Annual Access Fee
There is a $65 per year fee to access any of our insurance benefits. This fee covers the costs of administering your insurance plan(s). It will appear on your invoice annually, for as long as you remain on any insurance product.

Application Fee
There is a $40 application fee to cover the cost of setting up your account and processing your application. This fee also helps to offset the costs of our customer service line, which will be available to you as long as you are a member. You will be charged this fee every time you complete a new eligibility application and subsequently enroll in an insurance plan or plans.

Paper Enrollment Fee
Enrollment in health and dental insurance is available online. If you choose to enroll in health or dental insurance using a paper enrollment form you will be charged a $15 Paper Enrollment Fee, in addition to the Access Fee and the Application Fee.

Billing Policy
You will receive an invoice for insurance and any applicable fees 45 days prior to the start of the month of coverage. Payment is due by the 1st of the month prior to coverage. If you elect to pay via EFT (automatic debits from your bank account), your full outstanding balance will be debited from your account on the 2nd of the month (or, if the 2nd is on a weekend or holiday, the debit will occur on the next business day).

In addition, there is a 30-day grace period. If you have not paid for your insurance by the end of the 30-day grace period, your coverage will be terminated. The effective date of the termination will be the last day of the last month for which you paid. Any medical bills accrued after your termination date will become your responsibility to pay.

Example: For July coverage, you will receive a bill on May 15. Payment is due by June 1. If you elect to pay by EFT, payment will be debited from your account on June 2. If you have not paid by June 30, your insurance coverage will be terminated effective June 30.

First Insurance Payment
When you enroll in any insurance plan, you must submit payment for your first two months of coverage at the time of enrollment. Once your coverage begins, this payment is non-refundable, even if you terminate your insurance plan(s) after one month of coverage. Please note that the rules for termination vary by insurance type - please see the appropriate sections for specific details. Depending on your situation, you may also need to pay the yearly Access Fee and one-time Application Fee along with your first insurance payment.

Monthly Invoices
If you enroll in any of our insurance plans, your monthly invoices will be available to you online. We will send you an email reminder when your new invoice is posted.

Monthly Payments
You can pay for your monthly insurance premiums in any of the following ways:

Electronic Funds Transfer - Automatic direct debits from your checking or savings account each month. Funds will be deducted on the 2nd of each month. If the 2nd is on a weekend or holiday, the debit will occur on the next business day. To set up monthly automatic direct debits, contact our Administrative Office.

One-time EFT - Individually-requested electronic debits from your account. Enter your payment information at your convenience. The funds will be transferred from your account within 2-3 business days of requesting the debit. To pay using a one-time debit from your account, click the "online payment" link on your billing page.

Paper Check - Mail a paper check payable to "Freelancers Union" to our Administrative Office. To ensure the check is credited properly, please include your full name and Member ID number on the check. Your Member ID number is located on the upper right corner of your bill.

Paper Bill Fee
If you prefer to receive paper invoices, there will be an additional administrative fee of $2 per month. Please note that even if you select to receive a paper bill, all late notices and termination notices will be sent via email only. To request paper invoices, contact our Administrative Office.

Re-enrollment Fees
Freelancers Union's insurance plans have been designed to encourage long-term participation. Therefore, if you terminate your insurance plan(s), you may be subject to waiting periods and fees if you choose to re-enroll. If you need to complete a new eligibility application, you will be billed for the $40 Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee. Re-enrollment rules differ by insurance plan and carrier. Please see below for more information.

Open Enrollment (Current Enrollees Only)
For current enrollees in any of our health insurance plans, Open Enrollment takes place once a year, in December, for coverage changes effective January 1. During Open Enrollment, you can switch plans or add or drop dependents from your plan. You will receive an email notifying you of the beginning of the Open Enrollment period.

Changing Plans
Once your coverage begins, you may switch to a different health insurance plan only during the Open Enrollment period. You cannot switch plans at any other time of the year. Plan changes cannot be made retroactively.

Adding Dependents
You can cover your spouse, domestic partner, or dependent children on your health insurance plan at the time you enroll. Otherwise, you can only add a spouse, domestic partner, or dependent children to your plan during open enrollment or as the result of a qualifying event.

1. Open Enrollment: For all health insurance plans, the open enrollment period occurs in December of each year, for changes effective on January 1. You will receive an email notification in advance of the open enrollment period and can add a spouse or dependent(s) at that time.

2. Qualifying Events: For all of the health insurance plans we offer, qualifying events are marriage, loss of coverage and a new child. Specific rules differ by insurance company; please see below:

- Marriage:
Empire Plans: You may add coverage for a spouse within 60 days of the date of marriage. The effective date will be the first of the month immediately following the date of marriage. If you do not add a spouse within 60 days of your marriage, you must wait until the next open enrollment period to do so. To add your spouse to your plan, you must submit a written request, along with a copy of your marriage certificate or license, to the Administrative Office, within 60 days of your date of marriage.

PerfectHealth Plans: You may add a spouse within 31 days of the date of marriage. The effective date will be the first day of the next month after either the date of marriage or the date you submit your request, whichever is later. You must provide a marriage certificate or license. If you do not add a spouse within 31 days of marriage, you must wait until the next open enrollment period to do so. To add your spouse to your plan, you must submit a written request, along with a copy of your marriage certificate or license, to the Administrative Office, within 30 days of your date of marriage.

- Domestic Partnership:
Empire Plans: You may add coverage for a domestic partner within 60 days of the date you become eligible for domestic partnership. You must provide all eligibility materials (see below). The effective date will be the first of the month immediately following the date you become eligible for domestic partnership. If you do not add a domestic partner within 60 days of meeting the eligibility requirements, you must wait until the next open enrollment period to do so. To add your domestic partner to your plan, you must submit a written request, along with a copy of all your domestic partner eligibility materials, to the Administrative Office, within 60 days of your eligibility for domestic partnership.

PerfectHealth Plans: You may add coverage for a domestic partner within 31 days of the date you become eligible for domestic partnership. You must provide all eligibility materials (see below). The effective date will be the first day of the next month after you submit your request and all eligibility materials. If you do not add a domestic partner within 31 days of meeting the eligibility requirements, you must wait until the next open enrollment period to do so.

- Termination of Coverage:
Empire Plans: You may add a spouse, domestic partner, or dependent within 60 days of terminating prior comparable coverage. The effective date will be the first of the month after you submit your request. You must provide proof of prior coverage in the form of a HIPAA Certificate or other written proof from the insurance company. If more than 60 days have elapsed since your spouse, domestic partner, or dependent terminated coverage, you must wait until open enrollment to add them to your plan.

PerfectHealth Plans: You may add a spouse, domestic partner, or dependent within 31 days of terminating prior comparable coverage. The effective date will be the first of the month after you submit your request. You must provide proof of prior coverage in the form of a HIPAA Certificate or other written proof from the insurance company. If more than 31 days have elapsed since your spouse, domestic partner, or dependent terminated coverage, you must wait until open enrollment to add them to your plan.

- New Child:
Empire Plans: You may add a child after a birth or adoption. If you add a newborn or adopted newborn to your plan, this must be done within 60 days of the birth in order for the effective date to be retroactive to the date of birth. You must provide proof of the birth oradoption.. Dependent child(ren) of a covered domestic partner may also be added to your health insurance plan and are governed by the same terms and conditions that apply to a member's child(ren).

PerfectHealth Plans: You may add a child within 31 days of a birth or adoption. The effective date will be the date of birth or adoption, or the date of the placement for adoption. If you do not add a child within 31 days of birth or adoption, you must wait until the next open enrollment period to do so. Dependent child(ren) of a covered domestic partner may also be added to your health insurance plan provided they meet the eligibility requirements.

To add a dependent to your health insurance plan due to a qualifying event, send a written request to our Administrative Office by fax, or mail, along with proof of the qualifying event, by fax, or mail. If you have any questions, contact the Administrative Office.

Removing Dependents
Empire Plans: Dependents can be terminated from your plan for any reason at any time. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively. To remove a dependent from your health insurance plan, contact our Administrative Office. Termination requests cannot be made over the phone - we must receive them in writing.

PerfectHealth Plans: Dependents can be terminated from your plan for any reason at any time. If you terminate a domestic partner due to dissolution of the domestic partnership, you must complete a Termination of Domestic Partnership Form and send it to our Administrative Office. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively. To remove a dependent from your health insurance plan, contact our Administrative Office. Termination requests cannot be made over the phone - we must receive them in writing.

Domestic Partner Coverage
Freelancers Union offers domestic partner coverage for all health insurance plans we offer. This coverage extends to both same-sex and opposite sex domestic partners and the children of covered domestic partners. The eligibility rules and guidelines vary by insurance carrier -- see below.

Empire Plans:
The Domestic Partner of a Subscriber and the Domestic Partner's Dependent children, if any, may be eligible for coverage. A Domestic Partner is an unmarried adult who is not related to the Subscriber by blood in a manner that would bar marriage under applicable state laws and who resides with the Subscriber in a continuous relationship of indefinite duration in which the Subscriber and the Domestic Partner have responsibility for each other's welfare and financial well-being.
- Eligibility
In order to be eligible for Domestic Partner coverage, Empire requires proof of the following:
1. Domestic Partnership Registration, under any applicable state or municipal laws; and
2. Cohabitation; and
3. joint responsibility for common welfare and financial obligations as demonstrated by at least two (2) of the following:

• evidence of shared rental payments of joint residence;
• evidence of a common household and shared household expenses;
• evidence of status of Domestic Partner as representative payee for the Subscriber's government benefits;
• evidence of joint responsibility for child care;
• evidence of a shared household budget for the purpose of receiving government benefits;
• designation of Domestic Partner as beneficiary for life insurance or retirement benefits;
• joint wills, or will designating Domestic Partner as executor and/or primary beneficiary;
• designation of Domestic Partner as the Subscriber's representative in a durable power of attorney or health care proxy;
• ownership of joint bank account, joint credit card or joint ownership of a motor vehicle (or other major item of personal property) or other evidence of joint financial responsibility;
• affidavit by shared creditor swearing to financial interdependence of Subscriber and Domestic Partner;
• other items of proof sufficient to establish economic interdependency.

A Domestic Partner cannot be added if either the Subscriber or the Domestic Partner has been a member of another domestic partnership within the last six (6) months. All persons added under this section will be considered family members.

Please see Adding Dependents for more information.

- Child(ren) of a Domestic Partner
The dependent child(ren) of a covered domestic partner may also be added to your Empire health insurance plan. Dependent children are governed by the same terms and conditions that apply to a member's child(ren).

Please see Adding Dependents for more information.

PerfectHealth Plans:
The Domestic Partner of a Subscriber and the Domestic Partner's Dependent children, if any, may be eligible for coverage.
- Eligibility
Two people of the same or opposite sex will be eligible if the following requirements have been met:
1. You and your partner must meet all of the following:

• Each is the sole partner of the other;
• Each is at least eighteen (18) years of age;
• Both currently share a common legal residence and have shared the residence for at least 12 months prior to their application for Domestic Partner coverage;
• Both must be jointly responsible for basic living expenses;
• Both are in a relationship of mutual support, caring, and commitment and intend to remain in such a relationship for the indefinite future; and
• Neither is related to the other by adoption or blood to a degree of closeness that would bar marriage in the state in which you reside, except for those states that legally recognize Domestic Partners as a legal valid marriage.

2. You and your partner must have in effect and provide proof of any one of the following:

• Designation of the partner as beneficiary for life insurance and retirement contract; or
• Designation of the partner as primary beneficiary in the your and your partner's will; or
• Documentation of one partner designating the other partner as his/her agent for:
  - personal relationship issues; or
  - health care decisions; or
  - health care agent.
  

3. Neither you nor your partner has filed a Termination of Domestic Partnership within the preceding 12 months.
4. To enroll an eligible partner, both you and your partner must complete and sign the PerfectHealth Statement of Domestic Partnership. Signatures must be witnessed and notarized. PerfectHealth reserves the right to make the final decision on the eligibility of the partner.

Please see Adding Dependents for more information.

- Child(ren) of a Domestic Partner
Your and/or partner's dependent children are eligible if the following are met:
1. The child(ren) is/are primarily dependent upon your and/or your partner for support; and a parent-child relationship exists between you and/or your partner and the child(ren) based on all of the conditions below:

• The child(ren) must be unmarried. They must live in the same household as you and your partner. Your home must be the primary place of residence;
• The child(ren) must be within the age limits stated in the "Who Are Eligible Dependents" section;
• You and/or your partner must assume full parental control, including any and all debts incurred by the child(ren) (i.e., charges for health care services and supplies); and
• You and/or your partner must:
• - be a biological parent;
  - have a court appointed legal relationship with the child(ren) (i.e., guardianship; adoption; foster child); or
  - be designated as the responsible party under a Qualified Medical Child Support Order (QMCSO).

Note: Dependency is required in accordance with the applicable Internal Revenue Service guidelines.
2. In the case of your and/or your partner's newborn child or enrolled dependent, such child is eligible for coverage from birth through the first 31 days of life as described in the Who Are Eligible Dependents section.
3. In the case of a full-time student, a full-time student is eligible for coverage when he/she meets the requirements of a full-time student as described in the Who Are Eligible Dependents section.
4. In the case of your and/or your partner's disabled dependent child, the disabled dependent child is eligible for coverage when he/she meets the requirements of a disabled dependent child as described in the Who Are Eligible Dependents section.

Please see Adding Dependents for more information.

- Termination of Domestic Partnership
If the partnership status changes and the partner is no longer eligible for coverage, the Covered Person must complete and file a Termination of Domestic Partnership Form has been submitted, you may not cover another partner for at least 12 months from the date of the status change.

Please see Removing Dependents for more information.

Terminating Coverage
For all health insurance plans we offer, you may terminate your coverage for any reason at any time. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively.

IMPORTANT: Once your health insurance coverage begins, your first two months of coverage are non-refundable. Therefore, if you choose to terminate coverage, you must wait until after your first two months of coverage to do so.

To terminate your health insurance coverage, contact our Administrative Office by fax email or postal mail and include the following in your request:
- Your full name
- Your Member ID number (located on the top right corner of your bill)
- Your desired effective date for the termination (you can only terminate as of the last day of a given month)
- Your reason for termination (for example: new job, moving, spouse insurance, etc.)

Termination requests cannot be made over the phone - we must receive them in writing.

Re-enrollment
Freelancers Union health insurance plans have been designed to encourage long-term participation. Therefore, if you terminate your coverage, you may be subject to a 9-month waiting period and fees if you choose to re-enroll.

If it has been less than 9 months since you terminated and you want to re-enroll:
We will waive the 9-month waiting period only if you can show that you have been continuously covered by a comparable health insurance plan. Such coverage must have commenced immediately upon dropping your coverage with Freelancers Union, and must have been terminated no more than 60 days before your new application for eligibility. As proof of prior coverage, you must provide a HIPAA Certificate or other written proof from the insurance company. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

-OR-

If you have not been continuously covered by a comparable health insurance plan during the entire period between dropping your coverage with Freelancers Union to no more than 60 days from when you start the eligibility application, you will be subject to the 9-month waiting period before you can re-enroll.

If it has been more than 9 months since you terminated:
You have satisfied the 9-month waiting period. If you choose to re-enroll, you will need to complete the eligibility application again and you will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

To re-enroll in any of our health insurance plans contact Member Services.

Reinstatement
Empire plans: If your coverage is terminated for non-payment, you can reinstate your coverage within 60 days of the effective date of the termination. To reinstate, you must contact the Administrative office and make a payment for all past due charges. Upon receipt of your payment, your coverage will be reinstated back to the effective date of the termination. Reinstatement requests received after 60 days from the effective date of the termination will not be honored.

PerfectHealth Plans: If your coverage is terminated for non-payment, you can reinstate your coverage within 31 days of the effective date of the termination. To reinstate, you must contact the Administrative office and make a payment for all past due charges. Upon receipt of your payment, your coverage will be reinstated back to the effective date of the termination. Reinstatement requests received after 31 days from the effective date of the termination will not be honored.

To request reinstatement of your coverage, contact the Administrative Office.

Pre-existing Conditions
A pre-existing condition is an injury or sickness that you have been diagnosed with or treated for in the last 6 months. If you consulted with a doctor, took medicine, or received other medical care or advice for the injury or sickness during the 6 months prior to becoming insured, your condition is considered pre-existing. Waiting periods may apply before you will be covered for further treatment or consultation.
Different health insurance carriers and plans handle diagnoses differently. If you think you have a pre-existing condition, we recommend that you check with your carrier (Empire or PerfectHealth) to determine if the specialists you see and the medications you take are covered.

The policy for pre-existing conditions differs by insurance company. Below is a snapshot of the policies for Empire and PerfectHealth. However, we recommend carefully reviewing your Benefits Booklet for more specific exclusions and limitations.
Empire Pre-existing Conditions Snapshot
Our Empire health insurance plans do not have any coverage restrictions or waiting periods for pre-existing conditions.

Pregnancy is not considered a pre-existing condition and genetic information may not be treated as a pre-existing condition in the absence of a diagnosis of the condition related to such genetic information.

PerfectHealth Pre-existing Conditions Snapshot
Pregnancy is considered a pre-existing condition. Additionally, if you have symptoms which would cause a person of ordinary prudence to seek medical advice, diagnosis, care or treatment within 6 months before becoming insured, those symptoms will be considered a pre-existing condition.

If you have been uninsured for more than 90 days before your enrollment date in one of Freelancers Union's PerfectHealth plans, there will be a waiting period of 12 months before a pre-existing condition is covered.

If you have had no gap in coverage or have been uninsured for a period of less than 90 days prior to enrolling with Freelancers Union, coverage for pre-existing conditions depends on how long you were enrolled in your previous plan. If you were covered under your previous plan for 12 months or more, treatment for pre-existing conditions will be covered with no waiting period. If you were covered under your previous plan for less than 12 months, the number of months you were covered on your previous plan will be credited toward your waiting period as follows: your waiting period will equal 12 months minus the number of months you were enrolled in your previous plan.

PerfectHealth will ask you for documentation of your previous coverage once you have enrolled. You may not be able to access coverage for pre-existing conditions until that paperwork is completed. In addition, PerfectHealth may have to authorize certain treatments or procedures before you receive them.

For questions about pre-existing conditions contact Member Services.

Open Enrollment
Dental Open Enrollment takes place once a year, in September, for coverage changes effective October 1. Current enrollees in any of our dental insurance plans can switch plans, add dependents, or drop dependents from their plans during the Open Enrollment period. If you are enrolled in health, life or disability insurance and have not yet enrolled in dental insurance, you can add dental insurance only during the Open Enrollment period. You will receive an email notification in advance of the Open Enrollment period.

Note: If you were enrolled in a Freelancers Union dental plan in the past and would like to re-enroll, you will be subject to a waiting period before you can re-enroll. See the Re-enrollment section below for more details.

Changing Plans
Once your coverage begins, you may switch to a different dental insurance plan only during the Open Enrollment period. You cannot switch plans at any other time of the year. Plan changes cannot be made retroactively.

Adding Dependents
You can cover your spouse, domestic partner, or dependent(s) on your dental insurance plan at the time you enroll. Otherwise, you can only add a spouse, domestic partner, or dependent to your plan during open enrollment or as the result of a qualifying event.
1. Open Enrollment: For all of the dental insurance plans we offer, the open enrollment period occurs in September of each year, for changes effective October 1. Before that period begins, you will receive an email notification. During open enrollment, you can add a spouse, domestic partner, or dependent(s).

2. Qualifying Events: For all of the dental insurance plans we offer, qualifying events are marriage, domestic partnership, termination of coverage, and a new child.

- Marriage: You may add a spouse within 30 days of the date of marriage. You must provide a marriage certificate or license. Coverage will be effective the first day of the next month after you complete the enrollment form. If you do not add a spouse within 30 days of your marriage, you must wait until the next open enrollment period to do so.

- Domestic Partnership: You may add a domestic partner to your plan within 30 days of the date you became eligible for domestic partner coverage. You must provide all eligibility materials (see below). Coverage will be effective the first day of the next month after you complete the enrollment form. If you do not add a domestic partner within 30 days of meeting the eligibility requirements for domestic partner coverage, you must wait until the next open enrollment period to do so.

- Loss of Coverage: You may add a spouse to your plan within 30 days of your spouse losing comparable dental insurance coverage. The effective date will be the first day of the next month after you complete the enrollment form. You must provide written proof of prior coverage from the insurance company. If more than 30 days have elapsed since your spouse lost prior coverage, you must wait until open enrollment to add your spouse to your plan.

- New Child: You may add a child within 30 days of a birth or an adoption. Coverage will begin the first day of the next month after you complete the enrollment form. If you do not add a child within 30 days of birth or adoption, you must wait until the next open enrollment period to do so.
Dependent child(ren) of a covered domestic partner may also be added to your dental insurance plan and are governed by the same terms and conditions that apply to a member's child(ren).

To add a dependent to your dental insurance plan due to a qualifying event, contact our Administrative Office.

Removing Dependents
For all dental insurance plans we offer, dependents may be terminated from your plan only during the Open Enrollment period or as the result of a qualifying event (including divorce, the termination of a domestic partnership, or if you cease to be a child's legal guardian). The effective date of the termination will be the last day of the month in which the termination is requested. If your dependent child reaches the age limit for the plan, Guardian will automatically terminate the child from your plan.

Upon termination of a domestic partnership, a Statement of Termination must be completed and filed with our Administrative Office. A new Declaration of Domestic Partnership cannot be filed for a period of at least twelve (12) months.

Note: Dependents terminated from a plan will be subject to the waiting period if they wish to re-enroll. Please see the Re-enrollment section below for more details.

To remove a dependent from your dental insurance plan, contact our Administrative Office. Termination requests cannot be made over the phone - we must receive them in writing.

Domestic Partner Coverage
Freelancers Union offers domestic partner coverage for the two group-rate dental plans available through the Guardian Life Insurance Company. This coverage extends to both same-sex and opposite-sex domestic partners and the children of covered domestic partners. The eligibility rules, enrollment guidelines and termination guidelines are outlined below.

Eligibility for Domestic Partnership:
In order to add a domestic partner to your dental insurance coverage you will be required to sign a Declaration of Domestic Partnership, acknowledging the following criteria:
1. you are each eighteen (18) years of age or older;
2. you reside together, having shared the same permanent residence for at least twelve (12) consecutive months, with the current intent to continue doing so indefinitely;
3. you are each other's sole domestic partner; are not married to anyone else nor have had another domestic partner within the prior twelve (12) months;
4. you are not related by blood closer than would otherwise prohibit legal marriage in the state of residence;
5. you are financially interdependent evidenced by at least four (4) of the following:
a. joint bank accounts
b. joint credit cards
c. joint ownership of a residence
d. joint mortgage or lease
e. common household expenses (e.g. utility bills)
f. granting each other power of attorney
g. designating each other as sole beneficiary/executor or evidence of other joint financial responsibilities.
6. you are jointly financially responsible for basic living expenses, including food, shelter and medical expenses;
7. the date your domestic partnership became effective.

The Declaration of Domestic Partnership will be available when you enroll online. If you've already completed the online enrollment and you wish to add a domestic partner to your plan due to a qualifying event, you can request a Declaration of Domestic Partnership by calling 866-420-5807 or emailing benefits@freelancersunion.org.

The Declaration of Domestic Partnership must be printed, signed, witnessed, and submitted to our Administrative Office via email, fax, or mail.

The dependent children of a covered domestic partner may also be added to your dental insurance plan. Dependent children of a domestic partner are governed by the same terms and conditions that apply to a member's children. Please see Adding Dependents.

Enrollment Guidelines:
A qualified domestic partner and his or her child(ren) can be added by completing the Declaration of Domestic Partnership within 30 days of a member's initial eligibility date. With respect to an insured member who acquires a domestic partner after their initial enrollment, the Declaration must be signed within 30 days of meeting the eligibility for domestic partnership. If the declaration is not completed within this 30 day period, you must wait until the open enrollment period to add your domestic partner to your dental plan. Children of a domestic partner can only be enrolled in your plan if the domestic partner is also enrolled.

Termination Guidelines for Domestic Partner Coverage:
Coverage extended under the domestic partnership will end when:
- the member dies; NOTE: there are no survivor benefits, conversion privileges, and no election of COBRA coverage for the domestic partner and/or his or her children.
- there is a change in one or more of the minimum eligibility standards noted in the eligibility section above.

With respect to the children of a domestic partner, coverage ends upon the death of the enrolled member; upon termination of the domestic partnership; or upon loss of eligibility as a dependent child under the terms of the contract.

Upon termination of a domestic partnership, a Statement of Termination must be completed and filed with our administrative office. A new Declaration of Domestic Partnership cannot be filed for a period of at least twelve (12) months.

Terminating Coverage
For all dental insurance plans we offer, you may terminate your coverage for any reason at any time. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively.

NOTE: if you wish to remove dependents from your plan but continue your own coverage, different rules apply.

IMPORTANT: Once your dental insurance coverage begins, your first two months of coverage are non-refundable. Therefore, if you choose to terminate coverage, you must wait until after your first two months of coverage to do so.

To terminate your dental insurance coverage, contact our Administrative Office by email, fax, or mail, and include the following in your request:
- Your full name
- Your Member ID number (located on the top right corner of your bill)
- Your desired effective date for the termination (you can only terminate as of the last day of a given month)
- Your reason for termination (for example: new job, moving, spouse insurance, etc.)

Termination requests cannot be made over the phone - we must receive them in writing.

Re-enrollment
Freelancers Union insurance plans have been designed to encourage long-term participation; therefore, if you terminate your enrollment, you will be subject to waiting periods and fees if you choose to re-enroll.

In the event you (and/or your dependents) terminate your participation in any of our dental insurance plans, in order to re-enroll, you (and/or your dependents) must wait for the Open Enrollment period that occurs a minimum of 12 months after your termination date. For example, if you terminate coverage in January 2006, the earliest date to re-enroll is October 2007. There is no exception to this rule.

If you wish to re-enroll in dental insurance and you have completed the waiting period:

- If you are not enrolled in any other Freelancers Union insurance plan (health, life and/or disability insurance) at the time you wish to re-enroll in dental insurance, you must first complete the eligibility application. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

- If you are enrolled in health, life, and/or disability insurance at the time you wish to re-enroll in dental insurance, you will not need to complete the eligibility application again.

To re-enroll in any of our dental insurance plans contact Member Services.

Reinstatement
If your coverage is terminated for non-payment, you can reinstate your coverage within 30 days of the effective date of termination. To reinstate, you must contact the administrative office and make payment for all past due premium. Upon receipt of your payment, your coverage will be reinstated back to the effective date of the termination. Reinstatement requests received after 30 days from the effective date of the termination will not be honored.

Pre-existing Conditions
The Freelancers Union dental insurance plans do not limit coverage for pre-existing conditions.

Open Enrollment
There is no Open Enrollment period for disability insurance. If you are not enrolled in any other Freelancers Union insurance plan (health, dental or life insurance), and you wish to enroll in disability insurance, you must first complete the eligibility application. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

If you are enrolled in health, dental, and/or life insurance at the time you wish to enroll in disability insurance, you do not need to complete the eligibility application again. You may enroll in disability insurance effective the first day of the next month after your enrollment is processed.

Changing Benefit Levels
Coverage Level: If you wish to change to a higher level of coverage, you must provide Guardian with proof that you are insurable for the new level of coverage. Guardian will contact you to request any necessary proof of insurability to change your coverage level. You are not entitled to the new level of coverage unless you receive written approval from Guardian.

Elimination Period: The elimination period for disability insurance is the number of days you must wait after becoming disabled before you will receive disability benefits.

If you wish to change from a 90 day to a 30 day Elimination Period, you must provide Guardian with proof that you are insurable for the new level of coverage. Guardian will contact you to provide any necessary proof of insurability to change your elimination period. You are not entitled to the new level of coverage unless you receive written approval from Guardian. The change in elimination period will take effect on the date that Guardian approves your request in writing, provided you are actively-at-work on a full-time basis on that date. If you are not actively-at-work on a full-time basis on that date, the change will take effect on the date you return to active work on a full-time basis. But, the change will not apply to a recurring disability.

If you wish to change from a 30 day Elimination Period to a 90 day Elimination Period, you do not need to provide proof of insurability. We will notify you when your change in elimination period will take effect. To change your benefit level or elimination period, contact our Administrative Office.

Adding Dependents
Disability insurance is only available to eligible members of Freelancers Union. Dependents may not be added to any of our disability plans.

Terminating Coverage
For all disability insurance plans we offer, you may terminate your coverage for any reason at any time. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively.

To terminate your coverage, contact our Administrative Office by email, fax, or mail and include the following in your request:
- Your full name
- Your Member ID number (located on the top right corner of your bill)
- Your desired effective date for the termination (you can only terminate as of the last day of a given month)
- Your reason for termination (for example: new job, moving, etc.)

Termination requests cannot be made over the phone - we must receive them in writing.

Re-enrollment
If you are not enrolled in any other Freelancers Union insurance plan (health, dental or life insurance), and you wish to re-enroll in disability insurance, you must first complete the eligibility application. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

If you are enrolled in health, dental, and/or life insurance at the time you wish to re-enroll in disability insurance, you will not need to complete the eligibility application again. You may enroll in disability insurance effective the first day of the next month after your enrollment is processed.

To re-enroll in any of our disability insurance plans contact Member Services.

Reinstatement

If your coverage is terminated for non-payment, you can reinstate your coverage within 60 days of the effective date of the termination. To reinstate, you must contact the Administrative Office and make a payment for all past due charges. Upon receipt of your payment, your coverage will be reinstated back to the effective date of the termination. Reinstatement requests received after 60 days from the effective date of the termination will not be honored.

Pre-existing Conditions
A pre-existing condition is a sickness or injury, including all related conditions and complications, for which, in the "look back period" (see below), you received advice or treatment from a doctor; took prescribed drugs; or received other medical care of treatment, including consultation with a doctor. Pregnancy qualifies as a pre-existing condition if it precedes the date that your insurance under this plan starts.

The "look back period" is the three-month period before the latest of the following: (a) the effective date of your insurance under this plan; (b) the effective date of a change that increases the benefits payable by this plan; and (c) the effective date of a change in your benefit election that increases the benefit payable by this plan.

This plan will not cover a disability caused by any pre-existing condition you had within 12 months prior to being insured under this plan; you can receive benefits for this condition after you have been insured under this plan for 12 months and have completed at least one full day of active work after the 12 month waiting period. If this plan replaces an existing disability insurance plan, Guardian will credit the number of months you were covered under your previous plan and under Guardian's plan to determine whether you have met the requirement for 12 months.

You may become disabled due to a pre-existing condition after: (a) a change which provides for an increase in the benefits payable by this plan; or (b) a change in your benefit election which increases the benefit payable by this plan. In this case, your benefit will be limited to the amount that would have been payable had the change not taken place. This limit does not apply if your disability starts after you complete at least one full day of active work after the change has been in force for 12 months in a row. Guardian will cover any disability that starts before your insurance under this plan.

For questions about pre-existing conditions contact Member Services.

Open Enrollment
There is no Open Enrollment period for life insurance. If you are not enrolled in any other Freelancers Union insurance plan (health, dental or disability insurance), and you wish to enroll in life insurance, you must first complete the eligibility application. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

If you are enrolled in health, dental, and/or life insurance at the time you wish to enroll in life insurance, you do not need to complete the eligibility application again. You may enroll in disability insurance effective the first day of the next month after your enrollment is processed.

Changing Benefit Levels
If you wish to change to a different level of coverage, you must provide Guardian with proof that you are insurable for the new level of coverage. Guardian will contact you to provide any necessary proof of insurability to change your coverage level. You are not entitled to the new level of coverage unless you receive written approval from Guardian.

To change your life insurance benefit level, contact our Administrative Office.

Adding Dependents
At the time you enroll, you may also purchase coverage for your spouse or your child(ren). You may not purchase coverage for a dependent unless you also purchase coverage for yourself.

If you have already enrolled in life insurance and would like to purchase life insurance for your spouse or child(ren), contact our Administrative Office.

Terminating Coverage
For all life insurance plans we offer, you may terminate your coverage, or your dependents' coverage, for any reason at any time. The effective date of the termination will be the last day of the month in which the termination is requested. Any payments you have made for future months of coverage will be refunded. Terminations cannot be made retroactively.

To terminate your coverage, contact our Administrative Office by email, fax, or mail and include the following in your request:
- Your full name
- Your Member ID number (located on the top right corner of your bill)
- Your desired effective date for the termination (you can only terminate as of the last day of a given month)
- Your reason for termination (for example: new job, moving, spouse insurance, etc.)

Termination requests cannot be made over the phone - we must receive them in writing.

Re-enrollment
If you are not enrolled in any other Freelancers Union insurance plan (health, dental or disability insurance), and you wish to re-enroll in life insurance, you must first complete the eligibility application. You will be charged an Application Fee. You will also be charged the annual Access Fee if it has been more than one year since you last paid an Access Fee.

If you are enrolled in health, dental, and/or disability insurance at the time you wish to re-enroll in life insurance, you will not need to complete the eligibility application again. You may enroll in life insurance effective the first day of the next month after your enrollment is processed.

To re-enroll in any of our life insurance plans contact Member Services.

Reinstatement

If your coverage is terminated for non-payment, you can reinstate your coverage within 60 days of the effective date of the termination. To reinstate, you must contact the Administrative office and make a payment for all past due charges. Upon receipt of your payment, your coverage will be reinstated back to the effective date of the termination. Reinstatement requests received after 60 days from the effective date of the termination will not be honored.

Note: Rules may change at any time without prior notice. If the above rules & procedures differ from what is listed in your Benefits Booklet, your Benefits Booklet prevails.