Who is Eligible?
You are eligible for coverage under the Fund if:
Your employer listed below has made contributions to the Fund on your behalf:
- City of Cambridge
- Cambridge School Department
- Cambridge Health Alliance
- Cambridge Retirement Board
Your dependents may also be eligible to receive benefits. Your covered dependents include:
- Your spouse
- Your children
Your Covered Children
- Your dependent children are eligible for benefits up to age 19 or age 25 if they are enrolled as a full-time student in a college or post-secondary school.
- If your child is a full-time student, you must provide documentation of your child’s full-time student status. The Registrar’s office at your child’s school can provide this documentation.
- Totally disabled, handicapped, and mentally disabled dependent children are eligible for benefits regardless of age, if your child is permanently disabled and is claimed as a dependent on your federal tax return.
- Legally adopted children, foster children or other children who depend on you for support are also eligible for benefits (with the age restrictions listed above), as long as you or your spouse is the legal guardian and you claim the child as a dependent on your federal tax return.
For more information click on Dependent Children Verification Requirements
How to Enroll
If you are eligible for the Cambridge Public Employees Dental and Vision Fund benefits, your Benefits Department will provide you with an enrollment form.
Be sure to complete the form accurately and return it promptly to your Benefits Department. The Benefits Department will then send your completed forms to the Fund Office.
Automatic or Active Enrollment
Most employees are enrolled in the Fund automatically when they first become eligible.
Employees at Cambridge Health Alliance must enroll during open enrollment or when they first start working and become initially eligible. Enrollment is not automatic for Cambridge Health Alliance employees.
New employees who fail to submit an enrollment form to their Benefits Department by their effective date will be automatically enrolled in the Cambridge Public Employees Dental and Vision Fund Plan with individual coverage only.
New Employees of Cambridge Health Alliance
New Cambridge Health Alliance employees who fail to submit an enrollment form to their Benefits Department by their effective date will not be enrolled and will not be eligible for enrollment or any changes until the next Cambridge Health Alliance annual open enrollment period or if you have a special enrollment period qualifying event.
When enrolling or adding eligible dependents, employees must complete an enrollment form provided by their Benefits Department.
You must also submit the necessary documentation that supports your dependent’s eligibility for benefits.
Examples of documentation include a:
- Marriage certificate,
- Birth certificate(s),
- Disabled Dependent Application, and
- Full-time student verification status for dependent children age 19 - 25.
Student Verification Requirements
It is the responsibility of the member to provide a verification letter for his/her dependent after the start of each semester verifying their status as full-time. Verification can be obtained from the School Registrar’s Office and must be submitted each semester during the student’s enrollment.
The Student Verification letter must be dated after the start of the semester and must include the:
- Name of the dependent,
- Current semester,
- Start and end date of the semester, and the
- Expected graduation date.
Pre-registration or pre-enrollment WILL NOT BE ACCEPTED for verification
Please keep in mind that if full-time student verification is for a previous semester or submitted late, the Fund is only able to go back 12 months on any dental claims.
Dependents of Cambridge Health Alliance Employees
Cambridge Health Alliance Employees who fail to enroll dependents when they first start working and become initially eligible will have to wait during open enrollment to add any dependents, unless you experience a special enrollment period qualifying event such as a birth of a child or marriage.
You will have 30-days from the qualifying event to enroll any dependents or will have to wait until the next open enrollment period.
You are able to enroll in Fund coverage when:
- You start work and become initially eligible for coverage;
and, if you are an employee of the Cambridge Health Alliance, you are also able to enroll;
- During the annual open enrollment period; or
- If you add or remove a dependent, generally due to a special enrollment period qualifying event.
The Benefits Department will send you an enrollment form when you are able to enroll.
Continuing, Losing and Reinstating Coverage
Your Fund coverage will generally continue as long as your employer makes contributions to the Fund on your behalf.
Contact your Benefits Department if you are eligible for benefits and:
- Are waiting for or receiving workers’ compensation and;
- Are on a leave of absence.
Contact your Benefits Department for more information on continuing your coverage.
If you lose Fund coverage, you may be eligible to continue coverage in other ways. For more information, read about Continuation Coverage Eligibility.
If you lose coverage and go on workers’ compensation or a leave of absence and then return to work, your coverage will resume on the first day of the month following the date you return to work.
If you make a voluntary change to part-time status, you will temporarily lose eligibility. That’s because your employer does not make contributions to the Fund for part-time workers.
You resume coverage on the first day of the month following the date when you resume full-time status.
Resuming Coverage Example
Here’s an example for both scenarios:
- You go on a leave of absence on July 15. You lose eligibility on July 16.
- You then return to work on August 1. Your coverage will resume on September 1, the first of the month after the date you returned to work.
Change of Coverage – Special Enrollment Period Due to a Qualifying Event
NOTE: THIS SECTION APPLIES ONLY TO CH ALLIANCE EMPLOYEES (CAMBRIDGE HOSPITAL)
A special enrollment period is a time when you are allowed to make changes to your Dental and Vision Fund Plan even though it is not an open enrollment period.
Normally, you are not allowed to enroll or make any changes to your Dental and Vision Fund Plan except during the annual open enrollment period. However, certain qualifying evens will trigger a special enrollment period allowing you to make changes for a brief period after the triggering event.
If you do not make the necessary changes to your Dental and Vision Fund Plan during the special enrollment period, you will have to wait until the next open enrollment period to make any changes.
You are eligible to change coverage outside of the Open Enrollment period for the following reasons:
- You marry and want to enroll your spouse and/or newly eligible dependent children. A copy of your marriage certificate and birth certificate for dependent children is required.
- You need to enroll a newborn or newly adopted child. In order to add a newly adopted child to your coverage, you must provide appropriate documents verifying the adoption in order to have the application accepted. To enroll a newborn you need to attach a copy of the certified birth certificate. A hospital birth announcement will not be accepted.
- Your spouse provided you with coverage. As a result of death, divorce, or separation, you are no longer eligible for coverage under his or her plan.
- Loss of your spouse’s job-based plan. Your spouse’s former employer provided you with coverage. He or she no longer works at the company that provided your plan. Or his/her company’s plan no longer provides coverage. As a result, you are no longer eligible for coverage.
You must let your Benefits Department know there has been a qualifying event.
Your change in status (such as moving from individual only coverage to family coverage) must be consistent with the type of qualifying event. Once the change is processed, your new status will be effective as the date of the qualifying event.
Have a question about eligibility? Contact us.