New Eligibility Rules Take Effect in January


December 2013


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Officials from the SIU and the Seafarers Health and Benefits Plan are continuing to get the word out concerning upcoming changes in eligibility rules for medical coverage through the SHBP.


Union and SHBP representatives have gathered with rank-and-file Seafarers during the monthly membership meetings and aboard ships. A comprehensive letter from the SHBP was mailed to all Plan participants and is available on the SIU website. Also, a detailed article ran in last month’s LOG and it, too, is posted on the website.


The new rules take effect Jan. 1, and they were crafted to comply with mandates stemming from the Affordable Care Act of 2010, commonly called ObamaCare. Under the updated regulations, new SIU members and those re-establishing eligibility will need less time to qualify for coverage. Eligibility for existing members will be divided into two six-month periods instead of throughout the entire year; children between the ages of 18 and 26 will be covered; and coverage limits will be removed.


For instance, new employees and those seeking to re-establish eligibility will now require 90 days of continuous employment to become eligible for benefits, instead of the 125 days of employment required under the old policy.


Moreover, under the new rules, employees must work 60 days over a six-month period to receive benefits during the next six-month period. The first period runs Jan.1-June 30, while the second period runs July 1-Dec.31.


“This means that if you have 60 days of covered employment any time between January 1 and June 30, 2014, you will be eligible for coverage from July 1 to December 31, 2014,” Seafarers Plans Administrator Maggie Bowen wrote in the aforementioned letter. “Covered employment may also include certain time when an employee attends upgrading classes at the Seafarers Harry Lundberg School of Seamanship (SHLSS), and certain time when an employee receives sickness and accident benefits.”


Aiming to help ensure that no member is adversely affected by the new rule, there will be a transition period during the first six months of 2014. For that period, the old eligibility rule will still be applicable – meaning that from Jan. 1, 2014 through June 30, 2014, a Seafarer will be eligible for benefits if he or she had 125 days of covered employment in 2013, and one day of covered employment in the past six months. However, if a member did not have eligibility under the old rule at the beginning of the year, he or she will re-establish eligibility after 90 days under the new rule for re-establishing eligibility. Starting July 1, 2014, a member will only be eligible for benefits if he or she meets one of the new eligibility rules.


While the new rules allow members to obtain eligibility much faster compared to the old system, the union and the SHBP recognize that this type of change generates questions about various individual scenarios. Members are encouraged to read the participant letter and the article in the November LOG, contact their port agents and call the SHBP at 1-800- 252-4674 with any questions.




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