Health Insurance

2023 SEIU Union Health Insurance Eligibility, Cost, and Coverage

Mira Research Team
Mira Research Team23 Jul 2023

SEIU union is a huge organization with four main benefits funds and 400,000 enrollees. If you are confused after reading through the benefits package, you're not alone. 

We spent a week digesting SEIU materials, researching eligibility criteria, reading member reviews and creating this comprehensive guide for you. SEIU is one of the most affordable ways for you to get healthcare if eligible. However, if the monthly premiums are cost prohibitive or you are not eligible for SEIU union health insurance, Mira is an excellent option at $45/month. 

Overview of SEIU Health Insurance

The Service Employees International Union (SEIU) is a pioneering labor organization representing over 2 million workers in the United States and Canada across diverse occupations including healthcare, public services, and property services. Members of SEIU have access to a unique and robust healthcare plan borne out of the collective bargaining power of the union. The SEIU Health Plan is collectively financed by contributions from employers and members, with administration handled by a joint board of union and employer trustees.

To become a member of SEIU and access its health plan, an individual must first be employed in a job or industry represented by SEIU in their region. As part of collective bargaining agreements with employers, union dues are typically deducted automatically from salary, ensuring a smooth transition to membership for new joiners. The SEIU represents workers in a wide range of occupations, including:

  • Healthcare: Nurses, home health aides, nursing home workers, doctors, and other healthcare professionals.
  • Government: Public employees, including teachers, firefighters, police officers, and other government workers.
  • Property Services: Janitors, security guards, and other property service workers.
  • Education: Teachers, education support professionals, and other education workers.
  • Social Services: Social workers, child care workers, and other social service workers.
  • Labor and Industries: Manufacturing, retail, and other industrial workers.
  • Transportation: Bus drivers, truck drivers, and other transportation workers.

What are the eligibility requirements for SEIU union health insurance?

Eligibility criteria for SEIU Union Insurance varies across different funds within the SEIU National Benefit Fund, but there are some commonalities. Generally, members become eligible for benefits after they have been working for a contributing employer for a certain amount of time, and the employer has made contributions to the fund. The specific criteria for each fund are as follows:

Base Eligibility CriteriaRequirement
EmploymentMust be a full-time or part-time SEIU member who works at least 20 hours per week.
Health and Welfare FundMust be enrolled in one of SEIU's health and welfare funds.
AgeMust be at least 18 years old.
CitizenshipMust be a U.S. citizen or a legal permanent resident.
Immigration StatusMust have a valid work authorization.

1. 1199SEIU National Benefit Fund: Members are generally eligible for benefits after they have been working for a contributing employer for 90 days or more, and the employer has made contributions to the fund for 30 days or more.
2. 1199SEIU Greater New York Benefit Fund: Similar to the National Benefit Fund, members are generally eligible for benefits after they have been working for a contributing employer for 90 days or more, and the employer has made contributions to the fund for 30 days or more.
3. 1199SEIU Greater New York Benefit Fund for New Jersey Members: Members become eligible for benefits after they have been working for a contributing employer for 180 days or more, except for Genesis and Actor’s Fund employees, who become eligible after 90 days.
4. 1199SEIU Home Care Benefit Fund: Members are eligible for health benefits once they have been working for a contributing employer for 100 hours or more per month for two consecutive months. This is followed by a one calendar month "waiting period."
5. 1199SEIU Licensed Practical Nurses Welfare Fund: Eligibility for health benefits is granted to full-time or part-time Licensed Practical Nurses of the City of New York Health and Hospitals Corporation.

Fund NameFund Eligibility Criteria
1199SEIU National Benefit FundWorking for a contributing employer for 90+ days with the employer contributing for 30+ days
1199SEIU National Benefit Fund for Rochester MembersWorking for a contributing employer for 90+ days with the employer contributing for 30+ days
1199SEIU Greater New York Benefit FundWorking for a contributing employer for 90+ days with the employer contributing for 30+ days
1199SEIU Greater New York Benefit Fund for New Jersey MembersWorking for a contributing employer for 180+ days (Genesis and Actor’s Fund employees 90+ days)
1199SEIU Home Care Benefit FundWorking 100+ hours/month for a contributing employer for two consecutive months
1199SEIU Licensed Practical Nurses Welfare FundFull-time or part-time Licensed Practical Nurse of the City of New York Health and Hospitals Corporation

This information is crucial for potential members as it provides a clear picture of the eligibility requirements for the different funds within SEIU Union Insurance, enabling them to assess whether their current employment situation matches these criteria.

What do I do if I am not qualified for SEIU health insurance?

If you do not qualify for SEIU health insurance, there are several other options to consider:

1. Employer-Sponsored Health Insurance: If you're employed, check to see if your employer offers a health insurance plan.
2. Individual Market Plans: You can purchase a plan directly from an insurance company or through a broker. These can be explored via the Health Insurance Marketplace during the open enrollment period, or a Special Enrollment Period if you qualify.
3. Mira: a membership plan allows you to get affordable essential care for as little as $45/month.
3. Medicaid or Children's Health Insurance Program (CHIP): If your income is low, you may qualify for these state and federal programs.
4. Catastrophic Health Plans: If you're under 30, you might be eligible for a catastrophic health plan – a type of insurance that protects you from very high costs in a worst-case health scenario.
5. Health Sharing Plans: These are cooperative groups, where members share each other's health costs.
6. Short-term Health Insurance: These temporary policies are typically for a few months to a year, but they do not offer comprehensive coverage.

How much does SEIU health insurance cost?

Because each region has its own SEIU health insurance plan, and each employer has a different contribution level to the plan, the premium you pay will vary depending on the plan offered by your local SEIU. We analyze popular SEIU plans and found that the average monthly premium is $149-$254 for an individual and $482-$650 for a family of 3. Example of SEIU health insurance plan premiums:

County of Sonoma 2023

Coverage LevelMedical PlanMonthly Employee CostYearly Employee Cost
EmployeeCounty Health Plan EPO$217.24$2606.88
EmployeeCounty Health Plan PPO$443.28$5319.36
EmployeeKaiser Permanente Traditional HMO$103.34$1240.08
Employee + 1County Health Plan EPO$385.76$4629.12
Employee + 1County Health Plan PPO$843.16$10117.92
Employee + 1Kaiser Permanente Traditional HMO$207.68$2492.16
Employee + 2 or moreCounty Health Plan EPO$505.72$6068.64
Employee + 2 or moreCounty Health Plan PPO$1150.32$13803.84
Employee + 2 or moreKaiser Permanente Traditional HMO$295.78$3549.36
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Syracuse University 2023

Coverage LevelMedical PlanMonthly Employee CostYearly Employee Cost
Employee OnlySUBlue$155.13$1861.56
Employee OnlySUOrange$150.61$1807.32
Employee OnlySUPro$141.47$1697.64
Employee + Spouse/Domestic PartnerSUBlue$352.53$4230.36
Employee + Spouse/Domestic PartnerSUOrange$342.37$4110.44
Employee + Spouse/Domestic PartnerSUPro$321.41$3856.92
Employee + Child(ren)SUBlue$309.27$3711.24
Employee + Child(ren)SUOrange$300.36$3604.32
Employee + Child(ren)SUPro$281.97$3383.64
Employee + Spouse/Domestic Partner + Child(ren)SUBlue$501.56$6018.72
Employee + Spouse/Domestic Partner + Child(ren)SUOrange$487.10$5845.20
Employee + Spouse/Domestic Partner + Child(ren)SUPro$457.28$5487.36

What does SEIU Union health insurance cover?

The national benefits fund is the largest and most comprehensive plan for SEIU members. The plan covers a comprehensive list of services including medical, vision, dental, accident, etc. It is important to note that just because a service is covered doesn't mean it is free for you. There might be costs such as copay, out-of-pocket before meeting deductible, and co-insurance that you are responsible for. 

Benefits Category2023 Coverage DetailsPrior Authorization Required
Medical ServicesTreatment in a doctor’s office, clinic, hospital, or home, well-child care, immunizations, acupuncture, allergy treatment, chiropractic, dermatology, physical/occupational/speech therapy, etc.No
Prescription DrugsCoverage for FDA-approved prescription medications for FDA-approved indications.No
Outpatient Hospital CareCoverage includes ambulatory care and observation care and services.No
Hospital Care365 days per year of inpatient care, includes semi-private room and board, acute care for medically necessary services, and up to 30 days per year for physical rehabilitation.Yes
Maternity CareAll prenatal and postnatal visits and delivery charges. Hospital Benefit for the mother and newborn, Disability Benefit for the mother.No
Emergency Department VisitsCoverage for legitimate medical emergencies within 72 hours of accident, injury, or onset of a serious illness.No
Vision CareOne eye exam every two years, one pair of eyeglasses or order of contact lenses every two years.No
Dental BenefitsThrough a Plan Network for basic and preventive services, major restorative care, and orthodontia treatment.No
Hearing AidsProvided once every three years.No
SurgeryInpatient or outpatient surgery based on the Fund’s allowance for the surgical procedure.Yes
AnesthesiaBased on the Fund’s Schedule of Allowances.No
Program for Behavioral HealthOutpatient care, Intensive Outpatient Programs, Inpatient care, Partial Hospitalization Programs for mental health. Inpatient detoxification and rehabilitation, outpatient care for substance abuse.Yes
DisabilityPartial salary replacement for non work-related accidents, injuries or illnesses.Yes
Services requiring Prior AuthorizationHome health care, long-term acute care hospital services, durable medical equipment, specific medications, MRI, MRA, PET and CAT scans, radiation therapy, hospice care, ambulatory surgery, etc.Yes
Paid Family LeavePartial salary replacement up to a maximum of 12 weeks leave within a 52-week period.Yes
Life InsuranceBased on Wage Class and annual base pay up to a maximum amount of $50,000.No
Hospice CareUp to a lifetime total of 210 days in a Medicare-certified hospice program.Yes
Accidental Death & DismembermentEqual to, half of life insurance amount, depending on the loss.No
BurialIf available, a free burial plot with permanent care or a $75 payment to the beneficiary.No
Joseph Tauber Scholarship ProgramFor eligible children of Benefit Fund members (age 22 or younger).No
Anne Shore Sleep-Away Camp ProgramFor eligible children of Benefit Fund members (ages 9 to 15).No
Social ServicesMember Assistance Program, Citizenship Program, Earned Income Tax Credit Assistance Program, Financial Wellness and Homebuyer Education Program, Monday Night Legal Clinic, Workers' Comp Legal ClinicNo

Comparing SEIU Union Insurance to Other Insurance Options

When it comes to choosing a health insurance plan, it's important to consider all available options and how they stack up against each other. The SEIU Union Insurance offers comprehensive coverage, but how does it compare to other common health insurance plans, such as employer-sponsored plans or private insurance?

Firstly, as a labor organization, SEIU offers its members access to health insurance plans that are often more affordable than employer-sponsored plans, particularly for those who fall into lower income brackets. This affordability is largely due to the collective bargaining power of the union, which negotiates with employers to contribute a portion of the insurance costs (source:

Furthermore, unlike most private insurance plans which often have high deductibles and out-of-pocket maximums, SEIU plans tend to have lower out-of-pocket costs. This means that members usually pay less for healthcare services throughout the year (source:

Can I lose health benefits by going on strike?

Whether or not you lose health benefits while on strike depends on the specific policies of your union and the terms of your collective bargaining agreement. Some unions have strike funds that can help maintain health benefits for striking workers, while others may not. It's recommended to consult with your local union representative or the SEIU directly to understand the potential impact on your health benefits before participating in a strike. However, generally, health benefits are typically maintained during a strike, but this can vary.

Can I opt out of SEIU health insurance if it is too expensive for me?

Yes, union members generally have the right to opt out of the union's health plan if they choose to. However, the process for doing so can vary depending on the specific rules of the union and the terms of your employment contract. It's important to thoroughly understand the implications of opting out, including the potential loss of certain benefits and protections. If you're considering this option, it's recommended to consult with your union representative or a benefits counselor to make sure you understand all the potential consequences. 

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Frequently Asked Questions About SEIU Union Insurance

What are SEIU’s policies on pre-existing conditions?

SEIU Union Insurance abides by the Affordable Care Act mandates, which prohibit insurance companies from denying coverage or charging more due to pre-existing conditions. Therefore, SEIU members cannot be denied coverage or charged higher premiums due to health conditions they had before their coverage starts.

How can I inquire or apply for SEIU insurance?

If you're interested in SEIU insurance, you can visit the SEIU website for more information. You'll find details about the application process, eligibility requirements, and contact information for further inquiries.

What is the process of transitioning from another provider to SEIU?

Transitioning from another health insurance provider to SEIU typically involves canceling your current coverage and applying for SEIU insurance. It's important to ensure you're eligible for SEIU coverage before terminating your current plan. You can find more information on transitioning to a new health insurance provider on the website. 

How are out-of-network procedures handled?

For out-of-network procedures, SEIU Union Insurance generally covers less of the cost, meaning you would pay more out-of-pocket. It's recommended to check with SEIU before receiving services from out-of-network providers to understand the costs involved.

Mira Research Team

The Mira Research team conducts original data and medical research on the most applicable topics of today and translates them into easy-to-understand articles to educate the public. Each of our articles is carefully reviewed and curated with interviews and opinions from medical experts, public health officials, and experienced administrators. The team has educational backgrounds from New York University, the University of Virginia, more.