BOIS FORTE BAND OF CHIPPEWA

BURIAL FUND PROGRAM

 

 

BURIAL FUND HISTORY:

 

The Burial Fund established by the Bois Forte Tribal Government in December of 2005, was designed to pay funeral expenses for Bois Forte Band Members.

 

PURPOSE:

 

The Fund was established to provide financial assistance toward funeral costs to assure a dignified burial for the deceased and assistance to the family in a time of need.

 

WHO IS ELIGIBLE FOR BOIS FORTE BURIAL FUND?

 

Deceased enrolled members of the Bois Forte Band of Chippewa, or a deceased child who is eligible for enrollment into the Bois Forte Band who dies prior to completing the enrollment process.

 

MAXIMUM BENEFIT:

 

The Bois Forte Burial Fund will pay directly to the funeral home of choice, a maximum of $5,000.00 for funeral related costs. The family or representative of the deceased is responsible for any costs over $5,000.00.

 

WHAT SERVICES ARE COVERED BY THE FUND?

 

Funeral Home Services and Expenses offered by the identified funeral home with costs as establish by the funeral homes General Price List (GPL) to include:

 

 

 

 

 

Revised 01/21/2010

 

 

Casket:

The family or deceased shall have a choice of caskets. The combination of funeral service expenses and casket covered is $5000.00. Any casket chosen above this amount, must be paid by family. The funeral home may have available such options as a special casket or caskets that would be appropriate for Ojibwe tradition; either by casket panels (i.e., eagle insert, dream catcher, etc.), or Pendleton blanket interior parts.

 

Headstone Expense:

Should the family select a casket and services less than $5,000.00, the balance may be applied towards the purchase of a cemetery headstone or marker. Any combined selection of funeral services and headstone expenses that exceed $5,000.00, will be the responsibility of the deceased’s family.

 

HOW DO I APPLY FOR ASSISTANCE WHEN A MEMBER DIES?

 

The appointed representative or designated family member of the deceased should contact the Bois Forte Enrollment Coordinator located at the Bois Forte Tribal Government office in Nett Lake, Minnesota, phone number (218) 757-3261 or 1-800-221-8129. In the event there is not an appointed representative or family member, the next of kin will be accepted to act as the deceased’s representative in the matter of the Bois Forte Burial Fund.

 

 

WHAT DOCUMENTS ARE NEEDED FOR FUNERAL COSTS TO BE PAID?

 

The following documents need to be submitted for payment to occur:

 

WHO IS THE DESIGNATED REPRESENTATIVE?

 

The designated representative of the deceased is the person who is named in a living will, health care directive, or person making the funeral arrangements.

 

WHAT INFORMATION IS NEEDED TO ESTABLISH ELIGILBILTY FOR THE DECEASED?

 

The following information is required:

Revised 01/21/2009

 

TO WHOM IS THE PAYMENT IS MADE?

 

The cost of the funeral expenses, casket and other related costs, shall be paid directly to the chosen funeral home within 30 days, upon the Tribal Council’s receipt of an itemized billing statement. Headstone expense will be paid directly to the monument firm within 30 days after the receipt of an itemized billing statement.

 

WHO IS THE DESIGNATED REPRESENTATIVE?

 

The designated representative of the deceased is the person who is named in a living will, health care directive, or person making the funeral arrangements.

 

SPIRITUAL ADVISER OR CLERGY STIPEND

 

A $250.00 clergy or spiritual advisor stipend shall be made payable directly to the clergy or spiritual advisor. If a spiritual advisor has an assistant, the assistant may be paid $125.00. All other expenses incurred shall be the responsibility of the family.

 

HOTEL ALLOWANCE

 

A hotel allowance of $150 will be available to the deceased representative.  The representative of the deceased will be responsible for making room reservation and payment for hotel rooms. Any other hotel expenses shall be the responsibility of the family.

 

WHAT IF THERE IS OTHER EXPENSES RELATED TO THE FUNERAL?

 

To be eligible the applicant must be immediate family and be enrolled member of the Bois Forte Band of Chippewa. There will be only one stipend issued per family of the deceased. The maximum amount of funeral related expenses received from the Bois Forte Tribal Government funeral program cannot exceed $500.00 per family.

 

After the deceased’s representative or next of kin notifies and fills out an application with the Enrollment Coordinator, the Tribal Government shall make available a stipend in the amount of $500.00. The stipend is intended to assist the family with expenses for food, travel, lodging, clothing and other miscellaneous expenses. Such stipend shall be paid by check to the designated representative. Food expenses are considered taxable and the people to whom that check is made payable needs to provide his/her social security number.

 

 

 

 

 

 

 

 

 

 

Revised 01/21/2009

 

 


The following funeral home services are allowable expenses under the Bois Forte Burial Fund Policy:

 

 

Services not covered by the Bois Forte Burial Fund Policy:

 

 

The individual Band member’s burial fund shall not be transferable to any other person for his/hers burial expense. Unused portions may not be transferable or paid to family or the representative of the deceased.

 

The Bois Forte Band of Chippewa assumes no liability for any costs related to an individual’s funeral or burial in excess of the benefits provided by this policy.

 

The Bois Forte Tribal Government may, at it’s sole discretion and without further notice to Band members, amend or terminate the burial fund program if is deemed to be harmful to the Band’s financial condition or for any other reason.

 

This fund is not retroactive prior to December 27, 2005.

 

All claims must be filed within 60 days.

 

Please sign and date below indicating that you have fully read the Bois Forte Burial Fund Policy and fully understand its terms and that you are in full agreement of all that it entails.

________________________________               _____________________

Signature of Representative                                                  Date

Revised 01/21/2009

 

 

BOIS FORTE BURIAL FUND POLICY

 

                                 APPLICATION FOR FUNERAL HOME EXPENSES

 

Name of Deceased: _______________________________________________________

 

Maiden or other names: ____________________________________________________

 

 

Date of Birth: _______________ Enrollment Number: _________________

(or proof of eligibility for enrollment attached)

 

Date of death: _______________ Hospital or Funeral Home verification must be received

                                                       by the Enrollment Officer at the time of this application.

 

Representative of Deceased: ________________________________________________

Are you the personal representative of the deceased’s estate? Yes_____ No ______

If yes, attach a copy of the will or other documents appointing you.

If no, are you the next of kin? Yes _____ No _____

If yes, what’s your relationship to the deceased? ________________________________

If no, who is the next of kin? ________________________________________________

 

Address of Representative: _________________________________________________

 

Phone Number Home: ___________________ Work: _________________

 

Name of Funeral Home: ___________________________________________________

 

Address: ___________________________________________________

 

Funeral Home Director: ___________________________________________________

 

Phone Number: _____________________ Fax Number: ___________________

 

Representative signature: ________________________________ Date: _____________

 

 

Processed by:

 

Signed : ____________________________________ Date: ______________________

 

 

 

 

 

 

 

 

Revised 01/21/2009


 

                             BOIS FORTE BURIAL FUND POLICY

 

 

 

APPLICATION FOR SPIRITUAL ADVISOR OR CLERGY STIPEND:

 

Name of deceased: ______________________________________________

 

Date of Birth: __________________ Date of Death ____________________

                                                           (verification of death occurrence must be

                                                           attached).

 

Enrollment Number: _____________________________________________

(or proof of enrollment attached).

 

Representative of Deceased: _______________________________________

 

Address:                                         _______________________________________

 

 

Phone Number                  Home: ________________ Work: ____________

 

Signed: _____________________________________ Date: ______________

 

 

Check will be made payable to Spiritual Advisor or Clergy:

 

Name of Spiritual Advisor or Clergy: _________________________________

Address: ________________________________________________________

 

Name of Assistant Spiritual Advisor or Clergy: _________________________________

Address: ________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

Processed by:

 

Signed: _______________________________ Date: ____________________

 

Revised 01/21/2009


 

BOIS FORTE BURIAL FUND POLICY

 

 

 

APPLICATION FOR MISCELLANEOUS EXPENSES:

 

Name: ________________________________________________________

 

Enrollment # :_________________ Social Security #:__________________

 

Address: _______________________________________

 

Phone Number: Home: ________________ Work: ___________

 

Name of deceased:_______________________________________________

 

Bois Forte Enrollment #:__________________________________________

 

Date of Birth: __________________ Date of Death ____________________

                                                           (verification of death occurrence must be

                                                           attached).

Signed: _____________________________________ Date: ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Processed by:

 

Signed: _______________________________ Date: ____________________

 

 

Revised 01/21/2009

BOIS FORTE BURIAL FUND POLICY

 

 

 

APPLICATION FOR HOTEL ALLOWANCE:

 

Name: ________________________________________________________

 

Address: _______________________________________

 

Phone Number: Home: ________________ Work: ___________

 

Name of deceased:_______________________________________________

 

Bois Forte Enrollment #:__________________________________________

 

Date of Birth: __________________ Date of Death ____________________

                                                           (verification of death occurrence must be

                                                           attached).

Signed: _____________________________________ Date: ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Processed by:

 

Signed: _______________________________ Date: ____________________

 

 

Revised 01/21/2009