Leaving the Plan

Leaving the plan

 
Ineligibility for you or a dependent

A subscriber’s membership may end because he or she

  • Is laid off
  • Leaves a job
  • Loses coverage due to a reduction in work hours
  • No longer lives in the FCHP service area
  • Fails to make the required contributions to maintain benefits under this plan (or his or her employer fails to do so)
  • Otherwise no longer meets plan eligibility

A dependent’s membership may end because of

  • Loss of the subscriber’s eligibility
  • Attainment of age 26
  • Divorce
  • The subscriber’s death

If a subscriber’s group coverage ends, the subscriber and any dependents may have a right to choose continued group coverage to the extent required by state and federal law. Contact the Plan Administrator for information on eligibility and continued enrollment. (For more information about continuation of coverage once you are no longer eligible through your group, or conversion to a consumer plan, see Options for continuing coverage.)

Cancellation by the plan

You do not have to worry that the plan will cancel your contract because you are using services or because you will need more services in the future. FHLAC may cancel contracts only for the following reasons:

  • You no longer live or work in the FCHP service area
  • You made some misrepresentation or you conspired with another party to defraud FHLAC and/or the plan. In such a case, cancellation will be as of your effective date or other date FHLAC determines appropriate. In any case of misrepresentation, FHLAC and its affiliates may deny enrollment to you in the future.
  • You commit an act of physical or verbal abuse that poses a threat to a plan provider, a plan employee or agent or another plan member. In such an instance, FHLAC must determine that the act of abuse was not related to your physical or mental condition.
  • The plan is no longer offered by Teamsters Local 170 Health and Welfare Fund. If you would like to remain an FCHP member, you can join a consumer plan. (See Options for continuing coverage for more information.)
  • As allowed by state or federal law or regulation.

In accordance with Massachusetts state law and the Federal Genetic Information Nondiscrimination Act, FHLAC will not require genetic testing or the submission of genetic information as a condition of initial or continued enrollment. FHLAC will not discriminate or make any distinction among members based on any genetic test or information. Genetic information will not be used for decisions regarding coverage or costs of coverage.

Disenrollment by the subscriber

To cancel your contract, you must notify your Plan Administrator. The Plan Administrator will submit a transaction request in accordance with the group agreement. If the subscriber or Teamsters Local 170 Health and Welfare Fund cancels the contract, we will not provide benefits for services, supplies or medication received after the cancellation date.

Eligibility for Medicare

If you are a subscriber age 65 or older, your eligibility may change in one of the ways shown below.

  • If you are employed after age 65, you and your dependents may remain covered under this contract as long as you are an active member of Teamsters Local 170 Health and Welfare Fund eligible for group benefits.
  • If you become eligible for Medicare and you are no longer employed, you are no longer eligible for coverage under this contract. You may be eligible for enrollment in Fallon Senior Plan™, our Medicare Advantage product, either through Teamsters Local 170 Health and Welfare Fund or directly with FCHP. To enroll, you must have both Medicare Part A and Part B, live in the Fallon Senior Plan service area and pay the premium charge when applicable. Please contact Customer Service for more information.
  • If you are not eligible for Medicare upon reaching age 65, you may continue to be covered under this plan.

Once you have retired and become eligible for Medicare, you may elect to continue with the plan through Fallon Senior Plan. You may join Fallon Senior Plan even if enrollment is closed to the general public. To enroll, you must have both Medicare Part A and Part B, live in the Fallon Senior Plan service area, and pay the premium charge when it is due. You must write to us within 90 days of reaching age 65 and pay the premium charge when it’s due. If you have a spouse and/or dependents who were covered under your group membership before you turned 65, they may continue coverage in that group for as long as they are eligible.

Changing to other health insurance

As long as Teamsters Local 170 Health and Welfare Fund agrees, you may change your coverage to any other health benefits plan offered where you work. You may do this within 30 days of any of the following:

  • The anniversary date of your group. There will generally be an open enrollment period preceding Teamsters Local 170 Health and Welfare Fund’s anniversary date, during which you can arrange for changes that will be effective on the anniversary date. There also may be a special enrollment period determined by FHLAC and Teamsters Local 170 Health and Welfare Fund.
  • The day you move to a place outside the FCHP Select Care service area
  • The date you become eligible to enroll in another federally qualified health maintenance organization within the FCHP Select Care service area for which you were not formerly eligible because of where you live
  • The date this plan is no longer a part of the health benefits plan offered by Teamsters Local 170 Health and Welfare Fund.
  • The date the plan stops operation

Please note: Nothing in this section changes the application of the coordination of benefits between the plan and any other health benefits plan.

Obtaining a certificate of creditable coverage

If you cancel your enrollment with this plan, FHLAC will send you a Certificate of Creditable Coverage, free of charge. This certificate gives you proof of continued coverage that can help you
obtain other coverage without a pre-existing condition clause. You may request additional copies of the certificate by calling Customer Service.