Forms
Health & Welfare Fund
Paraprofessional Health & Welfare Fund
×
Funeral Expense Benefit Application
Instructions:
If you have paid the funeral expenses of a Covered Teacher who has recently passed away, you may be eligible to make application for the benefit.
In the event that funeral expenses are incurred as a result of the death of a person who is a Covered Teacher at the time of his/her death, the Fund will pay a funeral expense benefit equal to the amount of such expense, but not exceeding four thousand five hundred dollars ($4,500).
The Fund will make payment of this funeral expense benefit to the estate of the Covered Teacher or to a person equitably entitled thereto, in the opinion of the Trustees, upon satisfactory proof of payment of such expense.
If you wish to apply for the benefit, please complete the application and return it with a copy of the death certificate and receipt of bills. Please feel free to call if you have any questions.
×
Hearing Aid Benefit Application
Instructions
IMPORTANT: Read and follow the instructions on this form.
If a Covered Teacher or Eligible dependent requires a hearing aid, the charge for the hearing aid up to a maximum of $5,000 ($2,500 per ear) will be paid for by the Fund directly to the supplier provided the following requirements are met:
-
- The eligible person has undergone an Audiology Test, which has been authorized by a licensed physician, conducted at an appropriate hospital/facility; and the audiology report(s) and graph(s) are accompanied with the benefit request.
- The invoice issued for the hearing aid is by the Audiology Department of an appropriate hospital/facility or by a supplier recommended by the Audiology Department; and that the invoice accompanies the benefit request.
Please note that this benefit does not include payment for any portion of the charge made by the hospital or facility for the Audiology Test. The hearing aid benefit will cover the cost of the hearing aid itself – no hearing aid accessories, additional fees, etc.
A HEARING AID BENEFIT WILL NOT BE PAID FOR HEARING AIDS NOT
FOLLOWING THE ABOVE MENTIONED TERMS, NOR FOR A HEARING AID OF
THE SAME PRESCRIPTION AS ONE PREVIOUSLY PAID FOR BY THE FUND FOR
THE SAME PATIENT AND THE SAME EAR WITHIN A FIVE YEAR PERIOD
This benefit does not pay for repairs nor does it pay for replacement of a lost or damaged hearing aid, so recipients may want to insure their hearing aid against loss or damage.
×
Hospitalization Income Supplement Benefit Form
If a Covered Teacher is confined to a hospital because of illness or injury for three or more consecutive days, the Covered Teacher can receive the Hospitalization Income Supplement benefit beginning with the third day of hospitalization.
This benefit is payable up to 52 weeks for each hospital stay, as long as the member remains eligible.
The amount of the Income Supplement is as follows:
Consecutive Days Amount
In a Hospital of Benefit
0 – 2 None
3 – 6 $75
7 – 13 $150
14 – 20 $300
21 – 27 etc. $450 etc.
If you are confined to the hospital for three or more consecutive days, obtain a claim form from the Fund Office or print from the attachment on line. You need not wait until you are discharged from the hospital to print or request your claim form, although you should not submit the claim until you are discharged.
Instructions
Please complete the Claim Form in its entirety but only complete the block at the top of the Hospital Verification Form.
Return both forms to us. We’ll take care of contacting the hospital involved in each case and we also verify your “Covered Teacher” status.
Obviously, the sooner you mail us back the forms, the sooner we can proceed with our part. Please do not divert from this procedure as it can only delay your benefit.
Also, the Internal Revenue Service has determined that this type of benefit represents taxable income. You should then, report the income on your income tax form for the year in which the benefit is received.
×
MedicAlert Benefit Application
The Plan will pay for one MedicAlert ID if you or a family member has a medical condition that needs to be identified in an emergency situation.
Instructions
Please review the attached forms, complete the appropriate form carefully and clearly and return it to:
B.T.U. Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198
Do not send the form to MedicAlert.
However, before you complete and return your form to us for processing, you should be aware that although the Boston Teachers Union Health and Welfare Fund will pay to the MedicAlert Foundation International, their charge for your MedicAlert membership, and will forward your MedicAlert Enrollment Form, or otherwise, to the MedicAlert Foundation, your compliance with the conditions and instructions on the MedicAlert Enrollment Form and the service provided by the Foundation are not responsibilities of the Fund.
Please review your completed form for accuracy before sending it to us.
Your benefit includes the basic MedicAlert ID. If you select a product other than the basic stainless steel type, you must enclose a check payable to the B.T.U. Health and Welfare Fund for the difference in cost.
Please sign and date the displayed letter and return it with your completed form.
×
KidSmart MedicAlert Benefit Application
The Plan will pay for one MedicAlert ID if you or a family member has a medical condition that needs to be identified in an emergency situation.
Instructions
Please review the attached forms, complete the appropriate form carefully and clearly and return it to:
B.T.U. Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198
Do not send the form to MedicAlert.
However, before you complete and return your form to us for processing, you should be aware that although the Boston Teachers Union Health and Welfare Fund will pay to the MedicAlert Foundation International, their charge for your MedicAlert membership, and will forward your MedicAlert Enrollment Form, or otherwise, to the MedicAlert Foundation, your compliance with the conditions and instructions on the MedicAlert Enrollment Form and the service provided by the Foundation are not responsibilities of the Fund.
Please review your completed form for accuracy before sending it to us.
Your benefit includes the basic MedicAlert ID. If you select a product other than the basic stainless steel type, you must enclose a check payable to the B.T.U. Health and Welfare Fund for the difference in cost.
Please sign and date the displayed letter and return it with your completed form.
×
Funeral Expense Benefit Application
Instructions
If you have paid the funeral expenses of a Covered Paraprofessional who has recently passed away, you may be eligible to make application for the benefit.
In the event that funeral expenses are incurred as a result of the death of a person who is a Covered Paraprofessional at the time of his/her death, the Fund will pay a funeral expense benefit equal to the amount of such expense, but not exceeding four thousand five hundred dollars ($4,500).
The Fund will make payment of this funeral expense benefit to the estate of the Covered Paraprofessional or to a person equitably entitled thereto, in the opinion of the Trustees, upon satisfactory proof of payment of such expense.
If you wish to apply for the benefit, please complete the application and return it with a copy of the death certificate and receipt of bills. Please feel free to call if you have any questions.
×
Hearing Aid Benefit Application
Instructions
IMPORTANT: Read and follow the instructions on this form.
If a Covered Paraprofessional or Eligible dependent requires a hearing aid, the charge for the hearing aid up to a maximum of $5,000 ($2,500 per ear) will be paid for by the Fund directly to the supplier provided the following requirements are met:
-
- The eligible person has undergone an Audiology Test, which has been authorized by a licensed physician, conducted at an appropriate hospital/facility; and the audiology report(s) and graph(s) are accompanied with the benefit request; and
- The invoice issued for the hearing aid is by the Audiology Department of an appropriate hospital/facility or by a supplier recommended by the Audiology Department; and that the invoice accompanies the benefit request.
Please note that this benefit does not include payment for any portion of the charge made by the hospital or facility for the Audiology Test. The hearing aid benefit will cover the cost of the hearing aid itself – no hearing aid accessories, additional fees, etc.
A HEARING AID BENEFIT WILL NOT BE PAID FOR HEARING AIDS NOT
FOLLOWING THE ABOVE MENTIONED TERMS, NOR FOR A HEARING AID OF
THE SAME PRESCRIPTION AS ONE PREVIOUSLY PAID FOR BY THE FUND FOR
THE SAME PATIENT AND THE SAME EAR WITHIN A FIVE YEAR PERIOD
This benefit does not pay for repairs nor does it pay for replacement of a lost or damaged hearing aid, so recipients may want to insure their hearing aid against loss or damage.
×
Hospitalization Income Supplement Benefit Form
If a Covered Paraprofessional is confined to a hospital because of illness or injury for three or more consecutive days, the Covered Paraprofessional can receive the Hospitalization Income Supplement benefit beginning with the third day of hospitalization.
This benefit is payable up to 52 weeks for each hospital stay, as long as the member remains eligible.
The amount of the Income Supplement is as follows:
Consecutive Days Amount
In a Hospital of Benefit
0 – 2 None
3 – 6 $75
7 – 13 $150
14 – 20 $300
21 – 27 etc. $450 etc.
If you are confined to the hospital for three or more consecutive days, obtain a claim form from the Fund Office or print from the attachment on line. You need not wait until you are discharged from the hospital to print or request your claim form, although you should not submit the claim until you are discharged.
Instructions
Please complete the Claim Form in its entirety but only complete the block at the top of the Hospital Verification Form.
Return both forms to us. We’ll take care of contacting the hospital involved in each case and we also verify your “Covered Paraprofessional” status.
Obviously, the sooner you mail us back the forms, the sooner we can proceed with our part. Please do not divert from this procedure as it can only delay your benefit.
Also, the Internal Revenue Service has determined that this type of benefit represents taxable income. You should then, report the income on your income tax form for the year in which the benefit is received.
×
MedicAlert Benefit
The Plan will pay for one MedicAlert ID if you or a family member has a medical condition that needs to be identified in an emergency situation.
Instructions
Please review the attached forms, complete the appropriate form carefully and clearly and return it to:
B.T.U. Paraprofessional Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198
Do not send the form to MedicAlert.
However, before you complete and return your form to us for processing, you should be aware that although the Boston Teachers Union Paraprofessional Health and Welfare Fund will pay to the MedicAlert Foundation International, their charge for your MedicAlert membership, and will forward your MedicAlert Enrollment Form, or otherwise, to the MedicAlert Foundation, your compliance with the conditions and instructions on the MedicAlert Enrollment Form and the service provided by the Foundation are not responsibilities of the Fund.
Please review your completed form for accuracy before sending it to us.
Your benefit includes the basic MedicAlert ID. If you select a product other than the basic stainless steel type, you must enclose a check payable to the B.T.U. Paraprofessional Health and Welfare Fund for the difference in cost.
Please sign and date the displayed letter and return it with your completed form.
×
KidSmart MedicAlert Benefit
The Plan will pay for one MedicAlert ID if you or a family member has a medical condition that needs to be identified in an emergency situation.
Instructions
Please review the attached forms, complete the appropriate form carefully and clearly and return it to:
B.T.U. Paraprofessional Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198
Do not send the form to MedicAlert.
However, before you complete and return your form to us for processing, you should be aware that although the Boston Teachers Union Paraprofessional Health and Welfare Fund will pay to the MedicAlert Foundation International, their charge for your MedicAlert membership, and will forward your MedicAlert Enrollment Form, or otherwise, to the MedicAlert Foundation, your compliance with the conditions and instructions on the MedicAlert Enrollment Form and the service provided by the Foundation are not responsibilities of the Fund.
Please review your completed form for accuracy before sending it to us.
Your benefit includes the basic MedicAlert ID. If you select a product other than the basic stainless steel type, you must enclose a check payable to the B.T.U. Paraprofessional Health and Welfare Fund for the difference in cost.
Please sign and date the displayed letter and return it with your completed form.