Welfare Notes - September 2012

September, 2012

Unfit For Duty

If you are Unfit for Duty, your eligibility for coverage may be extended; however, you must inform the Plan office of your Unfit for Duty status with documentation from your attending physician.  Periodic updates of your status should be submitted if your disability continues.

Unfit for Duty does not automatically add time onto the eligibility period.  The extension of eligibility due to Unfit for Duty is dependent upon the Unfit For Duty dates and the Fit For Duty date.

When an eligible member becomes Fit for Duty he has 3 months starting in the month after becoming Fit for Duty to work 60 days to continue his eligibility. 

As an example if a member’s eligibility period is 02/01/12 through 01/31/13 and he becomes Unfit For Duty in July 2012 and becomes Fit for Duty in September 2012, his eligibility is not extended.  In this example the Fit For Duty date would make October, November, and December the time frame for him to work the 60 days needed to keep eligibility from lapsing.  The eligibility period, however, covers him through January 2013 so the Unfit for Duty would not affect the eligibility period.

If a member with an eligibility period of 02/01/12 through 01/31/13 became Unfit for Duty in October 2012 and Fit for Duty in February 2013, his eligibility would be extended for February 2013, as well as, the months of March 2013, April 2013, and May 2013 when he would have to work at least 60 days to keep his eligibility from terminating.

If the member in this example failed to work 60 days between March 2013 through May 2013, eligibility would terminate in the month following the last extension month (May 2013) and the member must work 120 days within 12 months to become eligible again. 

Time worked in the extension months after becoming Fit for Duty does not count in the 120 days within 12 months required if eligibility is terminated.  Participants who regain eligibility after being terminated must re-enroll in a plan.      

Please check with the Plan office if you have any concerns about your eligibility or enrollment in a Plan.     

Michelle Chang, Administrator  
Patty Martin  
Virginia Briggs, Claims   
Michael Jacyna, Eligibility