Enrollment

Enrolling In The Plan

Although you may meet the Plan’s requirements for eligibility, to receive benefits you and your dependents must also enroll in the Plan. You must do so before the Plan will provide coverage. As part of enrollment, you must provide copies of the following (as applicable):

• A marriage certificate for your spouse
• A Certificate and a Declaration of Domestic Partnership for your Domestic Partner
• Birth certificates for each of your dependent children
• Certificates of adoption or the equivalent for any adopted children
• For a foster child, the initial placement order or subsequent final orders placing the child in your foster care and the Foster Family Placement Contract you enter into with the applicable government agency
• For children over whom you have legal guardianship, a copy of the court order granting you legal guardianship

Enrollment for Newly Eligible Active Employees

When you first become eligible for the Plan, you must select a medical coverage provider. You may choose between either the Medical Plan or the Kaiser HMO. If you do not make a choice, you will be automatically enrolled in the “Indemnity Medical Plan” described here.

If you are enrolled in the Indemnity Medical Plan you can change to the Kaiser HMO option only during the annual open enrollment period, described below.

When you enroll for medical benefits in the active plan, you will be automatically enrolled for the following benefits:

• Dental benefits
• Vision coverage (through the Vision Service Plan)
• Employee Life Insurance and Survivor Income Benefits
• Dependent Life Insurance (if applicable for your spouse and/or eligible children)
• Accidental Death & Dismemberment (AD&D) Insurance
• Prescription Drug Coverage
• Alcoholism and Chemical Dependency Benefits (unless you have elected Kaiser, in which case you will receive this type of coverage through Kaiser)

HMO Open Enrollment Requirements

You and your eligible dependents will be automatically covered by the indemnity medical plan, unless you timely elect the Kaiser HMO option. You must make this election on a separate HMO enrollment form. Send your completed HMO enrollment form to the Fund Administrator for processing. Do not send this enrollment form directly to the HMO. The election you make applies to your entire family. If you do not choose HMO coverage when you first become eligible for coverage, you will have to wait until the next annual Open Enrollment Period to elect Kaiser coverage. The Kaiser Open Enrollment Period is ordinarily during the month of July – this is the only time you can switch to the Kaiser HMO plan.

Provided that you keep the Fund aware of any changes in your home address, you will receive a notice, normally in June of each year, of your option to change to the HMO plans, and instructions regarding how to secure enrollment literature and forms for changing your provider. You may request from the Fund Administrator a packet explaining your options and containing a change request form.

Adding Or Dropping Dependents

If you are enrolled in either the Medical Plan or the Kaiser HMO and newly marry, establish a domestic partnership, or add a dependent child to your family you must notify the Fund Administrator. You must enroll your spouse or child within thirty days of the date of marriage or birth or adoption. If you drop dependents, for example, because of divorce or placement for adoption, you must notify the Fund Administrator, and you must complete and submit a new Bay Area Delivery Drivers Security Fund Enrollment Form to the Fund Administrator.

 Enrollment Form

Enrolling In the Plan

Although you may be eligible to participate in the Plan, you must also take steps to enroll to receive plan benefits. Benefits will not begin until the Fund Administrator’s Office has received your enrollment form. Enrollment forms can be obtained from the Fund Administrator and from the Union. To ensure that you are eligible for benefits as soon as you meet the eligibility requirements, you should submit your enrollment form before completing the minimum eligibility requirements.

As part of enrollment, you must provide copies of the following (as applicable):

• A marriage certificate for your Spouse,
• A Certificate and a Declaration of Domestic Partnership (or equivalent form) for your Domestic Partner,
• Birth certificates for each of your Dependent children,
• Certificates of adoption or the equivalent for any adopted children;
• For a foster child, the initial placement order or subsequent final orders placing the child in your foster care and the foster family placement contract you enter into with the applicable government agency;
• Proof of disability for an adult disabled child;
• For children over which you have Legal Guardianship, a copy of the court order granting you Legal Guardianship.

More on  Enrollment

HMO Open Enrollment Requirements

You and your eligible Dependents will be covered by the Indemnity Medical Plan unless you timely elect the Kaiser HMO option. You must make this election on a separate HMO enrollment form. Send your completed HMO enrollment form to the Fund Administrator (not directly to Kaiser) for processing. The election you make applies to your entire family. If you do not choose HMO coverage when you first become eligible for coverage, you will have to wait until the next annual Open Enrollment Period to elect HMO coverage (unless you have a Special Enrollment event). The Open Enrollment Period is ordinarily during the month of July but will be determined by the Board of Trustees on an annual basis.

Provided that you keep the Fund aware of any changes in your home address, you will receive a notice, normally in June of each year, of your option to change to the HMO plan, and instructions regarding how to receive additional enrollment literature and forms for changing your provider. You may request from the Fund Administrator, a packet explaining your options and containing a change request form.

You can elect to switch from the Kaiser HMO Plan to the PPO plan at any time during the year by contacting the Fund Administrator. If the change is outside the 30-day window (or 60 days in certain circumstances), the change will be effective the first day of the month following the month you made the change.

Special Enrollment

New Spouse and/or Dependent Child(ren) If you get married (whether or not you are currently enrolled in coverage) you may request special enrollment for you, your new Spouse and/or any Dependent Child. You must request this special enrollment within 30 days after the date of marriage, Coverage will be effective no later than the first day of the first Calendar Month beginning after the Plan has received your request for special enrollment. You will need to provide the appropriate documentation for each applicable Dependent as described on page 5 of the SPD.

If you acquire a new child either through birth, adoption, or placement for adoption (whether or not you are currently enrolled in coverage), you can request special enrollment for you, your Spouse (whether or not he/she is currently enrolled in coverage), your new child, and/or any other Dependent Children. You must request this special enrollment within 30 days after the date of birth, adoption, or placement for adoption. Your coverage, your Spouse’s coverage and/or your Dependent Child’s coverage will begin on the date of birth, adoption, or placement for adoption (as applicable). If you do not request this special enrollment within 30 days of birth, adoption or placement for adoption then enrollment will be prospective only, and not retroactive to birth, adoption, or placement for adoption.

 Qualified Medical Child Support Orders (QMCSO) (Special Rule for Enrollment)

This Plan will provide benefits in accordance with a Qualified Medical Child Support Order (“QMCSO”) or a National Medical Support Notice which creates, recognizes or assigns a child’s right to receive benefits as your covered Dependent. When the document providing for coverage of a child as your Dependent is submitted to the Fund, the Fund will review the Order to determine whether it satisfies the legal requirements for a QMCSO (in other words, whether it is “qualified”) or a National Medical Support Notice.

QMCSOs should be sent to the Fund Administrator. The child named in the QMCSO will be enrolled in the Plan option you are enrolled in, unless the QMCSO specifies a particular option.

For additional information (free of charge) regarding the procedures for administration of QMCSOs, contact the Fund Administrator.

Enrollment Form

You will not be eligible for the Retiree Plan until you enroll in the Plan (even if you have been covered without interruption under the Active Employee Plan prior to your retirement).

To enroll in the Retiree plan you must provide the following:

• Retiree Application competed by you and an officer of your Local.
• Copy of Pension Award Letter from Western Conference of Teamsters (or another Plan recognized for this purpose by the Board of Trustees) or
• Documentation showing you are eligible for (old age) Social Security Benefits or
• Documentation showing you are eligible for Social Security Disability Benefits.

Dependents who were eligible under your Active coverage will continue to be covered under your Retiree plan as long as they meet the definition of a dependent.

All benefits remain the same as Active Employees except Retirees and their dependents are not eligible for:

• Dental benefits
• Dependent Life Insurance (there is a reduced Life Benefit for the Retiree)
• AD & D and survivor income benefit
• Short-Term Disability Income Coverage

HMO Open Enrollment Requirements

You and your eligible dependents will be automatically covered by the indemnity medical plan, unless you timely elect the Kaiser HMO option. You must make this election on a separate HMO enrollment form. Send your completed HMO enrollment form to the Fund Administrator for processing. Do not send this enrollment form directly to the HMO. The election you make applies to your entire family. If you do not choose HMO coverage when you first become eligible for coverage, you will have to wait until the next annual Open Enrollment Period to elect Kaiser coverage. The Kaiser Open Enrollment Period is ordinarily during the month of July – this is the only time you can switch to the Kaiser HMO plan.

Provided that you keep the Fund aware of any changes in your home address, you will receive a notice, normally in June of each year, of your option to change to the HMO plans, and instructions regarding how to secure enrollment literature and forms for changing your provider. You may request from the Fund Administrator a packet explaining your options and containing a change request form.

Adding Or Dropping Dependents

If  you are enrolled in either the Medical Plan or the Kaiser HMO and newly marry, establish a domestic partnership, or add a dependent child to your family you must notify the Fund Administrator. You must enroll your spouse or child within thirty days of the date of marriage or birth or adoption. If you drop dependents, for example, because of divorce or placement for adoption, you must notify the Fund Administrator, and you must complete and submit a new Bay Area Delivery Drivers Security Fund Enrollment Form to the Fund Administrator.

Retiree Welcome Packet-Application