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Home > Health Plan > B5 - Electing Coverage/Eligibility
ELECTION OF COVERAGE AND ELIGIBILITY PROVISIONS
This plan provides coverage only for you; family coverage is not provided. You become covered:
Election of Coverage and Authorization of Payroll Deductions
The Collective Bargaining Agreement between your employer and your local union requires that you elect whether or not to participate in the Health Plan. If you elect to participate, you must make a weekly contribution via payroll deduction.
Eligible employees may elect:
The weekly payroll deduction of $5 can be made under an Internal Revenue Code Section 125 Cafeteria Plan that your employer can adopt. Under the Cafeteria Plan, no federal or state tax is withheld from or due on your contribution amount.
Election Form
The Benefits Fund Office or your employer will provide you with an Election and Payroll Deduction Authorization Form at the time you first become eligible for health coverage. A completed, signed form must be returned to the Benefits Fund Office in a timely manner or you will not have health benefits coverage.
If you do not receive an Election and Payroll Deduction Authorization Form, contact the Benefits Fund Office immediately by e-mail or by calling.
If you do not elect coverage and authorize payroll deductions, you will not be eligible for health benefits.
Enrollment Periods
New Employee/Initial Enrollment. The enrollment period ends 60 days following the Health Coverage Effective Date. If you do not make an election within this time, you will not have health coverage. The next opportunity to enroll will be the Open Enrollment Period or the Special Enrollment Period, both explained below.
Open Enrollment Period. In December of each year, you may enroll or change your existing enrollment. The change will become effective on January 1 of the following year. Contact the Benefits Fund Office during November or early December and the proper forms will be sent to you.
Special Enrollment Period. If you are declining enrollment because of other health insurance or group health plan coverage, you may be able to enroll in the Health Plan if you lose or gain eligibility for that other coverage (or if the employer stops contributing towards your other coverage). However, you must request enrollment within 30 days after your other coverage changes.
The Summary of the Cafeteria Plan page of this website includes a complete list of events and situations which may allow you to enroll under the Special Enrollment Period provisions.
To request Special Enrollment, contact the Benefits Fund Office.
Which Eligibility Provisions Apply to You—Rate-Per-Hour or Flat-Rate?
The eligibility provisions that apply to you are based on whether your employer makes a Rate-Per-Hour Contribution or a Flat-Rate Contribution each month:
Eligibility Based on Rate-Per-Hour Employer Contributions
If your employer makes a contribution for every covered hour that you work each month, these Rate-Per-Hour Eligibility Provisions apply to you.
If your employer contributes a flat amount each month, see Flat-Rate Eligibility for the eligibility provisions that apply to you.
Initial Rate-Per-Hour Eligibility
Before your health coverage becomes effective, you must satisfy certain waiting periods as specified in your Collective Bargaining Agreement and other eligibility provisions.
Eligibility is based on the average number of hours you work in covered employment during a certain period. Hours of covered employment are the hours that you work for which your employer contributes to the Health Fund on your behalf.
The Table of Rate-Per-Hour Effective Dates provides examples of coverage dates for employee-members whose rate-per-hour employer contributions start after three months, after 15 months orafter 18 months of employment. Refer to your Collective Bargaining Agreement to determine when your employer is required to begin making contributions on your behalf.
Definition of a Week
A week is a payroll week. For example, if you are paid from Sunday through Saturday, this is what the Plan means when it refers to a week. You should count your hours for each week that ends in the month for which you are determining your eligibility. This means that some of the days for the first week may be contained in the prior month and some of the days in the month that follow the last week may not be counted.
Average Weekly Hours per Month
Use the following formula to determine your average weekly hours worked during a calendar month:
Initial Rate-Per-Hour Eligibility Chart
The following chart illustrates the hours and time periods you need to work to be eligible for benefits.
Prescription Drug
Continuing Rate-Per-Hour Eligibility
You will continue to be eligible if you meet the following requirements:
Prescription Drug
Termination and Reinstatement of Rate-Per-Hour Eligibility
Your eligibility for all benefits will end when you fail to work an average of at least 12 covered hours per week during weeks that end in 2 full months in a row. Coverage ends on the last day of the first month in which you fail to work the required average covered hours. You will lose all coverage for at least 2 months and will not be reinstated until you again work an average of at least 12 covered hours per week during weeks that end in 2 full months in a row.
You may be eligible to make self-payments to continue coverage under COBRA. See COBRA Continuation Coverage for more information.
The following chart shows when coverage ends and when it is reinstated:
Prescription Drug
Reinstatement After You Return-to-Work
If you were previously covered under the Plan and are returning to work immediately after:
Table of Rate-Per-Hour Effective Dates
These effective dates assume that:
If your Collective Bargaining Agreement contains different requirements, this table does not apply to you.
If you work the required hours each month and your employer fully contributes for those hours, and if: If you work the required hours each month and your employer fully contributes for those hours, and if: If you work the required hours each month and your employer fully contributes for those hours, and if:
This concludes the section on Rate-Per-Hour Eligibility Provisions. You can skip the following Flat-Rate Eligibility Provisions and go directly to the final section on Miscellaneous Eligibility Provisions.
Eligibility Based on Flat-Rate Employer Contributions
If your employer contributes a flat amount each month, these Flat-Rate Eligibility Provisions apply to you.
If your employer makes a contribution for every covered hour that you work each month, see Rate-Per-Hour Eligibility for the eligibility provisions that apply to you.
Initial Flat-Rate Eligibility
Before your health coverage becomes effective, you must satisfy certain waiting periods as specified in your Collective Bargaining Agreement and other eligibility provisions.
You first become eligible on the first day of the month after your employer makes the required monthly contribution on your behalf.
Eligibility is based on your employer's contribution on your behalf:
The Table of Flat-Rate Effective Dates provides examples of coverage dates for employee-members whose flat-rate employer contributions start after three months, after 15 months or after 18 months of employment. Refer to your Collective Bargaining Agreement to determine when your employer is required to begin making contributions on your behalf.
Initial Flat-Rate Eligibility Chart
The following chart shows the employer contributions that must be made to be eligible for benefits.
Prescription Drug
Continuing Flat-Rate Eligibility
You will continue to be eligible if you meet the following requirements:
Prescription Drug
Termination and Reinstatement of Flat-Rate Eligibility
Your eligibility for all benefits will end when employer contributions are no longer made on your behalf. Coverage ends on the last day of the first month for which a contribution was made. Coverage is reinstated on the first day of the month after you again meet the eligibility requirements.
You may be eligible to make self-payments to continue coverage under COBRA. See COBRA Continuation Coverage for more information.
The following chart shows when coverage ends and when it is reinstated:
Reinstatement After You Return-to-Work
If you were previously covered under the Plan and are returning to work immediately after:
Table of Flat-Rate Effective Dates
These effective dates assume that:
If your Collective Bargaining Agreement contains different requirements, this table does not apply to you.
This concludes the section on Flat-Rate Eligibility Provisions.
Miscellaneous Eligibility Provisions
Special Rules for Continuing Eligibility
You may remain eligible for benefits under the Plan when your eligibility would otherwise end if you qualify under one of the following conditions.
Military Service. If you are inducted into the armed forces of the United States or if you enlist in military service, your eligibility will end. However, coverage for you may be continued if you satisfy the eligibility criteria of the Uniformed Service Employment and Reemployment Rights Act of 1994, as amended (USERRA).
If you are called into uniformed service for fewer than 31 days, your medical coverage during that leave period will be continued, provided that you pay your share of the premium as established by the Trustees from time to time. Contact the Benefits Fund Office to determine the amount you must contribute to continue your coverage during a leave of fewer than 31 days.
If you are called into uniformed service for 31 or more days, you can continue your coverage for up to 24 months after your coverage under the Plan would otherwise terminate (termination provisions are described above for Rate-Per-Hour and for Flat-Rate eligibility). If you fail to provide advance notice of your uniformed service, you will not be eligible to continue coverage unless the failure to provide advance notice is excused. The Trustees will, in their sole discretion, determine if your failure to provide advance notice is excusable under the circumstances and may require that you provide documentation to support the excuse. If the Trustees determine that your failure to provide advance notice is excused, you may then elect to continue coverage and pay all amounts required to continue coverage in accordance with the COBRA Continuation of Coverage election and payment procedures. Your continuation coverage will then be effective retroactive to the date you lost coverage due to your leave of absence to perform uniformed service.
If the Benefits Fund Office has been notified that you are entering the uniformed service, you shall have the option of continuing the same class of coverage under the Plan. Election, payment and termination of this USERRA continuation coverage will be governed by the election, payment and termination rules for COBRA Continuation of Coverage, provided the COBRA rules do not conflict with USERRA.
COBRA and USERRA coverage run concurrently. This means that if you are not simultaneously eligible for COBRA and USERRA, then you will be entitled to the more generous benefit provisions under each law for periods in which you remain eligible for both forms of continuation coverage. If you fail to follow the COBRA rules when electing and paying for USERRA coverage, you may lose the right to continue coverage under USERRA. Once lost, the right to USERRA continuation coverage cannot be reinstated. However, if circumstances make it otherwise impossible or unreasonable for you to timely elect and pay for USERRA continuation coverage, the Trustees may, in their sole discretion, reinstate your right to USERRA continuation coverage provided that you pay all amounts required for such continuation coverage.
If you are discharged from the uniformed service under honorable conditions and have USERRA reemployment rights, eligibility may be reinstated on the date you return to work in covered employment or make yourself available for work in covered employment, provided your return to work is within 90 days from the date of your discharge or such shorter or longer period required by law if you serve less than 180 days or are hospitalized when your military service is terminated.
Extension of Coverage During Disability. If you are unable to work because you are totally disabled, your coverage may be automatically continued at no cost to you. If at the time of your total disability you had elected Single Coverage, and you were working enough hours to qualify for Single Coverage, then your coverage will be extended for up to two months following your date of disability.
A new two-month will apply to a newly-occurring disabling condition unrelated to a previous condition which occurs more than four weeks after you return to work. Only one two-month extension will apply to the same or related condition, even if you have returned to work for any period of time.
Any period of extended coverage provided here at no cost, will reduce the period allowed for self-payment under the COBRA Continuation Coverage provisions by a period equal to the extended coverage.
If your employer is required to make contributions under the Family and Medical Leave Act or under a provision of the Collective Bargaining Agreement during a portion of your period of total disability, the automatic extension will be available to you in addition to the period of time covered by your employers contributions. COBRA Continuation Coverage may become available once you exhaust your entitlement to health coverage under this provision.
Family and Medical Leave Act (FMLA). Under the Family and Medical Leave Act of 1993, you may qualify to take up to 12 weeks of unpaid leave for a serious illness, to care for your newborn child or newly adopted child, or to care for your seriously ill spouse, parent or child. If the Family and Medical Leave Act applies to your employer (small employers are exempt), it requires your employer to maintain your health coverage for the length of your leave (up to 12 weeks) as if you were actively at work. The Act also states that if you take a Family and Medical Leave, you cannot lose any benefits accrued before the leave.
Your employer will let you know what payment methods are available for continuing coverage during a leave of absence under the Family and Medical Leave Act and may require that the employee portion of the contributions for health coverage during the leave be paid by you upon your return to work or while you are on leave.
The Fund will grant eligibility for a Family and Medical Leave and will maintain your current eligibility status for the duration of the leave, provided your employer properly grants the leave of absence under the Federal law and makes the required contributions to the Health Fund on your behalf.
If you do not return to work after your leave and you are no longer eligible to continue health coverage under the Plan, COBRA Continuation Coverage may become available.
See your employer if you believe you may be entitled to a leave under the Family and Medical Leave Act.
Certificate of Creditable Coverage.
When coverage for you ends, you will be provided with a Certificate of Creditable Coverage that indicates the period of time you were covered under this Plan. If you become covered under another health plan, show the Certificate to your next plan administrator. It may decrease or eliminate any pre-existing condition limitation period under that plan.
The following procedures are followed by the Plan in providing you with a Certificate.
Automatic Issuance of a Certificate of Creditable Coverage. The Plan will issue a Certificate of Creditable Coverage automatically as required by federal law as follows:
Individuals who lose coverage due to a COBRA qualifying event and elect COBRA Continuation Coverage will receive two Certificates—one upon the occurrence of the qualifying event and one upon the termination of COBRA coverage.
Delivery of a Certificate of Creditable Coverage. The Plan will send the Certificate by first class mail. If the Certificate is addressed and mailed to the participant's last known address, then the notice requirement will be satisfied.
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