Everett School Employee Benefit Trust

Appeal # 04-003

Employee presented her case in the issue of continued dependent coverage seven months after the dissolution of her marriage. She did not notify the benefits department at the time the divorce was final as she wanted to continue coverage. Not only were contributions deducted from her pay but the Benefit Trust made contributions as well. Her dependents should have been electing COBRA coverage. The difference in costs left her owing a total of $4,088.44 which needed to be repaid to the Benefit Trust.

The employee presented copious notes where she purportedly contacted Benefits to cancel insurance for her dependents. She believes that the mistakes were made in Human Resources. After some discussion she asked the Trust to forgive what she owes.

Since the Trust was not harmed financially and it would be costly to pursue this issue, it was decided not to collect from the employee. She will be sent a letter notifying her of the decision and urged to become familiar with the benefit information that can be found on the web and to take responsibility for knowing timelines, etc.

Appeal # 04-02

The Trust does not hear appeals from Pacific Care, Group Health or WDS. This was a Pacific Care matter and the employee needs to work through the Pacific Care process for appeal. The trust does not overturn the decision made by an insured provider.

Appeal # 04-004

Employee requested newborn be added 14 days past the 60 day deadline. It was decided that the child can be added at open enrollment or at status change of parent who has been part-time classified and is going to full-time certificated.