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Health & Welfare
Health & Welfare - Who's Eligible
Eligibility in Plan
Monthly Contributions
Eligibility - Monthly Contributions
Reinstatement of Eligibility - Monthly Contributions
Hourly Contributions
Initial Eligibility - Hourly Contributions
Continuing Coverage - Hourly Contributions
Bank of Hours - Hourly Contributions
Dependent Eligibility
Handicapped Dependent Children Eligibility
Eligibility in Plan
Your
Health and Welfare Plan is financed by contributions made by employers
as specified in their Labor Agreements with Local 1547 for each
participant who works for them. Some Labor Agreements specify
that Health and Welfare (H&W) contributions are paid as a monthly flat
rate (monthly contributions) and some specify that H&W contributions
are paid as an hourly rate (hourly contributions).
It
is your responsibility to check with your employer, the Administrative
Office, or Local 1547 frequently to make certain that Health and
Welfare (H&W) contributions are being made for you by your employer.
To
be eligible for benefits from your Plan, you must have worked a
certain minimum number of hours in previous months and your employer
must have contributed and reported the hours for you to the Fund.
You will be eligible for the benefits of your Plan if you meet the
following
monthly contribution
eligibility rules or the
hourly contribution
eligibility rules.
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Eligibility - Monthly Contributions
As an eligible employee covered
by an agreement calling for a flat rate monthly contribution, you
will be covered on the first day of the calendar month following the
calendar month you worked the number of hours or days specified by
your agreement (e.g., work during September provides
coverage for October). Please note that some agreements
require 1 hour, some 130 hours, and others require that you are
employed on certain days of the month.
Under most agreements, coverage will terminate on the last day of the
calendar month following the calendar month in which you last worked
the number of hours or days specified by your agreement (e.g., your
agreement requires 130 hours minimum and you have 140 hours in June
and employment is terminated in June, coverage is provided through
July 31).
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Reinstatement of Eligibility - Monthly
Contributions
If your coverage terminates because
you fail to meet the Eligibility rules of this Plan, your benefit
levels will be reinstated on the first day of the calendar month
following the month in which you are again employed by one or more
contributing employers and you work the number or hours or days
specified by your agreement.
This means that any deductible and copayment amounts you have
satisfied and/or benefits paid under this Plan prior to termination
of coverage will be applied, during the remainder of that calendar
year if re-employment occurs during that calendar year, to Covered
Charges incurred after the date of reinstatement.
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Initial Eligibility - Hourly
Contributions
You will be covered on the first day of the second calendar month
following accumulation of 390 or more work hours (reported and paid
to the Fund) within a consecutive three month period. Example:
The lag
month is necessary for the processing of reported hours by the
Administrative Office.
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Continuing Coverage - Hourly
Contributions
When you
have met the initial eligibility requirements as stated above, your
coverage can be continued in two ways:
(A) By work hour credits – you
will be eligible and covered as long as you have 130 or more hours
in your Hour Bank account. 130 hours is deducted from your Hour Bank
account for each month you are covered. The lag month continuously
applies in computing your coverage by work hour credits.
(B) By self-payment – if you do
not have 130 hours in your Hour Bank account, you may self-pay to
maintain your coverage. Self-payments can be made for the eighteen
months following the last month you were eligible. (See self-payment
rules.)
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Bank of Hours - Hourly Contributions
All hours worked and reported
are credited to your Hour Bank account. 130 hours are required to
provide you with one month’s coverage. All hours worked in excess of
130 in any one month are credited to your Hour Bank, which will
provide coverage during months of unemployment.
Example:
Hours worked
in month 160.0 The
30 hours remaining
LESS: coverage hours 130.0 are
in your Hour Bank
Remaining hours
30.0 for future coverage.
The maximum number of hours that
you can accumulate to your credit at any one time for coverage
purposes is 1,040 (which is equivalent to 8 months), after deduction for
the current month’s coverage.
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Dependent
Eligibility - Monthly and Hourly Contributions
If you are covered by a family
plan, your dependents are eligible when
you are eligible. Dependents are defined as your legal wife or
husband and your unmarried children less than nineteen years of age,
provided they are not in the Armed Forces. Eligible children, in
addition to your natural children, include legally adopted children,
step-children or foster children who live with you and are dependent
on you for principal support and maintenance. Unmarried children who
are attending school full-time are covered to their 24th birthday.
NOTE: The Plan may request legal
proof of marital status, such as a marriage certificate. A custody
order or divorce decree may be requested to ascertain which parent has
the responsibility to provide health and welfare coverage.
Your dependent’s coverage will
terminate on the date your coverage terminates.
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Handicapped Dependent Children
Eligibility - Monthly and Hourly Contributions
If you are
covered by a family plan, the benefits
of this Plan will continue for your dependent child if the child is
chiefly dependent upon you for support and maintenance and your
child is incapable of self-sustaining employment because of mental
retardation or physical handicap. The incapability of the child must
have commenced prior to attaining the maximum age of nineteen for a
dependent child. Coverage is not automatic; you must submit proof to
the Administrative Office at least 31 days prior to the child’s
attainment of the maximum age for a dependent child.
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