SHBP Enhances Eligibility Rule

 

April 2015

 

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Recent changes by the Seafarers Health and Benefits Plan aim to make it easier for SIU members to remain eligible for benefits.


The Seafarers Health and Benefits Plan (SHBP) has mailed and posted a letter to participants describing modifications to its rule for maintaining eligibility. These changes aim to make it easier for SIU members to stay eligible for benefits under the plan.

 

The March 2 letter from Seafarers Plans Administrator Maggie Bowen pointed out that eligibility rules for the SHBP “were changed effective Jan. 1, 2014 to implement new requirements under the Affordable Care Act (ACA). During the past year the SHBP Trustees have, as promised, reviewed and approved numerous appeals in order to cover participants who could not meet the 60-days-in- 6-months requirement. After careful review and discussion of the state of the industry, it was determined that shipping is tightening up and it may be harder for participants to maintain eligibility due to no fault of their own.”

 

The letter continued, “Therefore, effective Jan. 1, 2015 the Board of Trustees has decided to enhance the existing rule for maintaining eligibility by including the following provision: If a participant fails to obtain 60 days in a 6-month eligibility period, but has a combined total of 125 days distributed between the two prior consecutive 6-month periods, the participant will maintain eligibility for the following 6-month period. You must have covered employment in each of the two prior 6-month eligibility periods.”

 

Those that fail to meet one of the two requirements will need to re-establish eligibility under the 90-day rule, Bowen added.

 

Finally, the letter asked participants who incurred claims on or after Jan. 1, 2015, and had such claims denied due to eligibility, to contact the claims department at 1-800-252-4674.

 

A PDF version of the letter is posted in the SHBP section of the SIU website and also in a March 3 post in the News section.

 

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