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     Home → Welfare→ SPD → 1.1 ELIGIBILITY FOR EMPLOYEES


1.1 ELIGIBILITY FOR EMPLOYEES

An Employee becomes a Participant and is eligible for most of the Health and Welfare benefits described in this Booklet -– medical, prescription drug, vision, and dental programs, time loss benefits, life insurance, dependent life insurance, and accidental death and dismemberment benefits – if the Employee:

  • is an Employee of a Contributing Employer working pursuant to a Collective Bargaining Agreement that requires contributions to the Trust, or is an Employee covered by a Written Agreement between the Trust and the Employer that provides for employer contributions to the Trust on behalf of the Employee, and
  • is credited with at least 400 Covered Hours in not less than three nor more than five consecutive calendar months or is covered by a Flat Rate Contract, and
  • satisfies the Lag Month Eligibility Period, described below.


The Trustees may in their discretion provide expedited coverage as early as the first month that a Collective Bargaining or Written Agreement requires an Employer to contribute to the Plan.

How an Employee Becomes Eligible for Coverage

An Employee becomes eligible for coverage on the first day of the second calendar month after (1) a period of three to five consecutive calendar months during which the Employee is credited with at least 400 Covered Hours, or (2) the Employee’s Employer first contributes to the Plan for work by the Employee, as required by a Flat Rate Contract.

The 400 Covered Hours requirement may be satisfied in as little as one or two consecutive months, but coverage will not begin until the first day of the second month after the three consecutive month period in which the Employee has at least 400 Covered Hours – that is, the first day of the fifth consecutive calendar month. If an Employee does not complete at least 400 Covered Hours until a period of four consecutive calendar months, his coverage will begin as of the first day of the sixth consecutive calendar month. For an Employee who meets the requirement of at least 400 Covered Hours only in the maximum period of five consecutive calendar months, coverage will begin as of the first day of the seventh consecutive calendar month.

An Eligible Employee must enroll for coverage before the Trust will process his or her claims. Enrollment forms are available from the Trust Customer Service Office.

Continuation of Eligibility (Lag Month Eligibility Period)

An Eligible Employee will continue to be eligible for benefits by being credited with at least 80 Covered Hours during a calendar month. The Plan credits Eligible Employees working under a Flat Rate Contract with 80 Covered Hours each month the Employer contributes to the Plan for work by the Employee. To allow Employer reports to be received and processed, a reporting or “lag” month is used to determine monthly eligibility. So the Plan covers an Eligible Employee on the first day of the second month following the month in which the Employee is credited with 80 Covered Hours. This “lag” month is not lost; it is used to extend coverage through the month after an Eligible Employee stops working or is credited with less than 80 Covered Hours.

If after satisfying the eligibility rules you are credited with 80 Covered Hours during the month of: You will have eligibility during
the month of:
May
July
June August
July September
August October

The Trustees may in their discretion provide that no “lag” month will be used with respect to particular Collective Bargaining Agreements or Written Agreements.



 

 
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