Legal Plan

Eligibility and Plan Participation

ELIGIBILITY
You are eligible to participate in the Group Legal Plan if you are an active, part-time or full-time employee of the Company who is regularly scheduled to work for at least 20 hours per week.

COVERAGE FOR YOUR ELIGIBLE DEPENDENTS
Your eligible dependents become covered for Group Legal Plan benefits at the same time you do. 

Your eligible dependents include: 

  • your spouse or domestic partner; and
  • your unmarried dependent children.       

Definition of “Spouse”: In order to qualify as an eligible dependent, your spouse must be legally married to you in accordance with the state in which you reside. 

Definition of “Domestic Partner”: In order to qualify as an eligible dependent, your domestic partner must be registered as such with the Plan Administrator and the Claim Administrator.

Definition of “Children”: For plan purposes, your children include your unmarried dependent children under the age of 19 (or under age 25 if a full-time student) who reside in your household. 

WHEN YOUR COVERAGE BEGINS
If you want to participate in the Group Legal Plan, you should enroll within 31 days of the date that you are hired. If you enroll within 31 days of the date that you are hired, coverage for you and your eligible dependents will begin as of your date of hire. 

If you do not enroll in the plan when you are first eligible to do so, you will have to wait until the next open enrollment period (see Annual Open Enrollment Period below). 

Actively at Work
You must be actively at work on the date your participation begins. You are considered to be “actively at work” if you are performing the duties of your job at the Company’s place of business, or at any other place that the Company’s business requires you to go. If you are not actively at work on the date that your participation would otherwise begin, your participation will be postponed until you are actively at work. 

PAYING FOR YOUR BENEFITS
Participation in the Group Legal Plan is completely voluntary. You pay the cost of your coverage through convenient after-tax payroll deduction contributions. These contributions come out of your pay after federal and (in most cases) state and local taxes are deducted, so they will not reduce your taxable income. 

ANNUAL OPEN ENROLLMENT PERIOD
In the fall of each year, the Company sponsors an open enrollment period. During this period, you can elect to enroll for or cancel your Group Legal Plan coverage. This election will go into effect on the next January 1. 

You cannot cancel your Group Legal Plan coverage during the year. This coverage will automatically continue unless you elect to cancel it during the next annual open enrollment period.

LAYOFF OR LEAVE OF ABSENCE
You may elect to continue your Group Legal Plan coverage if you are temporarily laid off or go on an authorized leave of absence for non-FMLA* reasons. If you are in an unpaid status, the contributions you would otherwise have paid towards the cost of your coverage will be suspended during the first four months of leave. (Please refer to the repayment options described below). 

*Family and Medical Leave Act

Family and Medical (FMLA) Leave: You may elect to continue your Group Legal Plan coverage during an authorized Family and Medical (FMLA) leave of absence. If you are on an unpaid FMLA leave or receiving disability pay, the contributions you would otherwise have paid towards the cost of your coverage will be suspended during the first four months of leave. 

You have two options for repayment: 

  • You can pay your contributions during your leave via check. Checks should be made payable to “Tufts Health Plan” and mailed to: Human Resources, Benefits Specialist, Tufts Health Plan, 705 Mount Auburn Street, Watertown, MA 02472.
  • You can pay your contributions upon your return to work. You will receive an email from Human Resources informing you of the amount you need to repay. You will be given the option to pay this amount either via Payroll (in one pay period or over a few pay periods) or to write a check for the whole amount. 

If you do not return from your leave of absence, you will be responsible for any benefit contributions you have not made during your leave. Tufts Health Plan will deduct the amount you owe from your last check. If you do not receive a last check, a bill will be sent directly to your home and you will be required to pay the entire amount within 14 calendar days. 

You should contact Human Resources for more information concerning the continuation of your benefit coverage during an authorized FMLA leave. 

Military Leave: Reservists who are called to active duty with the Armed Forces of the United States have special benefit continuation and reemployment rights under the law (see Administrative Information). In addition, the federal Family and Medical Leave Act (FMLA) was amended to add two new leave rights related to military service, effective January 16, 2009: 

  • Active Duty Leave: Eligible employees are entitled to up to 12 weeks of leave because of “any qualifying exigency” due to the fact that the spouse, son, daughter, or parent of the employee is on active duty, or has been notified of an impending call to active duty status, in support of a contingency operation.
  • Injured Service Member Leave: An eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member who is recovering from a serious illness or injury sustained in the line of duty on active duty is entitled to up to 26 weeks of leave in a single 12-month period to care for the service member. The employee is entitled to a combined total of 26 weeks for all types of FMLA leave in the single 12-month period.