Eligibility

When Does Your Eligibility Begin?

You are eligible for benefits as of your hire date, if all appropriate forms are completed and returned signed to the VTA Benefit Fund Administrator.

When Does Your Eligibility for Coverage End?

Your eligibility for coverage under the benefits will end when one of these events occurs:

• The last day of your employment

• You work less than the required hours for eligibility

• You enter military service

• The group insurance policy is terminated

• If you begin work in September of a school year and resign at the end of the school year, then your coverage will continue until the last day in August following your termination.

Plan Cancellation or Termination

The Trustees intend to continue the benefits indefinitely. However, the Trustees reserve the right to change or discontinue the type and amounts of benefits offered by the Fund and the eligibility rules for coverage.

Benefits provided through the Fund and eligibility rules for active, retired, or disabled participants:

• Are not guaranteed,

• May be changed or discontinued by the Board of Trustees,

• Are subject to the rules and regulations adopted by the Board of Trustees,

• Are subject to the Trust Agreement which establishes and govern the Fund operations, and

• Are subject to the provisions of the group insurance policies purchased by the Trustees.

Who is Covered?

Covered by the Benefit Fund are all employees of the Valhalla School District who are employed .5 FTE or greater and for whom contributions are payable to the Valhalla Teachers’ Association Benefit Fund by the Valhalla School District.

Dependents

Dependents shall refer to the spouse or domestic partner of a covered employee and/or the natural children of the employee member or the legally adopted children of the employee member or a child who permanently resides in the member’s household for whom the member is the legal guardian.

Dependent children are covered when appropriate contributions are made to the Fund in amounts determined by the Trustees and uniform for each employee group. Dependents, when eligible, remain eligible until they reach their nineteenth(19th) birthday or until they reach their twenty-third(23rd) birthday provided they establish their status as full-time day students in a post-high school program of studies.

False statements on your eligibility forms concerning dependent status, spouse employment and spouse or child's benefits provided by the employer or dependent can result in the suspension of all benefits for up to one year.

Employees commencing unpaid leaves may remain eligible for benefits provided that they make application to the Fund in a timely manner and make appropriate contributions to the Fund.

Temporary Employees

Employees hired for a specific period, and then terminated, (i.e., as replacement for an absent employee) for whom appropriate contributions are made by the Board of Education are eligible for all appropriate benefits, but the maximum benefit in each category shall not exceed the published annual maximum benefit in each category during the SCHOOL YEAR in which they are employed.

GROUPS PRESENTLY RECEIVING BENEFITS FROM THE VTA BENEFIT FUND

Valhalla Teachers' Bargaining Unit: All employees who are employed ½ time or greater and are covered by Teachers’ contract.

Valhalla School Related Personnel: All employees who are ½ time or greater and are covered by the SRP contract.

Valhalla Administrators and Supervisors Bargaining Units: All employees who are ½ time or greater and are covered by the Administrators’ contract.

Individual Contract Holders: Any ½ time or greater administrative and clerical confidential employees for whom the Board of Education makes appropriate payments to the Fund.

LEVEL OF COVERAGE

The specific benefits and reimbursements provided to each group are specifically dependent upon the level of contribution made by the Board of Education or appropriate individual to the VTA Benefit Fund. Similar levels of contribution will result in similar benefits, except as noted herein.

• All permanent and continuing employees in each bargaining unit shall have the same level of benefits as others in the same unit.

• All temporary, terminal employees in a bargaining unit shall be eligible for no more than the annual maximum level of benefit in each category during the school year in which they are employed.

Inclusion of dependent coverage is similarly dependent upon the level of contribution made to the Fund. Similar levels of contribution will result in similar levels of dependent coverage regardless of group membership.

The specific level of contribution to the Fund is dependent upon the agreements made among and between the various employee groups and the Board of Education as a result of collective bargaining.

The determination of reimbursement levels and the nature of the benefit program is the responsibility of the Board of Trustees.

ELIGIBILITY FOR COVERAGE

No claims will be paid on a new employee prior to the receipt, by the fund administrator, of an official ‘notice of hire” from the central office establishing the official “date of hire” of the new employee, and completed eligibility forms filed by the new employee.

Dependents become eligible for benefits on the same date as the member, or if acquired later, on the date that they first become eligible dependents.

IF YOU TAKE A LEAVE OF ABSENCE

Eligible employees who cease employment for reasons of leaves of absence, parental leaves or other conditions set forth in the collective bargaining agreement, may continue to remain eligible for benefits provided they maintain their membership in the Valhalla Teachers’ Association and make appropriate contributions to the Valhalla Teachers’ Association Benefit Fund within thirty (30) days of cessation of active employment. If the eligible employee fails to act within the prescribed 30 day period, he or she may not thereafter become eligible for benefits unless he or she returns to covered employment. (Fund members, not in the VTA bargaining units can maintain coverage upon similar request and payment of an administrative fee as set by the Trustees.)

IF YOU RETIRE

RETIREMENT IS DEFINED AS LEAVING SERVICE WITH ELIGIBILITY TO DRAW PENSION BENEFITS FROM THE APPROPRIATE STATE SYSTEM.

Eligible employees who cease employment for reasons of retirement may continue to remain eligible for dental benefits provided they make appropriate contributions to the Valhalla Teachers’ Benefit Fund, within thirty (30) days of cessation of employment. A retiree is offered a choice of individual dental coverage or family coverage upon retirement. The choice made at the time of retirement may not be changed in the future, except in the case of the loss of a spouse due to divorce or death, in which case the member may elect to reduce coverage. If the member elects to drop Fund coverage, for any period of time, such coverage cannot be reinstated for any reason. (Fund members, not in VTA bargaining units, can maintain coverage upon similar request and payment of an administrative fee as set by the Trustees.)

Information regarding continuation of vision insurance through COBRA will be sent directly to the member's home from Titan, a Third Party Administrator.  There is no option to continue legal insurance. 

IF A COVERED EMPLOYEE DIES

If a covered employee dies while a member of the Benefit Fund some of his or her benefits are continued for 2 years for the employee’s eligible dependents provided that the employee was a member of the fund the five years preceding his or her death.

CLAIMS

1. Should a claim be rejected for technical reasons; the claimant may submit additional information, in support of the claim, from the professional practitioner involved (doctor, dentist, optician, etc.) in an effort to justify the claim. The Trustees cannot make decisions based on statements made by the claimant or other layman.

2. MEMBERS’ RESPONSIBILITY OF MONITORING CLAIMS: It is the member's responsibility to check on the disposition of a claim if he/she has NOT BEEN CONTACTED with either a payment for the claim or with information on why the claim has not been paid WITHIN (30) THIRTY DAYS of the submission of such claim.

3. ALL ITEMS ON CLAIM FORMS WILL BE SUBJECT TO VERIFICATION WITH THE PROVIDERS OF THE SERVICE(S) BY THE FUND.

THIRD PARTY REIMBURSEMENT/SUBROGATION

If a covered member or dependent is injured through the acts or omissions of a third party, the Fund shall be entitled to the extent it pays out benefits – to reimbursement from the covered member or dependent from any recovery obtained from the responsible third party. Alternatively, the Fund shall be subrogated, unless otherwise prohibited by law, to all rights of recovery that the covered member or dependent may have against such third party arising out of its acts or omissions that caused the injury. Subrogation means that the Fund becomes substituted in the injured person’s place to pursue a claim for recovery against a third party. Fund benefits will be provided only on the condition that a covered member or dependent agrees in writing:

(A). To reimburse the Fund, to the extent of benefits paid by it, out of any money recovered from such third party, whether by judgment, settlement, or otherwise;

(B).To provide the Fund with an Assignment of Proceeds to the extent of benefits paid out by the Fund on the claim and to cooperate and assist the Fund in seeking recovery. The Assignment will be filed with the person whose act caused the injuries, his or her agent, the court, and/or the provider of the services; and

(C). To take all reasonable steps to effect recovery from the responsible third party and to do nothing after the injury to prejudice the Fund’s right to reimbursement or subrogation, and to execute and deliver to the fund administrator all necessary documents as the Fund may require to facilitate enforcement of the Fund’s rights and not to prejudice such rights.

Board of Trustees: A covered employee may request a review of action by submitting notice in writing to the Board of Trustees, Valhalla Teachers’ Association Benefit Fund, 300 Columbus Ave., Valhalla, New York 10595 within 60 days after the action of the fund administrator. The Trustees shall act on the appeal within a reasonable period of time and render their decision in writing, which shall be final and conclusive and binding on all persons.