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      Home → Welfare → BenefitTabs:Eligibility

 


Initial Eligibility

Eligibility for employees is based on specific types of hours worked under a collective bargaining agreement. To initially establish eligibility you need 400 hours of covered work within a 3 to 5 month period. Also, you must enroll before you can file any claims for benefits. When you become initially eligible you may be subject to some limitations for pre-existing conditions. Also, the Plan's general limitations apply to all benefits and the rules for Utilization Management must be followed for hospitalizations and certain medical procedures for you to obtain maximum coverage.

Disclaimer: Effective July 1, 2003, the Plan was modified by the Board of Trustees to eliminate the “pre-existing condition” provision.

 


Dependent Eligibility

A Dependent of an Eligible Employee becomes eligible at the same time that the Employee becomes eligible, or the date the Dependent is acquired, if later.

A Participant with dual coverage (both husband and wife eligible to enroll in this Plan) may enroll both as a Participant and as a Dependent. A Participant or Dependant may enroll in this Plan as a Dependent of more than one Participant (for example: children of Participants with dual coverage under this Plan). Please refer to the Summary Plan Description (SPD) for further details.

 

Lag Month

Because the Trust office needs to process the contributions sent in by your employer, there is a lag month between the month your accumulated hours reach 400 and the month your eligibility begins. So, if you reach 400 hours for initial eligibility in April, then your coverage will begin on June 1st.

 

Continuing Eligibility

After you establish initial eligibility, you must work at least 80 hours per month to remain covered.

 

Hour Bank

The hour bank helps to keep you covered during months when you work less than 80 hours. When you establish initial eligibility, anything over 400 hours will start your hour bank. Each month after that, if you work more than 100 hours, anything worked over 100 hours will be added to your hour bank. If you work less than 80 hours and you have sufficient hours in your hour bank, hours will be withdrawn from the hour bank to make up the 80 hours needed for continued eligibility. The maximum number of hours you can save up in your hour bank is 480. Please note the hour bank is not available if the Employer is contributing on your behalf under a "flat rate" contract.

 

Losing Coverage

Your coverage will end when the combined sum of your worked hours and/or your hour bank is less than the 80 required for continued coverage. Other, less common, reasons for termination of eligibility can be found in the SPD. When you lose coverage you may be able to make payments under the COBRA provisions of the Pan to continue coverage for a limited time. If you qualify under total disability rules, you may also be able to continue coverage.

 

Reinstatement

You have 13 months after you lose coverage to reinstate without having to reestablish initial eligibility. To reinstate, you need to work 160 hours within one or two consecutive months. Keep in mind that the lag month applies when you reinstate eligibility. So, if you work the 160 hours to reinstate in the months of July and August, your coverage will begin again on October 1st.

 

 
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