Legally married spouse. This includes same-sexspouses provided the marriage occurs in a jurisdictionthat recognizes the legality of a same-sex marriage andhas issued a marriage license.

2. A ‘domestic partner’, defined as any individual,eighteen years of age or older, who is not married or relat-ed by blood to the member in a manner that would barmarriage in the State of New York, who has a close andcommitted personal relationship with the member, wholives with the member and has been living with same ona continuous basis, and who, together with the member,has registered with the City as a domestic partner of themember and has not terminated the domestic partnership.Members can obtain details concerning eligibility, enroll-ment and tax consequences from the New York CityOffice of Labor Relations Domestic Partnership LiaisonUnit at 212-306-7605.

3. Children under age 26. The term “children” forpurposes of this and the following definitions, includes:

a. natural children;

b. children for whom a court has accepted aconsent to adopt and for the support of whom a memberhas entered into an agreement;

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c. children for whom a court of law has madea member legally responsible for support and mainte-nance;

d. children who live with a member in a regu-lar parent/child relationship and are supported by themember.

The coverage termination date for children reaching age26 will be the end of the month during which the childreaches age 26.

An adult child under age 26 is not eligible for Fund cov-erage if he/she is eligible for health benefits coveragethrough his/her own employer or his/her spouse’semployer.

Enrollment Rules (Special Annual EnrollmentPeriod for Adult Children Under Age 26)

If your adult child is currently under age 26 andhas lost health benefits through his/her employeror his/her spouse’s employer for reasons otherthan non-payment of premium (i.e., discontinu-ance of employer provided health benefits) youmay enroll such child in the Fund’s plan.Eligibility becomes effective the 1st of the monthfollowing the enrollment. Additionally, eachyear during a special thirty (30) day open enroll-ment period between September 1st andSeptember 30th children under age 26 may beenrolled in the Fund. The child’s coverage willbe effective October 1st. This special annualopen enrollment period would be applicable foradult children under age 26 who previously“aged out” of Fund coverage or were over theFund’s age limits when they first became eligiblefor coverage but did not enroll at that time.

4. Unmarried children 29 years of age or under.New York State Insurance Law allows unmarried chil-dren to be covered under the member’s insured healthplan if they choose, by paying the premium cost of thecoverage until the unmarried child reaches his/her 30thbirthday. Welfare Fund coverage for children 29 years ofage or under, will also be extended and coordinatedwith the coverage afforded said children under NewYork City health plans.

5. Unmarried children who cannot support themselvesbecause of a mental illness, developmental disability,mental retardation, or physical handicap. If the disabili-ty occurred before the age at which coverage would oth-erwise terminate, and the dependent was covered by the

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City at that time, coverage will be continued, providedthe retiree submits to the Fund the acceptance of the dis-ability from your basic health carrier and a completed“Disabled Dependent Child Affidavit (DDCA)” formbefore the date Fund coverage would have otherwise ter-minated. The form is available at the UFT Welfare Fundwebsite www.uftwf.org or by calling the UFT WelfareFund Office at 212-539-0500.

The following procedure must be followed:

a. Obtain a “Certificate of Disability” fromyour City basic health carrier. Complete the formand mail it directly to your carrier. Your carrierwill send you a letter confirming your depend-ents’ disability status.

b. Request a “Disabled Dependent ChildAffidavit” (DDCA) from the Welfare Fund. Theform is available at the UFT Welfare Fund web-site www.uftwf.org. Complete the Affidavit andreturn it to the Fund along with a copy of theapproval letter from your carrier.

What are my Welfare Fund benefits?The UFT Welfare Fund provides:

Dental

Optical

Hearing Aid

Continuation of Coverage

Health and Cancer Helpline

Medicare Part D Catastrophic Reimbursement

Retiree Programs

Optional Rider Reimbursement and

Legal Plan with Elder Law Supplement.

Refer to the applicable chapter(s) in this Red Apple for thebenefits listed above.

Note: For other benefits provided by the UFT, consultyour UFT-RTC Retiree Handbook.

All eligible members are covered by a City basic healthplan of their choice. For detailed descriptions of thesebenefits refer to the NYC Health Benefits ProgramSummary Program Description booklet (SPD).Additionally, members may contact the different planslisted in that booklet for further information. The link forthis booklet (SPD) is available at the UFT Welfare Fundwebsite www.uftwf.org.

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How do I update information?All members must notify the Fund Office of a change inaddress, marital status or dependent status by filing aChange of Status Form. When enrolling or changingdependents, the member must attach and submit photo-copies of necessary documentation to the Change ofStatus Form (also available on the website or by callingour hotline). The Fund reserves the right to request addi-tional documentation verifying the bona fide relation-ship of any dependent to a member.

Please note that upon divorce or termination ofdomestic partnership a Change of Status Form mustbe completed with applicable documentationattached and submitted to delete a spouse or domes-tic partner.

If you fail to timely notify the Fund office of a divorce ortermination of domestic partnership and your formerspouse/domestic partner incurs claims paid for by theFund, you will be held financially responsible for repay-ment of those claims to the Fund.

May I decline further coverage for anenrolled eligible dependent?Yes. You may decline further coverage for an enrolled eli-gible dependent at any time by completing a Declinationof Welfare Fund Coverage for Eligible Dependents form.You can obtain this form from the Fund Office or from ourwebsite at www.uftwf.org.

If you decline Welfare Fund coverage for any dependent,you will only be permitted to re-enroll that dependent,upon submission of proof to the Fund of that dependent’sloss of other comparable coverage, within 30 days of theloss of such comparable coverage.

COVERAGE RULES

When does coverage begin?Coverage begins on the date that you meet the criteriaspecified in the “Who is Covered?” section.

Dependents become eligible on the same date as themember, or on the date they first become eligibledependents.

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When does coverage terminate?Coverage for a member terminates in the following situa-tions:

• when the member returns to “in-service” status; or

• when the NYC Department of Education ceasesto make contributions to the Fund on their behalf; or

• upon death.

Dependent coverage terminates when a member’s eligi-bility ends for any reason other than death, or on the datewhen the dependent no longer meets the definition of eli-gible dependent, whichever occurs first. In the cases ofthe member’s death, dependent coverage terminatesthree (3) months following the month in which the mem-ber died.

What do my dependents do if they lose coverage?1. COBRA – The Federal Consolidated Omnibus BudgetReconciliation Act of 1985, (COBRA), requires that the Cityand UFT Welfare Fund offer eligible dependents of mem-bers the opportunity to continue health and certain WelfareFund benefits at 102% of the group rate. The maximumperiod of coverage is thirty-six (36) months.

Refer to the COBRA Section of this booklet for furtherdetails.

2. DEPENDENT SURVIVOR COVERAGE – In cases ofthe member’s death, dependent coverage terminatesthree (3) months following the month in which the mem-ber died.

3. UNMARRIED DEPENDENT CHILDREN 29 YEARSOF AGE OR UNDER – New York State Insurance Lawallows unmarried children to be covered by the member’sinsured health plan, if they so choose, by paying the pre-mium cost of the coverage until the unmarried childreaches his/her 30th birthday. Welfare Fund coverage forunmarried children 29 years of age or under, will coor-dinate with the coverage afforded said children underNew York City health plans.

COORDINATION OF BENEFITS RULES

Benefits provided by the UFT Welfare Fund are subject toCoordination of Benefits (COB) provisions. COB is appli-cable when you or your dependents are covered by

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another group benefit plan. A patient’s basic health cov-erage will always be Primary and the UFT Welfare Fundbenefits Secondary.

Benefit claims under COB are payable under a Primary-Secondary formula. The Primary plan determines its ben-efits first, and pays its normal benefit. The Secondary plancomputes its benefit second, and may reduce its benefitpayment so that the insured does not receive more than100% reimbursement of expenses. In no event would theUFT Welfare Fund’s liability exceed the benefits payablein the absence of COB.

The order of payment is determined as follows:

1. If one plan does not have a COB provision, that planwill be Primary;

2. If the patient is our (UFT Welfare Fund) member, theUFT Welfare Fund is the Primary plan. However, if thepatient is the spouse/domestic partner of our member,and is covered under another group plan, the other groupis Primary and the UFT Welfare Fund is Secondary.

3. If the patient is a dependent child under both plans,the plan of the parent whose birthday (month and day)occurs first within the calendar year will be Primary,unless the parents are separated or divorced, then the fol-lowing rules will apply:

a. If a court order establishes that one of the parentsis financially responsible for medical, dental or otherhealth care expenses of a child, the contract underwhich the child is a dependent of that parent shall bePrimary;

b. If financial responsibility has not been estab-lished by a court order and the parent with custodyof the child has not remarried, the contract underwhich the child is the dependent of the parent withcustody will be Primary;

c. If financial responsibility has not been estab-lished by a court order and the parent with custodyhas remarried and the child is also covered as adependent of the step-parent, then the order of pay-ment shall be: 1st the contract under which the childis a dependent of the parent with custody; 2nd thecontract under which the child is a dependent of thestep-parent; 3rd the contract under which the child iscovered as a dependent of the parent without cus-tody.

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4. If none of the above applies, then the plan underwhich the patient has been enrolled the longest will bePrimary. However, the plan covering you as a laid-off orretired member, or as a dependent or such person, shallbe Secondary and the plan covering you as an in-servicemember shall be Primary, as long as the other plan has aCOB provision similar to this one.

NO-FAULT INSURANCE

The Fund will not pay any benefits that are covered byNew York State or other jurisdiction’s no-fault insurancelaw.

SPECIAL COORDINATION OF BENEFITS

Members and their spouse/domestic partner who are alsoUFT Welfare Fund members can receive UFT WelfareFund dental, optical, and hearing aid benefits from eachother’s coverage. This is known as Special Coordinationof Benefits (SCOB). In addition, their eligible dependentsmay receive benefits under each member’s coverage.Details are included within each specific benefit descrip-tion.

HOW TO OBTAIN FORMS, CURRENT PANEL LISTINGS AND INFORMATION

For forms needing validation, such as optical and hearingaid, members should access the Forms Hotline at 212-539-0539. Current panel listings and some forms are alsoavailable at the UFT Welfare Fund website atwww.uftwf.org.

Fund representatives are available to members whorequest assistance with specific health plan related prob-lems. Members should include in any correspondencetheir full name, address, Welfare Fund alternate ID num-ber or social security number, and telephone number.Members should always include photocopies of appropri-ate documentation such as the Health BenefitsApplication or the claim rejection notice from the healthplan and a Protected Health Information AuthorizationForm (PHI) available at the UFT Welfare Fund websitewww.uftwf.org, giving the Health Plan permission to dis-cuss your claims.

NOTE: Health Insurance claim forms are availabledirectly from the carrier and are not supplied throughthe Fund.

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SUBMISSION OF CLAIMS RULES

Dental Claims (Direct Reimbursement)* – These claimsmust be submitted to CIGNA within one (1) year from thedate of service. The penalty for late submissions will benon-payment of the claim.

Hearing Aid Claims – These claims must be submitted tothe UFT Welfare Fund no later than ninety (90) days fromthe date of service. The penalty for late submissions willbe non-payment of the claim.

Optical Claims (Direct Reimbursement)* – These claimsmust be submitted to the UFT Welfare Fund no later thanninety (90) days from the date of service. The penalty forlate submissions will be non-payment of the claim.

Optional Rider Reimbursement Benefit – You must noti-fy the Fund in writing within two (2) years from the datethe benefit should have been paid.

Medicare Part D Catastrophic Reimbursement Form –Due to legal requirements this form must be submitted byFeb. 1 of the year following the calendar year requested.

Generally speaking, no exceptions will be granted for thelate submissions of claims. However, physical inability tofile within the period e.g., because of hospitalization orlike circumstances, will be given consideration. Likewise,there will be no penalties for delays which are beyond themember’s control, such as by a primary carrier or arbitra-tor. In these cases, appropriate documentation will berequired. The late filing of a claim by a dentist, doctor orother provider will not be considered an exception, sinceit is the member’s responsibility to file claims.

Claim forms must be fully completed, giving all request-ed information or the claim cannot be processed. Claimswhich have been rejected and returned to the memberfor additional information must be resubmitted withinninety (90) days of the date of rejection, or by the origi-nal submission deadline, whichever is later. If claims areultimately rejected by the Fund Office, you may appealthe rejection. You must do so by writing the Board ofTrustees UFT Welfare Fund, 52 Broadway, 7th floor NewYork, NY 10004, within sixty (60) days of the rejection.

With respect to any claims incurred prior to a member’sdeath, benefits will be made payable, in the absence of anamed beneficiary(ies), to the first surviving class of thefollowing classes of successive preference beneficiaries:

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The deceased member’s:

a. widow/widower or domestic partner;b. surviving children;c. estate.

*Direct reimbursement means that a member has not utilized the services of a participating provider (panelist).When using the services of a panelist, the panelist willsubmit the claim.

SOME GENERAL QUESTIONS ANDANSWERS

What is the Fund?The Fund was established to provide certain benefits tosupplement City Basic Health Plans. It was created as aresult of collective bargaining between the UnitedFederation of Teachers and the NYC Department ofEducation located at 52 Chambers Street, New York, NewYork 10007. Employer contributions are predicated onthe amount stipulated in the current Collective BargainingAgreements and are provided at the annual rates, prorat-ed monthly, on behalf of each covered member.Members, other than COBRA members, do not makecontributions to the Fund.

Who administers the Fund?The Fund is administered by a Board of Trustees. It con-sists of five persons designated by the United Federationof Teachers. Current members of the Board of Trustees arelisted below and they can be communicated with in writ-ing at the Fund office. The Board of Trustees governs theWelfare Fund in accordance with an Agreement andDeclaration of Trust. The Board of Trustees employs anExecutive Director and staff who are responsible for theday-to-day operation of the Fund, including the determi-nation of eligibility and the processing of claims.

The Trustees and the Executive Director of the Fund aresubject to a body of law designed to protect the benefici-aries of the Fund. Under this body of law, the Fund ismandated to submit our financial records to an annualaudit by Certified Public Accountants. The Fund is furthermandated to submit copies of these audits annually to theInternal Revenue Service. Copies of these reports are pro-vided to the Comptroller of the City of New York.

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Who are the current members of the Boardof Trustees?The current members of the Board of Trustees are:

Michael Mulgrew, ChairKaren AlfordMichael MendelThomas MurphyMona Romain

What are my rights of appeal?Decisions of the Executive Director and the staff are sub-ject only to review by the Trustees upon appeal. The FundOffice uniformly applies all rules. The action of the FundOffice is subject only to review by the Board of Trustees.An appeal must be filed with the Fund Office within sixty(60) days of denial of the claim, by submitting notice inwriting to the Board of Trustees, United Federation ofTeachers Welfare Fund, 52 Broadway, New York, NewYork 10004. The appeal must contain reasons supportingwhy a decision should be overturned. Supporting docu-mentation should also be submitted. The Trustees shallact on the appeal within a reasonable period of time andrender their decision in writing, which shall be final, con-clusive and binding on all persons. If the Trustees havedenied your appeal, and you still believe you are entitledto the benefit, you have a right to file suit in the New YorkState Supreme Court.

Do the contributions to the UFT WelfareFund become part of the general treasury ofthe union?No. The United Federation of Teachers and the UnitedFederation of Teachers Welfare Fund are two (2) distinctand separate legal entities. Their resources are not com-mingled.

What becomes of the contributions that theDepartment of Education makes to theUnited Federation of Teachers WelfareFund?Under the Agreement and Declaration of Trust, contribu-tions to the Welfare Fund are used to provide benefits forcovered members and their families and to finance thecost of administration.

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Does the UFT Welfare Fund operate underERISA?No. The Fund is not subject to the provisions of theEmployees Retirement Income Security Act of 1974(ERISA).

Does the UFT Welfare Fund Operate underthe Supervision of the New York StateInsurance Department?No. The Fund is not within the jurisdiction of the NewYork State Insurance Department as it is a unilaterallyoperated trust fund, administered by union trustees only.

MISCELLANEOUS INFORMATION

AMENDMENT OR TERMINATION OF BENEFITS

This booklet and amendments constitute the plan of ben-efits for members provided by the United Federation ofTeachers Welfare Fund and, as such, includes the specif-ic terms and conditions governing the coverage and thebenefits provided for members by the Fund. In addition,there are various administrative policies and proceduresthat are applied on a uniform basis by the Fund, andclaimants will be informed whenever such policies andprocedures are applied.

The United Federation of Teachers Welfare Fund is main-tained for the exclusive benefit of employees and retireesof the New York City Department of Education who are“covered” under agreements with the UFT, and for whomthe employer contributes monies to the UFT WelfareFund and any other employee who is covered by a col-lective bargaining agreement under which the employermakes a contribution to the UFT Welfare Fund. However,the Fund reserves its rights, under applicable law, to alterand/or terminate the plan of benefits as it currently exists.

The benefits provided by this Fund may, from time totime, be changed, modified, augmented or discontinuedby the Board of Trustees, in its sole discretion. The Boardof Trustees adopts rules and regulations for the paymentof benefits and all provisions of this booklet are subject tosuch rules and regulations and to the Trust indenture thatestablished the Fund and governs its operations.

Your coverage and your dependent’s coverage will stopon the earliest of the following dates:

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When you are no longer eligible; or

When the NYC Department of Education ceasesto make contributions on your behalf to theFund; or

When the Fund is terminated.

Your dependents’ coverage will also terminateon the date when they no longer meet the defi-nition of “eligible dependent.”

Member benefits under this plan have been made avail-able by the Trustees as a privilege and not as a right andare always subject to modification or termination in theexercise of the prudent discretion of the Trustees. TheTrustees may expand, modify or cancel the benefits formembers; change eligibility requirements and otherwiseexercise their prudent discretion at any time without legalright or recourse by a member or any other person.

THIRD-PARTY REIMBURSEMENT/SUBROGATION

If a covered member or dependent is injured through theacts or omissions of a third party, the Fund shall be enti-tled – to the extent it pays out benefits – to reimbursementfrom the covered member or dependent from any recov-ery obtained from the responsible third party. Fund bene-fits will be provided only on the condition that the cov-ered member or dependent agrees in writing:

To reimburse the Fund, to the extent of benefits paid byit, out of any monies recovered from such third party,whether by judgment, settlement or otherwise; and

To take all reasonable steps to effect recovery from theresponsible third party and to do nothing after the injuryto prejudice the Fund’s right to reimbursement.

OVERPAYMENT/FUTURE OFFSET

In the event you receive an overpayment of Welfare Fundbenefits, on your behalf or on behalf of your dependent,you are obligated to refund this overpayment to the Fundimmediately. In the event you fail to refund this overpay-ment, the Fund can offset this overpayment against futurebenefits until this overpayment is fully recouped, or sus-pend your benefits, as well as those of your eligibledependents, until this overpayment is paid in full. Suchoffset and/or suspension can be applied to the member’sand eligible dependents’ benefits. An overpaymentincludes, but is not limited to, any payment made onclaims submitted by individuals who are no longer eligible

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for benefits (i.e., divorced spouse of a member who didnot elect to continue coverage under COBRA) as well as apayment of the wrong amount on a claim.

Privacy of Protected Health Informationunder the Health Insurance Portability andAccountability Act (“HIPAA”)A federal law, the Health Insurance Portability andAccountability Act, (“HIPAA”), requires the Welfare Fundto protect the confidentiality of your private health infor-mation. A complete description of your rights underHIPAA can be found in the Fund’s privacy notice, whichwas distributed to all members of the Fund prior to April14, 2003 and is distributed to all new members uponenrollment, a copy of which is available from the FundAdministrator. A copy of the Fund’s privacy notice is alsoavailable on the Fund’s website at www.uftwf.org.

The Fund will not use or further disclose information thatis protected by HIPAA (“protected health information”),except as necessary for treatment, payment, operations ofthe Fund, or as permitted or required by law. By law, theFund has required all business associates to also observeHIPAA’s privacy rules. In particular, the Fund will not,without authorization, use or disclose protected healthinformation for employment-related actions and deci-sions.

Under HIPAA, you have certain rights with respect to yourprotected health information, including certain rights tosee and copy the information, receive an accounting ofcertain disclosures of the information, and under certaincircumstances, amend the information. You also have theright to file a complaint with the Fund or with the U.S.Department of Health and Human Services if you believeyour rights under HIPAA have been violated.

“GRANDFATHERED” HEALTH PLAN DISCLOSURENOTICE

The United Federation of Teachers Welfare Fund (“Fund”)believes it is a “grandfathered health plan” under thePatient Protection and Affordable Care Act (“PPACA”). Agrandfathered health plan can preserve certain basic cov-erage that was already in effect when that law was enact-ed. A grandfathered plan may not include certain con-sumer protections of PPACA that apply to other plans, forexample, the requirement for the provision of preventivehealth services without any cost sharing. However,

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grandfathered health plans must comply with certainother consumer protections in the law, for example, theelimination of lifetime limits on benefits.

Questions regarding which protections apply and whichprotections do not apply to a grandfathered health planand what might cause a plan to change from grandfa-thered health plan status can be directed to the Fundoffice at 212-539-0500. You may also contact the U.S.Department of Health and Human Services atwww.healthreform.gov.

Dental Plan

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DENTAL PLAN• SCHEDULED BENEFIT PLAN

Members may choose to access either• a panel dentist through SIDS - Self-Insured

Dental Services (NY Area) or the FloridaPPO Panel (Florida Area) with little or noout-of-pocket cost

• or may choose any dentist and submit forreimbursement according to the UFTWelfare Fund Schedule of Covered DentalExpenses.

• DENTCARE (HMO)For members who want no out-of-pocketexpenses for covered dental services,Dentcare, a dental HMO is available. Membersmay select a participating dentist for each fam-ily member. The Primary dentist makes special-ist referrals, if needed.

• FLORIDA DENTAL DISCOUNT PLANAvailable upon retirement if you are a year-round Florida resident.

IMPORTANT INFORMATIONFORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS: www.uftwf.orgDENTAL PANELISTS:NEW YORK AREA:

SIDS: 866-679-SIDS (7437)516-394-9408www.uftdental.com

FLORIDA AREA:FLORIDA PPO PANEL (CIGNA):800-577-0576www.uftwf.org

DENTAL CLAIM INFORMATION:CIGNA: 800-577-0576

www.mycigna.comDENTAL HMO:

DENTCARE: 800-468-0600516-542-2700

FLORIDA DENTAL DISCOUNT PLAN:Healthplex America -MEMBER SERVICES888-200-0322 PLAN S200www.yourdentalplan.com/healthplex

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DENTAL PLAN

Who is covered?All eligible members and eligible dependents, as defined in the General Information section, are covered for den-tal benefits.

What dental benefit programs are available?The UFT Welfare Fund offers benefits through a choice ofthree (3) types of dental programs as follows:

1. A “fee-for-service” plan under which members mayreceive their dental services from a panelist (with little orno out-of-pocket costs). This is known as the UFT WelfareFund Scheduled Benefit Plan.

2. Non-participating dentist whereby a member will bereimbursed directly according to the UFT Welfare Fund'sschedule of covered dental expenses.

3. A Dental HMO plan under which comprehensivedental services are covered with no out-of-pocket expens-es, known as Dentcare.

NOTE: A Florida plan is available upon retirement if youare a year-round Florida resident. This plan is known asthe Florida Dental Discount Plan (Healthplex America).

Dental benefits are provided only to the extentthat the services, supplies, and the course oftreatment are necessary and appropriate, andthat they meet professionally recognized stan-dards of quality. Necessity and appropriatenessare determined after taking into account thetotal current oral condition of the patient.

How do I enroll in one of the dental plans?Upon enrolling in the UFT Welfare Fund, a member andhis/her covered dependent(s) are automatically enrolledin the Scheduled Benefit Plan. If you wish to select theDental HMO (Dentcare), or the Florida Discount DentalPlan, the UFT Welfare Fund's Dental Transfer Form (DTF)must be completed within sixty (60) days of employment.There is also a Dental Open Enrollment Period every yearin the fall during which time you may change plans bycompleting the UFT Welfare Fund's Dental Transfer Form(DTF) which is available on our website www.uftwf.org.

Your dental coverage remains unchanged when youmove from in-service to retiree status.

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NOTE: If you elect to receive dental coverage through thedental HMO, you may not receive reimbursementthrough the Scheduled Benefit Plan.

What are the benefits under the ScheduledBenefit Plan?This plan provides benefits for covered services under areimbursement schedule. The “Schedule of CoveredDental Expenses,” listing all covered services and themaximum reimbursement amounts, is delineated in aseparate document and is available on our websitewww.uftwf.org.

Within the Scheduled Benefit Plan there are two (2)options available:

• Participating Panel Program (NY Area) - provid-ed by Self Insured Dental Services (SIDS). Or inFlorida - Florida PPO Panel.

• Direct Reimbursement (using a non-participatingdentist).

What is the Participating Panel Program?

PANELISTS:

New York Area: SIDS, Inc.P.O. Box 9005Lynbrook, NY 11563-9005866-679-SIDS (7437) or 516-394-9408www.uftdental.com

Florida Area: Florida PPO Panelc/o CIGNA800-577-0576www.uftwf.org

Within the Scheduled Benefit Plan there is a dental paneloption available consisting of over 700 participating den-tists. In addition, the Florida PPO Panel consists of over1,600 participating dentists throughout the state ofFlorida. If you use a participating dentist, the reim-bursable services will be provided at no cost to you,except for a $150 co-payment for crowns, bridges, den-tures, root therapy; a $200 co-payment for certain treat-ment appliances; a $15 co-payment for exams, fillings,routine extractions and for each month of active ortho-

21

dontic treatment; and a $50 co-payment for surgicalextractions, osseous surgery and covered anesthesia.

A list of participating dentists is printed in a separate pam-phlet and is available on our website (www.uftwf.org) orby calling our hotline at 212-539-0539.

What is the Direct ReimbursementProgram?When you utilize a non-participating dentist, you may berequired to pay for the full cost of the service and thensubmit a claim for payment. Reimbursement is madeaccording to the scheduled amount or the actual charge,whichever is less.

What is a Pre-Treatment Estimate and whenis it required?A pre-treatment estimate is an advance notice of dentaltreatment that should be submitted before treatment iscommenced in order to determine what benefits areavailable. A pre-treatment estimate is required for inlaysor onlays, crowns, laminate veneers, bridgework, den-tures, periodontal surgery or when expenses for servicesprovided in a ninety (90) day period will exceed $500.

What is an Alternate Course of Treatment?For Covered Dental Expenses under this plan, when morethan one Dental Service could provide suitable treatmentbased on professional and customary dental standards,the Fund's dental plan administrator CIGNA, will deter-mine the Dental Service on which payment will be based.You are free to apply this benefit payment to the treat-ment of your choice; however, you are responsible for theexpenses incurred which exceed Covered Expenses. Forthis reason, CIGNA strongly recommends the use of pre-treatment estimate as described above, when major den-tal services are needed, so that you know in advancewhat the benefit plan will cover before any treatmentbegins. Under no circumstances will an alternate benefitbe applied to services that are not Covered DentalExpenses.

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How are benefits obtained under theScheduled Benefit Plan?

The UFT Scheduled Benefit Plan is administered byConnecticut General Life Insurance Company

(CIGNA), P.O. Box 182531,Chattanooga, TN 37422-7531

800-577-0576 www.mycigna.com

You can obtain benefit payments for services rendered byparticipating or non-participating dentists only if you filethe required dental claim form with Connecticut GeneralLife Insurance Company (hereinafter referred to as“CIGNA”) as described below. Dental Claim Forms/Pre-Treatment Estimate Forms are available on our website(www.uftwf.org) or by calling our hotline at 212-539-0539.

A. Dental Claim Form

The UFT Welfare Fund Dental Claim Form is used for twodifferent purposes. Indicate by checking the appropriatebox on the form whether it is a Pre-Treatment Estimate ora Payment Claim.

You should take a dental form with you when you firstvisit the dentist, and for each new course of dental treat-ment. Participating dentists will have their own form.

B. Using the Dental Claim Form

1. Submission of Form

When submitting the Dental Claim Form, you must com-plete all relevant items in the Member Information sec-tion. If not applicable, disregard patient and spouse infor-mation. The Authorization to Release Information mustalways be signed whether the form is a Pre-TreatmentEstimate or a Payment Claim (unless there is a signatureon file).

The dentist completes the Dentist Information section,including patient name. The dentist must sign the form.In lieu of completing this form, the dentist may attach hisor her own standardized form to the UFT Welfare FundDental Form, provided that all required information,including the procedure codes, and the dentist's signatureappear.

2. Assignment of Benefits

The benefits to which you are entitled will be paid to youunless you assign them. Sign the “Authorization toAssign Benefits” line if you wish payment to be sent

23

directly to your dentist (payment to SIDS and the FloridaPPO participating dentists is automatically assigned). Ifyou assign benefits, you will be notified of the paymentsmade so that you know the portion of the bill not coveredby this plan.

3. Pre-Treatment Estimate

A Pre-Treatment Estimate (which is an Advance Noticeof Dental Treatment) is required when the dental courseof treatment includes one or more of the following:

a. Periodontal Surgeryb. Inlays or Onlaysc. Crownsd. Bridgeworke. Denturesf. Laminate veneersg. The expense for services provided in a ninety

(90) day period would exceed $500.

The Pre-Treatment Estimate Form must be submittedalong with Pre-Treatment X-rays and must include allservices to be provided in the course of treatment withina ninety (90) day period.

In order to determine what benefits are available, as wellas the reimbursement, you and your dentist should sub-mit a Pre-Treatment Estimate Form to CIGNA, prior to thecommencement of treatment.

You and your dentist will each receive an Explanation ofBenefits (EOB) from CIGNA delineating the servicesauthorized.

NOTE: The Pre-Treatment Estimate only authorizes thework to be performed. To obtain benefits, a PaymentClaim must be submitted after the work has been per-formed listing dates of service. No payment will be madeif the patient is not eligible when services are rendered.

4. Periodic Submission of Claims

Upon completion of treatment, a complete PaymentClaim Form must be submitted to CIGNA with appropri-ate X-rays. If treatment continues over a long period oftime, your dentist may wish payment as the work pro-gresses. To be reimbursed on an on-going basis your den-tist can periodically file a Payment Claim Form, indicat-ing the work that has been performed to date, and thecharges. This process can be repeated during the durationof treatment.

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5. Important Information Regarding the ClaimForm

The Payment Claim Form must be submitted within one(1) year of the date of service. Be sure to sign the claimform. Remember, it is the member's responsibility toensure that all claims are submitted in a timely manner.Claims submitted more than one (1) year after completionof treatment will not be honored for payment.

Be sure to inspect the claim before it is submitted toensure that the listed services were actually performed.Please be advised that your signature authorizes reim-bursement for all dental procedures listed.

NOTE: Pre- and post-treatment X-rays must be submittedwith the Payment Claim Form for root canal therapy andnon-routine extractions.

What if I have questions regarding the status of a claim or payment?If you have any questions regarding your claim, pleasecontact CIGNA at 800-577-0576 or the Fund Office.

How are payments made?All payments for benefits under the Plan are made byCIGNA. You will receive a check from CIGNA unless youhave assigned the benefit to the dentist. If you haveassigned the benefit, payment will be made by CIGNAdirectly to the dentist.

Will I receive an Explanation of Benefits(EOB)?Yes. You will receive a statement from CIGNA, delineat-ing the specific services performed and amount(s) paid;regardless of to whom payment was made. Please reviewthis for accuracy. Report any discrepancies to the UFTWelfare Fund.

Are benefits provided for the replacementof, or addition to, prosthetics?Benefits are provided for the replacement of, or additionto prosthetic appliances only under the following circum-stances:

1. when replacement of an existing partial or fullremovable denture, or fixed bridgework replaces missingnatural teeth by a new partial or full removable denture,

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or by addition of teeth to an existing partial removabledenture; or

2. when replacement of existing fixed bridgeworkreplaces fixed bridgework, or by the addition of teeth toexisting fixed bridgework; or

3. when replacement of an existing partial denture,which replaces missing natural teeth by new fixed bridge-work but only when, as a result of the existing conditionof the oral cavity, a professional result can be achievedonly with bridgework.

Otherwise, the Covered Dental Expenses for the replace-ment of an existing denture are limited to the CoveredDental Expenses for a new denture. With regard to 1, 2 and3 above, satisfactory evidence must be presented that:

a. the replacement or addition of teeth isrequired to replace one (1) or more missingnatural teeth extracted or accidentally lostafter the existing denture or bridgework wasplaced and while the family member wascovered under the plan; and

b. the existing denture, bridgework, or crownwas placed at least five (5) years prior to itsreplacement, whether or not benefits werepaid for it by this Dental Plan, and that theexisting denture or bridgework cannot berepaired, duplicated, or made serviceable;and

c. the existing denture is an immediate tempo-rary denture that cannot be made perma-nent, and its replacement by a permanentdenture takes place within twelve (12)months from the placement of the immedi-ate temporary denture.

4. when, in the case of replacement of an existing freestanding crown, evidence satisfactory to CIGNA is pre-sented that the existing crown cannot be repaired ormade serviceable, whether or not benefits were paid for itunder this Dental Plan, and was placed at least five (5)years prior to its replacement.

What is not covered under the ScheduledBenefit Plan?1. Charges made by a practitioner other than a dentist.Exception: a licensed dental hygienist may perform clean-ing or scaling of teeth, if such treatment is rendered underthe supervision and direction of the dentist.

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2. Charges for services and supplies that are partially orwholly cosmetic in nature, including charges for person-alization or characterization of dentures.

3. Charges for crowns, inlays, onlays, dentures, bridge-work, or other prosthetic appliances, and the fitting there-of, which (a) were ordered under the plan, or (b) whichwere ordered while the individual was covered under theplan, but are finally installed or delivered to such individ-ual more than thirty (30) days after termination of coverage.

4. Charges for the replacement of a lost or stolen pros-thetic device.

5. Charges for any services or supplies that are for thecorrection or modification of an occlusion, includingorthodontic treatment, except to the extent those benefitsare provided for in the “Schedule of Covered DentalExpenses.”

6. Charges for any duplicate prosthetic device, or otherduplicate device or appliance.

7. Charges for dentures, crowns, inlays, onlays, orbridgework intended to increase vertical dimension, or todiagnose or treat TMJ dysfunction or stabilize periodon-tally involved teeth.

8. Charges for precision or other elaborate attachmentsor features for dentures, bridgework, or any other dentalappliances.

9. Charges for any services or supplies that are notspecifically included as Covered Dental Expenses.

10. Charges that would not have been made if no bene-fit plan existed, or charges that neither you nor any ofyour dependents are required to pay.

11. Charges for services or supplies that are furnished,paid for, or otherwise provided for by reason of the pastor present service, of any person in the armed forces of agovernment.

12. Charges for services or supplies which are paid for, orotherwise provided for under law of a government(national or otherwise), except where the payments or thebenefits are provided under a plan specifically estab-lished by a government for its civilian employees andtheir dependents.

13. Charges for any dental treatment, services or suppliesthat are not recommended and approved by the attendingdentist.

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14. Charges for services or supplies which do not meetprofessionally recognized standards of quality, are notnecessary for treatment of existing disease or injury, or arenot appropriate treatment, taking into account the totalcurrently existing oral condition.

15. Charges in excess of the allowances authorized bythe Fund.

16. Charges for specialty orthodontic or interim appli-ances.

DENTAL HMO PLAN – DENTCARE

If you elect to receive dental coverage throughthe Dentcare HMO, the Welfare Fund'sScheduled Benefit Plan is not applicable.Dentcare would provide all covered services.

Dentcare HMO333 Earl Ovington Blvd., Suite 300

Uniondale, NY 11553-3608800-468-0600; 516-542-2700

What are the benefits under the DentalHMO Plan (Dentcare)?The Dentcare HMO is a pre-paid program of comprehen-sive dentistry with no deductibles, co-payments or otherout-of-pocket expenses when provided or authorized byyour primary Dentcare dentist. There are no annual orlifetime maximums and they offer 100% coverage on allcovered dental services without having to file claimforms.

How do I enroll in the Dentcare HMOplan?Enrollment in the Dentcare HMO is strictly voluntary. Ifyou wish to select Dentcare you must complete the UFTWelfare Fund's Dental Transfer Form (DTF) during theFall Dental Open Enrollment Period. The form is avail-able from our website at www.uftwf.org. Once enrolled,you and your family will continue to be enrolled inDentcare until the next Fall Dental Open EnrollmentPeriod when you are permitted to change plans.

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Can each family member have a different dental plan?No. If you enroll in Dentcare, your entire family must alsobe enrolled in Dentcare.

How do I obtain benefits under theDentcare plan?You must choose your dentist from Dentcare's list of par-ticipating providers. That dentist will perform all neces-sary work or will refer you to one of Dentcare's special-ists.

Your primary dentist must refer you to specialists. There isno coverage without the proper referral.

It is not necessary for the entire family to have the samedentist. Each family member, including children, maychoose from the list of Dentcare's participating dentists.

Specific questions about the level of benefits or about par-ticipating dentists may be directed to Dentcare at 800-468-0600.

Once enrolled, Dentcare will send you an ID card indi-cating your primary dentist. Dentcare will also notify thedentist that you are a Dentcare patient. You may call yourDentcare dentist any time after the effective date of yourcoverage.

UFT FLORIDA DENTAL DISCOUNT PLAN

Administered by Healthplex AmericaMember Services 888-200-0322

Plan S200

Who is eligible for the Florida DentalDiscount Plan?Retirees who are year-round Florida residents. If youelect to receive dental coverage through the FloridaDental Discount Plan, the Welfare Fund's ScheduledBenefit Plan is not applicable. All covered serviceswould be provided by Healthplex America.

What are the benefits?Healthplex America is a pre-paid program of comprehen-sive dentistry with various levels of co-payments, depend-ing on the work being done.

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How many times a year can I visit my dentist?You are encouraged to visit your dentist regularly. Withyour Healthplex America dental plan, you are not limitedto a specific number of visits per year.

Can I change participating dentists?Yes. You may see any dentist in the Healthplex Americaprovider directory. However, UFT members who elect toparticipate in the UFT Florida Dental Discount Plan mayonly change their dental plan option during the Fall den-tal open enrollment period.

Is there any maximum coverage limitation?There are no limitations on benefits.

How do I pay for services?If your visit is for covered preventive care, like a routineexam, cleaning or x-ray, there is no charge for the proce-dure. The dentist is prepaid by the Healthplex Americaprogram. For other procedures, a co-payment may berequired. See your Schedule of Benefits for amounts. Youpay co-payments directly to the dentist.

What if I need a specialist?When treatment by a specialist is required and you visit aHealthplex America participating specialist, the co-paywill be on your Schedule of Benefits.

What if I go to a non-participating dentist?You will not be eligible for benefits. You must receivetreatment from a participating Healthplex America den-tist.

My wife and I spend the winter in Floridaand the summer in New York (snowbirds).Can we join the Florida Dental DiscountPlan?No. This plan is designed for year-round Florida residentsonly. Participating dentists do not exist outside of Floridaso you would have no dental coverage in any other areaof the country. Transfers in or out of other dental plans areallowed only during the Fall Dental Open EnrollmentPeriod.

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SPECIAL COORDINATION OF DENTAL BENEFITS (For members and their

spouse/domestic partner who are also UFT Welfare Fund members.)

A. SCHEDULED BENEFIT PLAN

Members and their spouse or domestic partner who arealso members are entitled to Special Coordination ofBenefits (SCOB) when the Scheduled Benefit Plan coversboth.

SCOB can significantly increase reimbursement for den-tal work. If you utilize the services of a non-participatingdentist whose charges are above the schedule ofallowances, you will be eligible for additional reimburse-ment under your spouse's/domestic partner's coverage.You are covered for up to twice the fee schedule, not toexceed the dentist's actual charges.

SCOB is applicable to panel dentists. If you utilize theservices of a panel dentist, you would generally have noout-of-pocket costs. You will not be charged co-paymentsthat are listed on our dental schedule. The Fund will paythe dentist for the applicable co-payments. However,payments for upgraded or non-covered services will stillbe the responsibility of the member.

SCOB does not extend limitations on time or frequency oftreatment. For example, one (1) exam every six (6) monthsdoes not become one (1) exam every three (3) months;but the reimbursement for the exam could be higher.

To obtain the special coordinated dental benefit, checkthe box on top of the form to indicate special coordina-tion of coverage and submit it directly to CIGNA.

NOTE: Do not assign these benefits to your dentist.Assignment will interfere with the Welfare Fund's abilityto administer your coordinated benefits.

B. SIDS/Florida PPO Panel

SCOB is applicable to panel dentists. If you utilize theservices of a panel dentist, you would generally have noout-of-pocket costs. You will not be charged co-paymentsthat are listed on our dental schedule. The Fund will paythe dentist for the applicable co-payments. However,payments for upgraded or non-covered services will stillbe the responsibility of the member.

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C. DENTCARE & SCHEDULED BENEFIT PLAN

1. You may also elect to have your family covered underDentcare and the Scheduled Benefit Plan. One memberenrolls in Dentcare and the other member stays in theScheduled Benefit Plan.

Under this option, you and your family members may useeither a Dentcare dentist or a non-Dentcare dentist.Services rendered by the non-Dentcare dentist would bereimbursed according to the Scheduled Benefit Plan.

2. SCOB (additional reimbursement as explained in PartA above) would no longer be applicable.

3. Out-of-pocket costs incurred under the ScheduledBenefit Plan are not reimbursable through Dentcare.

4. Only one member or spouse/domestic partner is per-mitted to enroll in Dentcare.

D. FLORIDA DENTAL DISCOUNT PLAN & SCHEDULED BENEFIT PLAN

1. You may also elect to have your family covered underthe Florida Dental Discount Plan and the ScheduledBenefit Plan. One member enrolls in the Florida DentalDiscount Plan and the other member stays in theScheduled Benefit Plan.

Under this option, you and your family members may useeither a Florida Dental Discount Plan dentist or a non-Florida Dental Discount Plan dentist. Services renderedby the non-Florida Dental Discount Plan dentist would bereimbursed according to the Scheduled Benefit Plan.

2. SCOB (additional reimbursement as explained in PartA above) would no longer be applicable.

3. Out-of-pocket costs incurred under the ScheduledBenefit Plan are not reimbursable through the FloridaDental Discount Plan.

4. Only one member or spouse/domestic partner is per-mitted to enroll in the UFT Florida Dental Discount Plan.

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35

Optical Plan

34

OPTICAL PLAN• PARTICIPATING OPTICAL CENTERS

Members can use the optical plan once everytwo (2) years by bringing a validated certificateto any of the participating optical centers. Theservice, if used at a participating optical center,includes a DISCOUNTED benefit, described inthis chapter.

• DIRECT REIMBURSEMENT PROGRAM

For those members who wish to use their opticalplan benefit at any non-participating opticalprovider, they may submit their validated certifi-cate along with original receipts and a copy ofthe prescription for reimbursement.

IMPORTANT INFORMATION

FOR VALIDATED OPTICAL CERTIFICATES CALL THE FORMS HOTLINE:

212-539-0539

WEBSITE ADDRESS: www.uftwf.org

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OPTICAL PLAN

Who is covered?All eligible members and dependents, as defined in theGeneral Information section, are covered for optical ben-efits.

What is the benefit?The optical benefit consists of one (1) “optical service”every two (2) years (counted from the date of your lastoptical service) obtained through a network of participat-ing panelists or direct reimbursement. The listing of par-ticipating panelists is available online at www.uftwf.org.

An optical service consists of a complete pair of singlevision, bifocal or trifocal eyeglasses, or the replacementof a frame, or lens, and at the same time, if necessary, aneye exam*. The optical service cannot be split betweentwo (2) visits or two (2) panelists.

1. A complete pair of eyeglasses includes:

A. A pair of single vision, bifocal or trifocal lenses,

AND

B. A basic frame.

2. A basic frame is defined as any frame with a mini-mum retail value of one hundred ($100.00) dollars.

3. A basic eye exam, as performed by an optometrist,will encompass a refraction which includes aretinoscopy, a tonometry (glaucoma test), and a physicalhealth evaluation and history. If the patient andoptometrist agree that dilation is required, the optometristis allowed to charge the member an additional $30.00.

4. Prescription sunglasses are a covered benefit.

5. You may elect to purchase contact lenses and receivea credit as per the fee schedule.

*Laws in certain states such as New Jersey, Connecticutand Florida prohibit examinations at certain optical cen-ters or mandate a specific charge for certain specifiedservices. Members are advised to check with centers out-side New York State to determine if the eye examinationis provided by that center without additional cost. In anyevent, the Welfare Fund will not reimburse any co-pay-ments for exams.

36

How are benefits obtained?1. You must obtain an Optical Benefit Certificate byrequesting it from the Fund Office or by calling the FormsHotline at 212-539-0539. This form is also available fromour website at www.uftwf.org. This request must indicatewhom the service(s) are for, so that the Fund may verifyeligibility prior to issuing the certificate(s).

2. You may obtain the service(s) from a participatingpanelist, or a non-participating provider whereby youmust submit for direct reimbursement.

3. Certificates will not be honored for payment if thepatient information is altered in any way.

Please Note: Certificates are not transferable.Photocopied certificates will not be accepted.Certificates cannot be faxed.

How do I use the Participating PanelistProgram?1. Present the validated certificate to any of theParticipating Optical Panelists designated on the currentlist of Welfare Fund Optical Centers before services arerendered and/or an order is placed*. Validated certificatesmust be presented to the Panelist before the expirationdate. If the certificate has not been used within the peri-od, a replacement may be obtained.

*Panelists are not required to accept a validated certifi-cate after an order is placed.

2. Upon completion of the service at the ParticipatingOptical Panelist, make sure to sign and date Part 6 of thecertificate before leaving the store. Payment will be madedirectly to the Participating Optical Panelist.

What are the advantages of using theParticipating Optical Panelist Program?1. There is no cost to you for a covered optical service.

2. The Fund has negotiated a discount and surchargeprogram with the panelists who have agreed to give allmembers and/or their dependents the following discountsin addition to the one hundred twenty-five dollar($125.00) reimbursement schedule:

1. For any frame or lenses (i.e. progressives) that areupgraded, they will receive a minimum 10% dis-count. The discount will be applied as follows:

37

Upgraded Service Example:

Retail PriceDesigner Frames: $220.00Progressives Lenses: $225.00

Total Retail Price: $445.00

10% Minimum Panelist Discount: ($ 44.50)Sub-Total: $400.50

Basic Frame Allowance (if upgraded): ($100.00)Sub-Total: $300.50Welfare Fund Benefit: ($125.00)

Member’s Final Cost: $175.50

OTHER SERVICE TYPES:

TYPE OF MINIMUM $100 $125 WELFARESERVICE 10% FRAME FUND

DISCOUNT ALLOWANCE PAYMENT

LENS – NO FRAME

LENS WITHFRAME

FRAMENO LENSES

Note: Member's Final Cost does not take into accountthe surcharge items in #3 below. These items are notincluded in the Total Retail Price for calculating themember's discount.

2. For any item purchased not in connection withtheir covered service, for example, a second pairof glasses, a minimum 10% discount off theretail price.

3. If the member/dependent chooses, or the pre-scription requires, items as listed below, the pan-elist may charge the member/dependent nomore than the following surcharges (per pair):

Tinting $15.00UV Block: $15.00Scratch Resistant Coating: $20.00Glare Free Coating: $30.00Polycarbonate: $35.00Photochromic (Transitions): $50.00

4. The provider cannot charge more than theirusual and customary prices, including sales andspecial promotions.

38

3. Because of its contractual relationship with the pan-elist, the Fund will offer its assistance in helping youresolve any problems with a participating optical panelistthat may arise.

What is the Direct ReimbursementProgram?Under direct reimbursement, which can only be used ifyou utilize a non-participating provider, you are requiredto pay for the full cost of the service at the optician andsubmit to the Fund for payment. Reimbursement is madein accordance with the fee schedule or the actual charge,whichever is less.

How do I get reimbursed?1. Attach an ORIGINAL PAID ITEMIZED receipt and acopy of the prescription to the validated certificate.Altered or photocopied receipts will not be accepted.Sign and date Part 6 and mail it to the Welfare Fund officefor reimbursement.

2. Reimbursement for covered services is made inaccordance with the fee schedule in effect at that time,not to exceed the actual charges.

3. Claims must be submitted for payment no later thanninety (90) days from the date of service.

What is not covered under the DirectReimbursement Program?1. Services rendered at participating optical panelists.

2. Assignment of payment to a provider.

What is not covered under the OpticalProgram?The Optical Plan does not cover non-prescription sun-glasses even if recommended by a physician for therapeu-tic reasons.

NOTE: The following will not be honored for reimburse-ment:

1. Expired certificates beyond the eligibility period asstated on the certificate.

2. Non-original certificates. All valid certificates mustbe original.

39

3. Certificates used by another person in the members'family. The certificate is only valid for the person whosename appears on the certificate.

Does Special Coordination of Benefits(SCOB) apply to the Optical Plan?Yes. Members and their spouse/domestic partner who arealso members are entitled to SCOB. This entitles each eli-gible family member, upon presentation at the same timeof two (2) validated certificates, to two (2) covered servic-es, one (1) service under each member's benefit record,whether using a participating provider or the direct reim-bursement method. In either event, reimbursement to theprovider or the member may not exceed the actual chargefor the optical service under SCOB.

If the patient does not want the second service, for exam-ple, a second pair of eyeglasses at the same time as thefirst, he or she can either:

1. use the second certificate toward the out-of-pocketamount of the first service; or

2. use the second service any time within ninety (90)days. After ninety (90) days, you must obtain a new vali-dated certificate.

REIMBURSEMENT/FEE SCHEDULE

1. The provider (or in the case of direct reimbursement,the member) shall receive payment of the usual and cus-tomary charge or up to $125.00, whichever is less, from theFund for a complete service which includes single vision,bifocal or trifocal lenses, a basic frame and eye exam.

2. The provider (or in the case of direct reimbursement,the member) shall receive payment from the Fund of theusual and customary charge or up to $125.00, whichev-er is less, for any partial service rendered. A partial serv-ice includes only a frame or lenses.

3. The provider (or in the case of direct reimbursement,the member) shall receive payment from the Fund of$20.00 for an eye exam only.

NOTE: If mandated by state law, panelists outside of NewYork State are allowed to charge the member the differ-ence between the mandated price and our fee schedule.

4. The provider (or in the case of direct reimbursement,the member) shall receive payment of no more than

40

$125.00 from the Fund towards the purchase of contactlenses. The member/patient is responsible for the bal-ance.

43

Hearing Aid Benefit Plan

42

HEARING AID BENEFIT PLAN• DIRECT REIMBURSEMENT PROGRAM

• Members can access the service once everythree (3) years.

• Members can obtain at least a 25% discountby utilizing a preferred provider.

• Members submit a validated Hearing AidCertificate, along with original paid receiptsto the Welfare Fund for a reimbursementmaximum of $1,000.00.

• The UFT Welfare Fund will also processyour retiree SHIP benefit if you are eligiblefor that benefit.

IMPORTANT INFORMATION

FOR VALIDATED HEARING AIDCERTIFICATES, CALL THE

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS: www.uftwf.org

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HEARING AID BENEFIT PLAN

Who is covered?All eligible members and dependents, as defined in theGeneral Information section, are covered for a hearingaid benefit.

What is the benefit?The hearing aid benefit provides one (1) hearing aid everythree (3) years (counted from the date of your last service).The benefit includes a comprehensive audiological eval-uation, ear impression and required visits necessary forthe proper fitting/use of the hearing aid.

NOTE: If a hearing aid is not dispensed, and you want toremain eligible for the entire benefit, you should pay foror submit the bill to your health insurance carrier orMedicare for the expense of the evaluation. This willassure your entitlement to a full hearing aid benefitshould you require it in the future.

How are benefits obtained?You must obtain a Hearing Aid Certificate/DirectReimbursement Form by requesting it online atwww.uftwf.org or by calling the Forms Hotline at 212-539-0539. This request must indicate whom the service(s)are for, so that the Fund may verify eligibility prior to issu-ing the certificate(s).

Please Note: Certificates are not transferable.Photocopied certificates will not be accepted.Certificates cannot be faxed.

What is the reimbursement?Under direct reimbursement you are required to pay forthe full cost of the service and submit to the Fund for pay-ment. Reimbursement will be $1,000.00 or the cost of thehearing aid, whichever is less.

Although this is a direct reimbursement benefit, theWelfare Fund has created a list of Preferred Providers whohave agreed to give a minimum 25% discount off the costof a hearing aid.

The Preferred Provider list is available by calling the FundOffice at 212-539-0500, or from our website atwww.uftwf.org.

44

How do I get reimbursed?1. Attach an ORIGINAL PAID ITEMIZED receipt to theHearing Aid Certificate/Direct Reimbursement Form.Altered or photocopied receipts will not be accepted.

2. Complete Parts 1and 2.

3. Sign and date Part 3.

4. Mail to the UFT Welfare Fund office. Claims must besubmitted for payment no later than 90 days from the dateof service.

5. The Welfare Fund also administers the Hearing Aidbenefit for SHIP (Supplemental Health Insurance Plan).Claims for retirees who are members of SHIP and are eli-gible to receive an additional benefit from SHIP, will havetheir SHIP claim processed when the Fund processes itsclaim.

What is not covered under the Hearing AidProgram?1. Charges associated with the return of a hearing aid.

2. Charges associated with repairs.

3. Charges for amplification devices (also known asAssistive Listening Devices - ALD).

What is not covered under the DirectReimbursement Program?The benefits are the same under the DirectReimbursement Program. However, when you do not usea participating provider, the cost of the services are notrequired to be discounted.

Does Special Coordination of Benefits(SCOB) apply to the Hearing Aid BenefitPlan?Yes. Members and their spouse/domestic partner who arealso members are entitled to SCOB. This entitles each eli-gible family member to two (2) hearing aids, one hearingaid under each member's benefit record. The two (2) cer-tificates can be combined when purchasing a single hear-ing aid. Reimbursement to the member may not exceedthe actual charge for the hearing aid under SCOB.

45

How is this benefit affected by my BasicHealth coverage?A patient's basic health coverage will always be Primaryand the United Federation of Teachers Welfare Fundhearing aid benefit Secondary.

Please note, assignment of payment to a provider is not permitted.

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Medicare Part DMEDICAREPART

D

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MEDICARE PART D BENEFIT• Reimbursement of the 5% out-of-pocket

expenditures in excess of the catastrophic level.

IMPORTANT INFORMATION

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS:www.uftwf.org

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MEDICARE PART D CATASTROPHIC REIMBURSEMENT

Who is covered?Retirees and their eligible spouse/domestic partner whohave enrolled in, and purchased, a Medicare Part DPrescription Drug Program and have reached the annual5% catastrophic coverage threshold are covered. Otherdependents are not covered.

What is the benefit?This benefit will reimburse the 5% out-of-pocket co-pay-ments incurred in the catastrophic coverage portion of theMedicare Part D plan.

How are benefits obtained? You must complete a Medicare Part D ReimbursementClaim Form and submit it to the Welfare Fund no laterthan February 1 in the year following the calendar year inwhich you incurred the 5% co-payment charges, alongwith the letter and Explanation of Benefits (EOB) receivedfrom your Health Insurance carrier.

NOTE: If you have not reached the catastrophic thresh-old of your Medicare Part D plan, you do not qualify forthe benefit and you should not file a claim form.

At the end of every year, the health plan that you areenrolled in for the Medicare Part D program will send youan Explanation of Benefits (EOB). The reimbursement isbased on what “you paid.” Member and Spouse totalscannot be combined.

Where can I get the Reimbursement ClaimForm? You can obtain the form in the following ways:

• by calling the Welfare Fund during businesshours at 212-539-0500; or

• by downloading it from the website atwww.uftwf.org.

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51

Optional RiderReimbursementOPTIONALRIDERREIMBURSEMENT

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OPTIONAL RIDER REIMBURSEMENT BENEFIT

• Partial reimbursement of Retiree Premium forRider/Health Insurance.

IMPORTANT INFORMATION

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS:www.uftwf.org

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OPTIONAL RIDER REIMBURSEMENT BENEFIT

(Partial Reimbursement of Retiree Premium for Rider/Health Insurance)

Who is covered?All eligible retirees as defined in the General Informationsection may be covered for the City Optional RiderReimbursement Benefit.

What is the Optional Rider Reimbursementbenefit? The benefit is available to retirees who have a pensioncheck deduction for the purchase of a New York CityOptional Rider or New York City health insurance.Members who have purchased a separate health plan thatcovers prescription drugs may also be eligible for the ben-efit. They must complete a Non-NYC Rider Claim Formand attach the appropriate documentation. This form isavailable by calling the Fund at 212-539-0500 or fromthe website at www.uftwf.org.

Retirees who are covered under a Health Benefit Planthrough their spouse or domestic partner may also be eli-gible for the optional rider reimbursement benefit. Theseretirees must submit to the Welfare Fund, every year, acompleted “Rider Claim Form.” This form is available bycalling the Fund at 212-539-0500 or from the website atwww.uftwf.org.

When do I get my reimbursement? The benefit is generally paid every spring for the preced-ing calendar year.

How is the benefit calculated? The current benefit (2012) reimburses up to $780.00annually, per eligible retired member and is payable atthe rate of $65.00 per eligible month. If the monthlydeduction is equal to or less than $65.00, reimbursementwill be the amount deducted per month from your pen-sion check.

Retirees who returned to work in positions that providein-service prescription drug benefits and use this benefitwill have their optional rider reimbursement reduced by

54

the cost of the prescription drugs paid by the Fund, cal-culated on a month-by-month basis.

NOTE: This benefit is not related to the Medicare Part Bpremium that is reimbursed by the NYC Employee BenefitProgram. For information on that benefit, call 212-306-7600.

How are benefits obtained? The benefit is issued automatically to retired membersbased on the City's health insurance deduction recordfurnished to the Welfare Fund. In most cases, it will notbe necessary to contact the Welfare Fund to obtain thisbenefit.

What do I do if I'm not a member of theTeachers Retirement System (TRS) or I am covered under my spouse? The eligible retiree should contact the UFT Welfare Fundin March and request a Rider Claim Form. This form isalso available on our website at www.uftwf.org.

What if I have not received my reimburse-ment? If you believe that you were eligible to receive this bene-fit but did not, it is your responsibility to notify the Fundin writing within two (2) years from the date the benefitshould have been paid.

Please do not contact the Fund in connection with thisbenefit before May 1, in order to allow time for process-ing.

CONTINUATION OFCOVERAGECONTINUATIONOFCOVERAGE

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CONTINUATION OF COVERAGE

What does my dependent do if he/she loses coverage?

• DEPENDENT SURVIVOR COVERAGE

• COBRA

• AGE 29 EXTENSION OF COVERAGE

IMPORTANT INFORMATION

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS: www.uftwf.org

The election of City (Medical/Hospital) COBRA does not enroll you in UFT Welfare Fund COBRA. A separate UFT Welfare Fund COBRA application

is required.

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CONTINUATION OF COVERAGE

What does my dependent do if he/she losescoverage? 1. DEPENDENT SURVIVOR COVERAGE

Dependent coverage terminates when a member's eligi-bility ends for any reason other than death, or on the datewhen the dependent no longer meets the definition of aneligible dependent, whichever occurs first. In cases of themember's death, the Welfare Fund extends eligibledependent coverage three (3) months following themonth in which the member died.

2. COBRA

The election of City (Medical/Hospital) COBRA does not enroll you in UFT Welfare Fund COBRA. A separate UFT Welfare Fund COBRA application

is required.

COBRA provides continuation of Fund coverage whencoverage would otherwise end because of a life eventknown as a “qualifying event.” Specific qualifying eventsare listed below. COBRA continuation coverage must beoffered to each person who is a “qualified beneficiary”(QB). A qualified beneficiary is someone who will losecoverage under the Fund because of a qualifying event.Depending on the type of qualifying event thespouse/domestic partner of a retired member, anddependent children of a retired member may be qualifiedbeneficiaries. Qualified beneficiaries who elect COBRAcontinuation coverage must pay for COBRA continuationcoverage.

When am I eligible for COBRA?Spouses/domestic partners1 of covered members havethe right to continue coverage if coverage is lost for anyof the following qualifying events:

1) death of the member; or

2) divorce or legal separation from the member; or

3) termination of the domestic partnership with themember.1

The law does not require that COBRA continuation coverage beextended to domestic partners. However, the Fund Board of Trusteeshas determined that such COBRA continuation coverage will beoffered to registered domestic partners of Fund members.

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Dependents of members have the right to continue cover-age if coverage is lost for any of the following qualifyingevents:

1) death of the parent-member; or

2) the dependent ceases to be a "dependent child"under the Fund's rule of eligibility.

Qualified Beneficiary (QB): Individuals entitled toCOBRA coverage on their own are called qualified bene-ficiaries (QB). Individuals who may be qualified benefici-aries are the spouse/domestic partner of the coveredmember and the dependent child(ren) of a covered mem-ber. In order to be a QB, an individual must be coveredunder the UFT Welfare Fund on the day before the eventthat causes the loss of coverage. The Health InsurancePortability and Accountability Act (HIPAA) amended thisrequirement to allow a child who is born to or adopted bythe covered employee, while on COBRA, to become aQualified Beneficiary.

NOTES: Individuals covered under another employersponsored group health plan prior to their COBRA startdate are still eligible to purchase UFT Welfare FundCOBRA. However, individuals who become coveredunder another employer sponsored group health planwhile on UFT Welfare Fund COBRA may not be eligibleto continue the UFT Welfare Fund COBRA (except forthe period that the new health plan excludes pre-existingconditions).

The Fund offers Medicare eligible enrollees and/or theirMedicare eligible dependent(s) continuation benefitssimilar to COBRA if a COBRA event should occur.

What are the periods of continued coverage?Continuation of coverage is available for a maximumduration of thirty-six (36) months for the member's eligi-ble dependents as a result of:

1 - death of member; or

2 - divorce; or

3 - legal separation; or

4 - termination of a domestic partnership; or

5 - dependents that cease to be a “dependent child”under the Fund's rules of eligibility.

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COBRA premiums for thirty-six (36) month periods arecalculated at 102% of the employer's cost for coverage tothe plan at the group rate.

Continuation of coverage can never exceed thirty-six (36)months in total, regardless of the number of events thatrelate to a loss of coverage. Coverage during the continu-ation period will terminate if the COBRA participant failsto make timely payments or if the COBRA participantbecomes covered under another employer sponsoredgroup health plan while on the UFT Welfare FundCOBRA (unless the new plan contains a pre-existing con-dition exclusion).

What are my notification responsibilities?Under the law, the member, retiree or eligible dependenthas the responsibility to notify either their payroll secre-tary or the Department of Education's HR Connect (In-Service), or City of NY Health Benefits Program (Retirees)and the Welfare Fund within sixty (60) days of an addresschange, death, divorce, legal separation, termination ofdomestic partnership or a child losing dependent status.

When a qualifying event (such as a member's death)occurs, your eligible dependents will be notified by theDepartment of Education's HR Connect (In-Service), orCity of NY Health Benefits Program (Retirees) of youroption to choose continuation coverage.

How do I elect City COBRA coverage? To elect City COBRA continuation of health coverage, theCOBRA eligible person must complete a “City of NYContinuation of Coverage Application.” This applicationis available through the payroll secretary, the Departmentof Education's HR Connect (In-Service), or City of NYHealth Benefits Program (Retirees), or the New York CityOffice of Labor Relations website (www.nyc.gov/olr).

What should I do if I am interested in elect-ing the UFT Welfare Fund COBRA?To elect UFT Welfare Fund COBRA you must:

• check off the box marked "yes" on the City COBRAapplication where it asks "Do you wish to purchasebenefits from your Welfare Fund?" The Welfare Fundwill receive a copy of your application from yourhealth carrier (this may take up to two (2) months).

and/or

60

• make a copy of your City COBRA application andsend it directly to the Welfare Fund Office. This willexpedite the process.

Upon notification, a Welfare Fund COBRA applicationwill be mailed to you so that you may enroll in the UFTWelfare Fund COBRA benefit plan.

If you do not elect City COBRA but you would like to pur-chase Welfare Fund COBRA, contact the Fund officedirectly at 212-539-0560.

Eligible persons choosing to elect COBRA coverage mustdo so within sixty (60) days of the qualifying event or ofthe date on which they receive notification of their rights,whichever is later.

When are my premium payments due?The initial premium is due within forty-five (45) days ofyour COBRA election. Thereafter, premiums are due onthe first of the month with a thirty (30) day grace period.Since there cannot be a gap in the coverage period, cov-erage and premiums are retroactive to the COBRA quali-fying event date.

When can I change my benefits selectedunder COBRA?COBRA participants are entitled to change the selectionof COBRA benefits during the City's Fall Open EnrollmentPeriod as designated for Retirees.

Whom can I call if I have any questionsabout COBRA?If you have questions about your COBRA continuationcoverage, you should contact the Fund or you may con-tact the nearest Regional or District Office of the U.S.Department of Labor's Employee Benefits SecurityAdministration (EBSA). Addresses and phone numbers ofRegional and District EBSA Offices are available throughEBSA's website at www.dol.gov/ebsa.

3. EXTENSION OF COVERAGE FOR UNMARRIEDCHILDREN 29 YEARS OF AGE OR UNDER

New York State Insurance Law allows unmarried chil-dren to be covered by the member's insured health plan,if they so choose, by paying the premium cost of the cov-erage until the unmarried child reaches his/her 30th

61

birthday. Welfare Fund coverage for unmarried children29 years of age or under, will coordinate with coverageafforded said children under the New York City healthplans.

What are the eligibility requirements?• Member must have Welfare Fund Coverage.

• Child must be unmarried.

• Child must be under age 30.

• Child must live, work or reside in New York State orthe health insurance company's service area.

• Child must not be covered by Medicare.

• Child may not be insured or eligible for comprehen-sive health insurance through his/her employer.

When will Welfare Fund Age 29 YoungAdult Coverage end?• When the child loses any of the eligibility require-

ments listed above.

• When premium payments are not received.

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63

Legal Plan

.-

64

LEGAL PLAN

• Obtain certain legal services.

• Access Elder Law Attorneys.

IMPORTANT INFORMATION

WEBSITE ADDRESS: www.uftwf.org

65

RETIREE LEGAL PLAN WITH ELDER LAW SUPPLEMENT

Who is covered?All eligible retirees and eligible dependents as defined inthe General Information section, are covered by thelegal plan.

Please Note: In the event of a retiree's death before theexpiration of the plan benefit year or his/her loss of eli-gibility, legal service benefits will be provided to mem-bers of the deceased's family until the end of the planbenefit year.

What is the benefit? The UFT Welfare Fund Retiree Legal Plan with ElderLaw Supplement provides certain services free and oth-ers at a discount. This benefit is fully described in a sep-arate booklet which is sent to you when you firstbecome eligible for the benefit. The booklet is sent toyou by the Plan Administrator, NYSUT MemberBenefits, 800 Troy Schenectady Rd, Latham, NY 12110-9924, 800-626-8101. You will also receive an ID cardand consultation coupons. The following is a brief out-line of plan benefits:

• Telephone advice and consultation with anattorney

• Legal letters written and telephone calls madeon your behalf

• Guaranteed maximum fees for specific legalmatters

• Discounts for Uncontested Estates - (Probate)

• National Referral Attorney Network

• Elder Law Supplement

• Last Will and Testament with Minors Trust

• Discounts for Personal Injury cases

• Document preparation at fixed rate

• Office consultation with an attorney

• Durable Power of Attorney

• Health Care Proxy

• Living Will

66

• Assistance with mortgage foreclosure

• Assistance with Debt consolidation

• Advice on Identity Theft Prevention and Victims

The Elder Law Supplement allows UFT Retirees access toElder Law Attorneys across the country. Elder LawAttorneys will provide the highest possible level of adviceregarding estate planning, trusts, complex wills, Medicaidapplications, nursing home planning, etc. This special-ized panel is available to you at a 20% reduction fromtheir usual fees. The free consultation coupon may not beused for a consultation with an Elder Law Attorney.

How are benefits obtained? The National Legal Office (the law firm of Feldman,Kramer and Monaco, P.C.) is the clearinghouse for alllegal matters. The attorneys at the National Legal Officewill answer your legal questions, write letters and reviewdocuments at no cost. If necessary, they will refer you toan attorney in your area for a free consultation or addi-tional legal services.

To reach the National Legal Office in Long Island, NY,call 631-231-4480.

All other New York State residents should call 800-832-5182.

Florida residents should call 954-424-1200 or toll-free,800-654-1945.

All other areas should call 800-292-8063.

NOTE: Upon eligibility for this benefit as a retiree,NYSUT will automatically refund any premiums paidafter your eligibility date if you were purchasing theNYSUT Legal Plan as an in-service employee.

67

Retiree Programs

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68

RETIREE PROGRAMS

• Informational meetings, cultural, instructional,recreational and other appropriate social services

IMPORTANT INFORMATION

FORMS HOTLINE: 212-539-0539

WEBSITE ADDRESS: www.uftwf.org

RETIREE PROGRAMS: 212-598-6879

69

RETIREE PROGRAMS

Who is covered?All eligible members, as described in the GeneralInformation section, are covered under Retiree Programs.Spouses/ Domestic Partners may also participate in theprograms described below.

What are retiree programs? The UFT Welfare Fund maintains a Department of RetireePrograms to develop and conduct informational meet-ings, with cultural, instructional, and recreational pro-grams for retirees.

The Department features Retiree Learning Centers in eachUFT borough office as well as programs in other sectionsof the Metropolitan area. Members participate in a widearray of activities such as a life-long learning program,seminars, day trips, theatre clubs, “dine arounds,” infor-mational meetings and special events. Courses are alsooffered in the Florida office.

Informational meetings, trips, and special events areoffered around the country wherever a cluster of mem-bers reside. Currently those areas include Arizona,California, Florida, Georgia, the greater Washington D.C.area, New Jersey, Nevada, North Carolina, Puerto Ricoand Israel.

Annual meetings are held in the NY Metropolitan areaand most of the locations listed above.

The Retiree Social Services Department provides assis-tance and support to retirees across the country with arange of social services such as information and referrals,short term counseling and weekly telephone reassurancecalls.

How are benefits obtained? The Department of Retiree Programs publicizes its activi-ties in the bi-monthly New York Teacher, the semi-annu-al Si Beagle bulletin and Florida Events Newsletter as wellas individual event flyers for each section throughout thecountry. Information is also available online atwww.uftwf.org.

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R

The Health and Cancer Helpline

HELPLINE

72

73

THE HEALTH AND CANCER HELPLINEA “listening ear” in your time of need

212-539-0500

• All members are eligible to use the counseling andinformation services provided by this program/unit inthe Welfare Fund.

• Full time staff and peer counselors provide help formembers who are afflicted with any type of life-threat-ening illness. Services provided include assistingmembers with obtaining a medical leave, helping nav-igate the insurance system and providing counselingwhile undergoing medical treatment. Referrals forcare-giving services; individual, marriage, or grouptherapy and substance abuse treatment are alsooffered.

• Most counseling is provided in-person or by telephoneduring business hours. You may want to call ahead toensure that time will be set aside for you. Call theFund's main number at 212-539-0500 and ask tospeak with a Health and Cancer “HelplineCounselor.”

• All contacts are strictly confidential.

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ResourcesRESOURCES

76

RESOURCES

• AFT and NYSUT Benefits

This section contains the contact information for our national organization, the AmericanFederation of Teachers (AFT) and our state organization, New York State United Teachers(NYSUT).

• Health Benefits Contact Information

A listing of helpful contact information includingtelephone numbers and websites is provided forquick reference.

IMPORTANT INFORMATION

Visit our website for moreinformation and links to these

resources

WEBSITE ADDRESS: www.uftwf.org

77

RESOURCES

AFT + : The Benefits of Belonging

The American Federation of Teachers, our national affil-iate, sponsors programs with economic benefits formembers in all AFT divisions, including K-12 teachers,paraprofessionals, public employees, AFT Healthcare,and higher education faculty and staff. For current benefits, please see: www.aft.org/benefits/ or call 800-238-1133, ext. 8643.

NYSUT Member Benefits Trust – Standing the Test of Time!

Whether it’s insurance, financial products, legal servicesor discount programs, New York State United TeachersMember Benefits has something to meet your needs. For current benefits, please see: www.nysut.org (a link toNYSUT Member Benefits is located on the right) or call800-626-8101.

HEALTH CARE CONTACT INFORMATION

Welfare Fund Health Plans

UFT Welfare Fund 212-539-0500

UFT Welfare Fund Forms Hotline 212-539-0539 www.uftwf.org

Cigna Dental 800-577-0576 www.mycigna.com

Dentcare (Healthplex) 800-468-0600

Direct Access Dental (SIDS) 516-394-9408

Direct Access Drugs (Medco/Express Scripts) 866-544-6779

Florida Dental Discount Plan(Healthplex America) 888-200-0322www.yourdentalplan.com/healthplex

Medco/Express Scripts (Prescription Drugs) 800-723-9182www.express-scripts.com

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NYC PICA Drug Program – Injectable & ChemotherapyDrugs

Express Scripts 800-467-2006 Curascript (Express Scripts Specialty Drugs)888-773-7376www.express-scripts.com

S.H.I.P. (UFT Retirees) 212-228-9060

SIDS (UFT Dental Panel) 866-679-SIDS(Long Island) 516-394-9408

New York City Health Benefits Program

Dept. of Education HR Connect 718-935-4000

New York City Health Benefits Program212-306-7600http://www.nyc.gov/html/olr/html/health/health_benefits_prog.shtml

NYC Retiree Health Benefits Program 212-306-7600

NYC Healthline (in-service & retirees) 800-521-9574

NYC Health Benefit Plans

Aetna/HMO 800-445-USHCwww.aetna.com/nycity_employees/

Aetna Medicare 888-267-2637

Av Med (Florida) 800-782-8633

Blue Cross/Blue Shield Plan (Florida Blue Direct Sales)800-999-6758

Cigna Medicare Select Plus Rx (Arizona) 800-627-7534

Cigna Healthcare 800-244-6224www.cigna.com

Elderplan 877-414-9015

EmblemHealth

GHI (in New York) 212-501-4GHI(4444)

GHI (outside New York) 800-223-9870

GHI Florida (within Florida) 800-358-5500

GHI HMO 877-244-4466

HIP Prime/VIP of NY 800-HIP-TALK www.emblemhealth.com

Empire Blue Cross (out of N.Y. state) 800-433-9592

Empire Blue Cross/Hospital Plan 212-476-7888

Empire EPO/HMO 212-476-7666www.empireblue.com/nyc

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GHI Retiree Drugs (Express Scripts) 877-534-3682www.express-scripts.com

Humana 866-205-0000

Medicare Part B Reimbursement 212-306-7600

United Healthcare (Medicare only) 888-867-5548

Vytra HealthCare 800-406-0806www.vytra.com