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Home > Health Plan > D5 - Electing Coverage/Eligibility
ELECTION OF COVERAGE AND ELIGIBILITY PROVISIONS
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You and your eligible dependents become covered:
All of these requirements are described in the following paragraphs.
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 any of the following levels of coverage:
No Coverage. You may elect not to participate and you will not receive any health coverage or
related benefits. There is no weekly payroll deduction if no coverage is elected.
Single Coverage. You may elect Single Coverage to receive health coverage and related benefits
for yourself only (no family members) and make a weekly payroll deduction of $5. Additionally, you must work the
minimum hours necessary to maintain Single Coverage. Note that Single Coverage includes the disability Income
Protection Benefit if you qualify as a full-time employee.
Family Coverage. You may elect Family Coverage to receive health coverage and related benefits
for yourself and your eligible family members and make a
weekly payroll deduction of $15. Additionally, you must work the minimum hours necessary to maintain Family Coverage.
The weekly payroll deduction of either $5 or $15 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.
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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 and your family 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 and your family members will not be eligible for health
benefits.
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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 for yourself or your dependents (including your spouse)
because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in
the Health Plan if you or your dependents lose or gain eligibility for that other coverage (or if the employer stops contributing
towards your or your dependents' other coverage). However, you must request enrollment within 30 days after your or your
dependents' other coverage changes.
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able
to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth,
adoption, or placement for adoption.
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.
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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:
Your employers method of making contributions is specified in your Collective Bargaining Agreement with your local union.
Contact your employer, your local union or the Benefits Fund Office
if you need more information on which contribution method your employer uses.
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Eligibility Based on Rate-Per-Hour Employer Contributions
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subject within this section
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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.
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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 for you and your dependents 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.
For certain benefits, you must meet the hours requirement and also a waiting period. For instance, to be eligible for
Dental Benefits, you must meet the hours requirements as well as a two-month period in which your Health Benefits have
been in effect. To be eligible for Income Protection Benefits, you must meet the hours requirement as well as a four-month
period during which your Health Benefits have been in effect.
The Table of Rate-Per-Hour Effective Dates provides examples of
coverage dates for employee-members whose rate-per-hour employer contributions start after 30 days, after three months or
after six months of employment. Refer to your Collective Bargaining Agreement to determine when your
employer is required to begin making contributions on your behalf.
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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.
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Average Weekly Hours per Month
Use the following formula to determine your average weekly hours worked during a calendar month:
Divide the total number of covered hours
worked during payroll weeks that end in the
calendar month |
= |
Average Weekly Covered Hours During the Calendar Month |
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By the number of payroll weeks that end in the
calendar month (this will be either 4 or 5 weeks) |
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Initial Rate-Per-Hour Eligibility Chart
The following chart illustrates the hours and time periods you need to work to be eligible for the different types of benefits offered.
| You become eligible for this benefit |
When you have worked these Average Covered Hours |
For each week ending during this period |
Your initial coverage begins |
| Life Insurance Accidental Death
& Dismemberment Comprehensive Medical Prescription Drug Vision |
12 per week |
2 full calendar months in a row |
The first day of the month following the 2-month period |
| Dental |
12 per week |
4 full calendar months in a row |
The first day of the month after your medical benefits have been in effect
for 2 full calendar months |
| Income Protection |
28 per week |
3 of the 4 preceding months in a row |
The first day of the month after your medical benefits have been in effect
for 4 full calendar months in a row |
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Your Continuing Rate-Per-Hour Eligibility
You will continue to be eligible if you meet the following requirements:
| To continue to be eligible for this benefit |
You must work these Average Covered Hours |
For each week ending during this period |
| Life Insurance Accidental Death
& Dismemberment Comprehensive Medical Prescription Drug Vision Dental |
12 per week |
2 full calendar months in a row |
| Income Protection |
28 per week and not less than 12 per week |
3 of the 4 preceding calendar months in a row 2 preceding full calendar months in a row |
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Your Dependents' Eligibility
Coverage for your eligible dependents is based on the
number of hours you work and on certain waiting periods; additionally, you must have elected
Family Coverage. Your dependents become eligible as shown below:
| Your dependents become eligible for this benefit |
When you have worked these Average Covered Hours |
For each week ending during this period |
Initial coverage begins |
| Dependent Life Insurance Comprehensive Medical Prescription Drug Vision |
28 per week |
3 of the 4 preceding calendar months in a row |
The first day of the month after your medical benefits have been in effect for 2 full calendar months in a row |
| Dental |
28 per week |
3 of the 4 preceding calendar months in a row |
The first day of the month after your medical benefits have been in effect for 8 full calendar months |
| Your dependents continue to be eligible |
28 per week (and not less than 12 per weekevery month) |
3 of the 4 preceding calendar months in a row |
|
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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:
| Your coverage for these benefits |
Ends when you fail to work these Average Covered Hours |
For each week ending during this period |
Coverage Ends |
Reinstatement Occurs |
| Income Protection Dependent Coverage |
28 per week |
3 of the 4 preceding calendar months in a row |
The last day of the 4-month period |
The first day of the month afteryou again meet the 28-hours requirement |
| All benefits |
12 per week |
1 calendar month |
The last day of that month. Coverage is lost for two months. |
The first day of the month after you again meet the continuing eligibility requirements |
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Reinstatement After You Return-to-Work
If you were previously covered under the Plan and are returning to work immediately after:
- a leave of absence for a period of total disability covered under the Plan of a least one calendar month but not more
than 12 calendar months; or
- a temporary layoff of at least one calendar month but not more than six calendar months; or
- a sanctioned strike,
you will become covered again, to the extent that you were previously covered, on the date you return to work, provided that
your employer is required to begin making contributions on your behalf immediately.
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Termination of Your Dependents Eligibility
Your dependents will lose coverage on the earliest of the following dates:
- the last day of the month in which you become ineligible for coverage; or
- the last day of the month in which you do not work the required hours for dependent coverage; or
- the last day of the month in which your dependent fails to meet the definition of an eligible dependent; or
- the date you and your spouse divorce (coverage for your spouse ends on the date of your divorce).
In the event of your death, coverage for your spouse and your dependent children continues until the earliest of:
- the last day of the third month following the date of your death;
- the last day of the month in which your dependent fails to meet the definition of an eligible dependent; or
- the date your dependent becomes eligible for health coverage under another group plan or policy.
If you have elected Family Coverage and were working enough hours to qualify for Family Coverage, dependents coverage
may be continued by making self-payments under COBRA. See COBRA Continuation
Coverage for more information.
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Table of Rate-Per-Hour Effective Dates
These effective dates assume that:
- you are working continuously for an employer participating in the Fund,
- your Collective Bargaining Agreement requires rate-per-hour employer contributions on your behalf, and
- the contributions begin with the first weekly pay period after you complete at least:
If your Collective Bargaining Agreement contains different requirements, this table does not apply to you.
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If Rate-Per-Hour Contributions Begin After 30 Days... |
If you work the required hours each month
and your employer fully contributes for those hours, and if: |
| Your first day of employment is between these inclusive dates |
Your Health Coverage is effective |
Your Dental Coverage and Your Dependents' Health Coverage are effective |
Your Income Protection Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
07/1/08 |
09/1/08 |
11/1/08 |
03/1/09 |
| 04/2/08 05/1/08 |
08/1/08 |
10/1/08 |
12/1/08 |
04/1/09 |
| 05/2/08 06/1/08 |
09/1/08 |
11/1/08 |
01/1/09 |
05/1/09 |
| 06/2/08 07/1/08 |
10/1/08 |
12/1/08 |
02/1/09 |
06/1/09 |
| 07/2/08 08/1/08 |
11/1/08 |
01/1/09 |
03/1/09 |
07/1/09 |
| 08/2/028 09/1/08 |
12/1/08 |
02/1/09 |
04/1/09 |
08/1/09 |
| 09/2/08 10/1/08 |
01/1/09 |
03/1/09 |
05/1/09 |
09/1/09 |
| 10/2/08 11/1/08 |
02/1/09 |
04/1/09 |
06/1/09 |
10/1/09 |
| 11/2/08 12/1/08 |
03/1/09 |
05/1/09 |
07/1/09 |
11/1/09 |
| 12/2/08 01/1/09 |
04/1/09 |
06/1/09 |
08/1/09 |
12/1/09 |
| 01/2/09 02/1/09 |
05/1/09 |
07/1/09 |
09/1/09 |
01/1/10 |
| 02/2/09 03/1/09 |
06/1/09 |
08/1/09 |
10/1/09 |
02/1/10 |
| 03/2/09 04/1/09 |
07/1/09 |
09/1/09 |
11/1/09 |
03/1/10 |
| 04/2/09 05/1/09 |
08/1/09 |
10/1/09 |
12/1/09 |
04/1/10 |
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If Rate-Per-Hour Contributions Begin After 3 Months... |
If you work the required hours each month
and your employer fully contributes for those hours, and if: |
| Your first day of employment is between these inclusive dates |
Your Health Coverage is effective |
Your Dental Coverage and Your Dependents' Health Coverage are effective |
Your Income Protection Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
09/1/08 |
11/1/08 |
01/1/09 |
05/1/09 |
| 04/2/08 05/1/08 |
10/1/08 |
12/1/08 |
02/1/09 |
06/1/09 |
| 05/2/08 06/1/08 |
11/1/08 |
01/1/09 |
03/1/09 |
07/1/09 |
| 06/2/08 07/1/08 |
12/1/08 |
02/1/09 |
04/1/09 |
08/1/09 |
| 07/2/08 08/1/08 |
01/1/09 |
03/1/09 |
05/1/09 |
09/1/09 |
| 08/2/08 09/1/08 |
02/1/09 |
04/1/09 |
06/1/09 |
10/1/09 |
| 09/2/08 10/1/08 |
03/1/09 |
05/1/09 |
07/1/09 |
11/1/09 |
| 10/2/08 11/1/08 |
04/1/09 |
06/1/09 |
08/1/09 |
12/1/09 |
| 11/2/08 12/1/08 |
05/1/09 |
07/1/09 |
09/1/09 |
01/1/10 |
| 12/2/08 01/1/09 |
06/1/09 |
08/1/09 |
10/1/09 |
02/1/10 |
| 01/2/09 02/1/09 |
07/1/09 |
09/1/09 |
11/1/09 |
03/1/10 |
| 02/2/09 03/1/09 |
08/1/09 |
10/1/09 |
12/1/09 |
04/1/10 |
| 03/2/09 04/1/09 |
09/1/09 |
11/1/09 |
01/1/10 |
05/1/10 |
| 04/2/09 - 05/1/09 |
10/1/09 |
12/1/09 |
02/1/10 |
06/1/10 |
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If Rate-Per-Hour Contributions Begin After 6 Months... |
If you work the required hours each month and your employer fully contributes for those hours, and if: |
| Your first day of employment is between these inclusive dates |
Your Health Coverage is effective |
Your Dental Coverage and Your Dependents' Health Coverage are effective |
Your Income Protection Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
12/1/08 |
02/1/09 |
04/1/09 |
08/1/09 |
| 04/2/08 05/1/08 |
01/1/09 |
03/1/09 |
05/1/09 |
09/1/09 |
| 05/2/08 06/1/08 |
02/1/09 |
04/1/09 |
06/1/09 |
10/1/09 |
| 06/2/08 07/1/08 |
03/1/09 |
05/1/09 |
07/1/09 |
11/1/09 |
| 07/2/08 08/1/08 |
04/1/09 |
06/1/09 |
08/1/09 |
12/1/09 |
| 08/2/08 09/1/08 |
05/1/09 |
07/1/09 |
09/1/09 |
01/1/10 |
| 09/2/08 10/1/08 |
06/1/09 |
08/1/09 |
10/1/09 |
02/1/10 |
| 10/2/08 11/1/08 |
07/1/09 |
09/1/09 |
11/1/09 |
03/1/10 |
| 11/2/08 12/1/08 |
08/1/09 |
10/1/09 |
12/1/09 |
04/1/10 |
| 12/2/08 01/1/09 |
09/1/09 |
11/1/09 |
01/1/10 |
05/1/10 |
| 01/2/09 02/1/09 |
10/1/09 |
12/1/09 |
02/1/10 |
06/1/10 |
| 02/2/09 03/1/09 |
11/1/09 |
01/1/10 |
03/1/10 |
07/1/10 |
| 03/2/09 04/1/09 |
12/1/09 |
02/1/10 |
04/1/10 |
08/1/10 |
| 04/2/09 05/1/09 |
01/1/10 |
03/1/10 |
05/1/10 |
09/1/10 |
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.
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Eligibility Based on Flat-Rate Employer Contributions
Click on any item to go directly to that
subject within this section
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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.
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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.
Eligibility for you and your dependents is based on your employer's contribution on your behalf:
- If your employer makes a full-time contribution, you and your dependents are eligible for benefits, including the
Income Protecton Benefit for you.
- If your employer makes a part-time contribution, your dependents are not eligible and you are not eligible for the
Income Protection Benefit.
- If a contribution is not made on your behalf, you and your dependents are not eligible.
You first become eligible on the first day of the month after your employer makes the required monthly contribution on your
behalf. To be eligible for Dental Benefits, your Health Benefits must have been in effect for two months.
The Table of Flat-Rate Effective Dates provides examples of coverage dates
for employee-members whose flat-rate employer contributions start after 30 days, after three months or after six months of employment.
Refer to your Collective Bargaining Agreement to determine when your employer is required to begin making contributions
on your behalf.
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Initial Flat-Rate Eligibility Chart
The following chart shows the employer contributions that must be made to be eligible for the different types of benefits offered.
| You become eligible for this benefit |
When this employer contribution is made |
Your initial coverage begins |
| Life Insurance Accidental Death
& Dismemberment Comprehensive Medical Prescription Drug Vision |
1 part-time or full-time contribution |
The first day of the month after the month in which the contribution is made |
| Dental |
part-time or full-time contributions |
The first day of the month after your medical benefits have been in effect
for 2 full calendar months |
| Income Protection |
1 full-time contribution |
The first day of the month after the month in which the contribution is made
|
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Your Continuing Flat-Rate Eligibility
You will continue to be eligible if you meet the following requirements:
| To continue to be eligible for this benefit |
This employer contribution must be made |
| Life Insurance Accidental Death
& Dismemberment Comprehensive Medical Prescription Drug Vision Dental |
part-time or full-time contribution |
| Income Protection |
full-time contribution |
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Your Dependents' Eligibility
Coverage for your eligible dependents is based on full-time
employer contributions being made and on certain waiting periods; additionally, you must have elected
Family Coverage. Your dependents become eligible as shown below:
| Your dependents become eligible for this benefit |
When this employer contribution is made |
Initial coverage begins |
| Dependent Life Insurance Comprehensive Medical Prescription Drug Vision |
1 full-time contribution |
The first day of the month after month in which the contribution is made |
| Dental |
full-time contribution |
The first day of the month after your medical benefits have been in effect for 8 full calendar months |
| Your dependents continue to be eligible |
full-time contribution |
|
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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. You will lose coverage for the Income Protection Benefit and
for Dependent Coverage if a full-time contribution is not made on your behalf. 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:
| Your coverage for these benefits |
Ends when |
Coverage Ends |
Reinstatement Occurs |
| Income Protection Dependent Coverage |
a full-time contribution is not made |
The last day of the month for which a full-time contribution was made |
The first day of the month afteryou again meet the eligibility requirements |
| All benefits |
no contribution is made |
The last day of the month for which a contribution was made |
The first day of the month after you again meet the eligibility requirements |
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Reinstatement After You Return-to-Work
If you were previously covered under the Plan and are returning to work immediately after:
- a leave of absence for a period of total disability covered under the Plan of a least one calendar month but not more
than 12 calendar months; or
- a temporary layoff of at least one calendar month but not more than six calendar months; or
- a sanctioned strike,
you will become covered again, to the extent that you were previously covered, on the date you return to work, provided that
your employer is required to begin making contributions on your behalf immediately.
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Termination of Your Dependents Eligibility
Your dependents will lose coverage on the earliest of the following dates:
- the last day of the month in which you become ineligible for coverage; or
- the first day of the month for which a full-time employer contributuion is not made on your behalf; or
- the last day of the month in which your dependent fails to meet the definition of an
eligible dependent; or
- the date you and your spouse divorce (coverage for your spouse ends on the date of your divorce).
In the event of your death, coverage for your spouse and your dependent children continues until the earliest of:
- the last day of the third month following the date of your death;
- the last day of the month in which your dependent fails to meet the definition of an
eligible dependent; or
- the date your dependent becomes eligible for health coverage under another group plan or policy.
If you have elected Family Coverage andyour employer has made full-time contributions on your behalf, dependents
coverage may be continued by making self-payments under COBRA. See COBRA Continuation
Coverage for more information.
Top of Flat-Rate Section
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Table of Flat-Rate Effective Dates
These effective dates assume that:
- you are working continuously for an employer participating in the Fund,
- your Collective Bargaining Agreement requires flat-rate employer contributions on your behalf, and
- the contributions begin with the month after you complete at least:
If your Collective Bargaining Agreement contains different requirements, this table does not apply to you.
|
If Flat-Rate Contributions Begin After 30 Days... |
| Your first day of employment is between these inclusive dates |
Your and your Dependents' Health Coverage is effective |
Your Dental Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
06/1/08 |
08/1/08 |
02/1/09 |
| 04/2/08 05/1/08 |
07/1/08 |
09/1/08 |
03/1/09 |
| 05/2/08 06/1/08 |
08/1/08 |
10/1/08 |
04/1/09 |
| 06/2/08 07/1/08 |
09/1/08 |
11/1/08 |
05/1/09 |
| 07/2/08 08/1/08 |
10/1/08 |
12/1/08 |
06/1/09 |
| 08/2/08 09/1/08 |
11/1/08 |
01/1/09 |
07/1/09 |
| 09/2/08 10/1/08 |
12/1/08 |
02/1/09 |
08/1/09 |
| 10/2/08 11/1/08 |
01/1/09 |
03/1/09 |
09/1/09 |
| 11/2/08 12/1/08 |
02/1/09 |
04/1/09 |
10/1/09 |
| 12/2/08 01/1/09 |
03/1/09 |
05/1/09 |
11/1/09 |
| 01/2/09 02/1/09 |
04/1/09 |
06/1/09 |
12/1/09 |
| 02/2/09 03/1/09 |
05/1/09 |
07/1/09 |
01/1/10 |
| 03/2/09 04/1/09 |
06/1/09 |
08/1/09 |
02/1/10 |
| 04/2/09 - 05/1/09 |
07/1/09 |
09/1/09 |
03/1/10 |
|
If Flat-Rate Contributions Begin After 3 Months... |
| Your first day of employment is between these inclusive dates |
Your and your Dependents' Health Coverage is effective |
Your Dental Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
08/1/08 |
10/1/08 |
04/1/09 |
| 04/2/08 05/1/08 |
09/1/08 |
11/1/08 |
05/1/09 |
| 05/2/08 06/1/08 |
10/1/08 |
12/1/08 |
06/1/09 |
| 06/2/08 07/1/08 |
11/1/08 |
01/1/09 |
07/1/09 |
| 07/2/08 08/1/08 |
12/1/08 |
02/1/09 |
08/1/09 |
| 08/2/08 09/1/08 |
01/1/09 |
03/1/09 |
09/1/09 |
| 09/2/08 10/1/08 |
02/1/09 |
04/1/09 |
10/1/09 |
| 10/2/08 11/1/08 |
03/1/09 |
05/1/09 |
11/1/09 |
| 11/2/08 12/1/08 |
04/1/09 |
06/1/09 |
12/1/09 |
| 12/2/08 01/1/09 |
05/1/09 |
07/1/09 |
01/1/10 |
| 01/2/09 02/1/09 |
06/1/09 |
08/1/09 |
02/1/10 |
| 02/2/09 03/1/09 |
07/1/09 |
09/1/09 |
03/1/10 |
| 03/2/09 04/1/09 |
08/1/09 |
10/1/09 |
04/1/10 |
| 04/2/09 - 05/1/09 |
09/1/09 |
11/1/09 |
05/1/10 |
|
If Flat-Rate Contributions Begin After 6 Months... |
| Your first day of employment is between these inclusive dates |
Your and your Dependents' Health Coverage is effective |
Your Dental Coverage is effective |
Your Dependents' Dental Coverage is effective |
| 03/2/08 04/1/08 |
11/1/08 |
01/1/09 |
07/1/09 |
| 04/2/08 05/1/08 |
12/1/08 |
02/1/09 |
08/1/09 |
| 05/2/08 06/1/08 |
01/1/09 |
03/1/09 |
09/1/09 |
| 06/2/08 07/1/08 |
02/1/09 |
04/1/09 |
10/1/09 |
| 07/2/08 08/1/08 |
03/1/09 |
05/1/09 |
11/1/09 |
| 08/2/08 09/1/08 |
04/1/09 |
06/1/09 |
12/1/09 |
| 09/2/08 10/1/08 |
05/1/09 |
07/1/09 |
01/1/10 |
| 10/2/08 11/1/08 |
06/1/09 |
08/1/09 |
02/1/10 |
| 11/2/08 12/1/08 |
07/1/09 |
09/1/09 |
03/1/10 |
| 12/2/08 01/1/09 |
08/1/09 |
10/1/09 |
04/1/10 |
| 01/2/09 02/1/09 |
09/1/09 |
11/1/09 |
05/1/10 |
| 02/2/09 03/1/09 |
10/1/09 |
12/1/09 |
06/1/10 |
| 03/2/09 04/1/09 |
11/1/09 |
01/1/10 |
07/1/10 |
| 04/2/09 - 05/1/09 |
12/1/09 |
02/1/10 |
08/1/10 |
This concludes the section on Flat-Rate Eligibility Provisions.
Top of Flat-Rate Section
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Miscellaneous Eligibility Provisions
Qualified Medical Child Support Order
A Qualified Medical Child Support Order (QMCSO) is a court order that requires a participant to provide medical coverage
for his or her children (called alternate recipients) in situations involving divorce, legal separation, or a paternity dispute.
Coverage will be provided to a child even if that child does not reside with the employee or was not covered under the Plan
due to custody-related issues, if that child is identified as an alternate recipient under a QMCSO.
The Benefits Fund Office will notify affected participants and alternate recipients if a QMCSO is received. If you, your child
or the child's custodial parent or legal guardian would like a copy at no charge of the Plan's written procedure for QMCSOs,
or have any questions, please contact the Benefits Fund Office.
Top of Miscellaneous Provisions Section
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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 and your dependents' eligibility will end. However, coverage for you and your
dependents 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 and dental 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 enterin | 
