Many spouses of Local 246 members are eligible to receive benefits through another group plan, which would be his/her primary plan. If your spouse is eligible for benefits under another plan, the Fund’s coordination of benefits regulations require that:
- Your spouse must submit his/her own claim to his/her primary plan first.
- After the claim is paid by your spouse’s primary plan, a claim for any unpaid balance may be submitted to this Fund (secondary) along with the explanation of benefits received from your spouse’s plan.
- Any additional benefits that may be due under this Fund for this claim will be paid by this Fund.
- The total amount paid for each claim from any group plan under which your spouse is eligible and from this Fund cannot exceed 100% of the total amount of the claim.
- When two group plans exist, claims for eligible dependent children are paid by the primary coverage first. Who is primary is determined by the day and month of the birth of the persons carrying the coverage. The year is not counted. The person born on the earlier month and day is primary.
The Fund has the right to go back and recoup any money it paid out for claims incorrectly billed to this Fund as primary coverage, when in fact it was secondary. If your spouse is covered under another group plan through an employer or as a retiree under a group program, please fill out the Coordination of Benefits form and return it to this Fund Office either by mail or fax at (212) 385-1859.