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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

     Reinstatement of Eligibility - 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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Reinstatement of Eligibility - Hourly Contributions

If your coverage terminates because your Hour Bank account has less than 130 hours, the balance of your hours, if any, will be carried for 4 months. If, during that 4 months, you work and add hours to your Hour Band, your eligibility will be reinstated on the first day of the second month with the first month being the lag month, after the Hour bank has a total of 130 hours. If you do not work sufficient hours during the 4-month period following termination to obtain reinstatement, the balance of your hours, if any, will be absorbed back into the Fund and you will be required to satisfy the initial eligible rules to again be covered.

However, if you have continuously self-paid during this period and thereafter, your Hour Bank will be kept frozen and upon returning to work, the hours will be used toward the 130-hour requirement and you will not need to satisfy the initial eligibility rules.

If your transfer to a plan providing monthly coverage, the balance in your Hour Bank will be frozen for up to 36 months. If you do not return to a plan with Hour Bank eligibility within this 36 month period, the Hour Bank will be absorbed back into the Fund. If you return to an Hour Bank plan after the 36 month period, you will be required to satisfy the initial eligible rules to again be covered.

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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Dependent Eligibility - Monthly and Hourly Contributions

If you are eligible for an active or COBRA plan, your dependents are eligible when you are eligible. Dependents are defined as your legal spouse and your dependent children less than 26 years of age. Eligible children, in addition to your natural children, include legally adopted children, step-children or foster children. Dependent children can be on the plan until his/her 26th birthday.

NOTE: The Plan will request legal proof of dependent status, such as a state-issued marriage certificate for a spouse, a state-issued birth certificate for a dependent child. 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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