Health & Welfare and Pension Funds
of Philadelphia and Vicinity

Eligibility Provisions

A member of the Teamsters Health and Welfare Fund of Philadelphia and Vicinity will become and remain eligible for the Benefits Program in accordance with the "Qualifying Schedule" shown in the eligibility provisions of the Summary of Benefits Schedule. It is important to consult that schedule because, depending upon the terms of the collective bargaining agreement between your Local Union and your Employer, there are different methods of determining when you become eligible for benefits and when you lose eligibility for those benefits.

A Family Member means, in addition to yourself, any one of your eligible dependents who is covered under this Plan as defined below under "Dependents." Benefits for each of your covered dependents will be determined on the same basis as for you except where noted.

DEPENDENTS

1. Your spouse (as defined herein), provided you are not separated.
2. Your unmarried children (including any stepchildren, adopted children or children living with you for whom you are appointed legal guardian by a court and for whom you are financially responsible) until their 19th birthday.
   Dependent children will be covered for benefits up to their 23rd birthday or date of graduation (whichever occurs first) if they are enrolled as full-time students at an accredited educational institution. Proof of attendance as a full-time student must be submitted to the Fund each semester.
   Any individual who is a full-time member of the Armed Forces or who is eligible for coverage as an Employee under this or any other employer-sponsored plan is not eligible to be a Dependent under this Plan.
3. Your wholly dependent, unmarried children who are physically or mentally incapable of self-support upon attaining age nineteen (19) will continue to be covered PROVIDED you furnish the Fund office with proof of this incapacity before their coverage terminates at age nineteen (19). You should request the appropriate form from the Fund office. Thereafter, yearly certifications are required to verify the continuing nature of the dependent's handicapped status.
4. Your wholly dependent parents, providing you are unmarried and have no other dependents and such parents are living in your household. The Fund's coverage will be secondary for parents who are eligible to apply for benefits under any medical assistance program for the aged provided by a State or the Federal Government.

NOTE: When both a husband and wife are covered by the Fund as eligible members, Plan deductibles and co-payments will not be taken. Beyond that, payment will be determined based upon Fund allowances (UCR, etc.) and under Coordination of Benefits (see General Provisions and Definitions section).

Change in Family Status:

It is important that you give prompt, written, notice to the Fund office on a Census Card of any change in your Family Members, such as marriage, birth of a child, death of your spouse, divorce, or separation. (Furthermore, a description of the procedures governing qualified medical child support order determinations can be obtained, without charge, from the Fund office.)  Failure to report any change in your Family Members may result in a delay of payment of a claim at a future date or may adversely affect your COBRA right to continued coverage. Census Cards are always available at the Fund office. In certain situations you may be required to submit a certified copy of your most recent federal income tax return and other necessary documents in order to establish proof of dependency for a particular Family Member. Similarly, it is most important that you immediately notify the Fund of any change in your address.

 Last Date Updated :  01/10/07