Summary of Eligibility Rules

RETIREE ELIGIBILITY

Retiree Eligibility Requirements

In order to qualify for Retiree Eligibility, a Participant must meet ALL of the following requirements:

1. Has sufficient hours of contributions at the master rate made to the Fund to satisfy the eligibility requirements for a Regular, Early or Disability Pension from the Pension Fund; and

2. Has not had a Separation from Employment unless, after the Separation from Employment, has worked at least 6,000 hours in covered employment for which contributions were made to the Fund (or in certain circumstances 5,000 hours if the Participant becomes totally and permanently disabled.)  A Separation from Employment means the Participant fails to work at least 500 hours for a signatory employer during a period of three consecutive Plan Years, or is employed as an Operating Engineer for a non-signatory employer who is doing Operating Engineer work but not making contributions to the Fund; and

3. Has at least 3,000 hours of contributions made to the Fund on his behalf as an Active Employee at the then-existing master rate; and

4. Has refrained, at all times after retirement, from any employment for a non-contributory employer if that employer performs Operating Engineer work; and

5. Has been eligible for Active Health and Welfare benefits for at least two of the eight consecutive Eligibility Quarters immediately preceding his pension effective date.  However, if the Participant has worked 30,000 or more hours in contributory employment, he must have been eligible for at least three of the twenty consecutive quarters preceding his pension effective date.  This requirement is different for Pro-Rata or Reciprocal pensioners. Contact the Fund Office for details; and

6. Makes the required monthly self-payment for coverage in a timely manner.  The self-payment amounts are set by the Trustees and are subject to change from time to time.  Self-payments may be deducted from the Retired Employee’s pension check, paid by credit or debit card through the Fund’s secure premium payment portal at www.oefi.org or by check mailed directly to the Fund Office. Contact the Fund Office for details; and

7. Is not engaged in any type of gainful employment and covered or eligible to be covered by group health insurance through that employment or continuation coverage under COBRA through that employment; and

8. Within five years prior to retirement, must have been eligible for at least three Eligibility Quarters under the Active Plan.  At least 3,000 hours is required for minimum coverage (3,000 hours provides two years of coverage).

The length of Retiree Eligibility is based on employment for employers who made contributions to the Health and Welfare Fund on behalf of the Participant. A Participant is eligible for one year of Retiree Eligibility for each 1,500 hours on which contributions were made on his behalf to the Health and Welfare Fund.

Termination of Retiree Eligibility

Retiree Eligibility will be terminated on the earliest of the following dates:

1. The date your pension under the Operating Engineers Pension Trust is terminated, except if one
of the following applies:

  • You have returned to active employment with contributing employers. In this case, your
    Retiree Eligibility will continue until Active Eligibility is earned through either the Quarterly
    or Monthly Eligibility System (see page 4). In the interim, you must continue to pay your
    Retiree Premium through the Retiree Plan.
  • Your Disability Pension is terminated. In this case, your Retiree Eligibility will continue for a
    maximum of five consecutive months or until you gain Active Eligibility, whichever occurs
    first. However, you must continue your premium payments under the Retiree Plan during
    this five-month period.

2. If fewer than 15,000 hours were contributed on your behalf to the Operating Engineers Health
and Welfare Fund prior to the effective date of your pension award under the Operating
Engineers Pension Trust, the last day of the month during which your Retiree Health and Welfare
coverage has equaled one year for each full multiple of 1,500 hours of employment.

3. The last day of any month for which the required premium has not been received by the Fund
Office.

4. The first day of the month in which you engage in gainful employment and are covered or eligible
to be covered by any other group health insurance through that employment, including
continuation coverage under COBRA, whether or not you elect that coverage.

5. The first day of the month following the month in which you fail to provide the documents
requested by the Fund Office to determine your annual earned income.

6. The first day of any month in which you work IN ANY CAPACITY ANYWHERE for an employer not
signatory to a Collective Bargaining Agreement requiring contributions to the Fund, if that
employer does Operating Engineer work.

The Fund Office will notify any individual of termination of Retiree Eligibility, in writing, by First Class
U.S. Mail. The individual will have 60 days in which to file a written request for review (an appeal of the
decision).

ANNUAL OPEN ENROLLMENT

During December of each year, the Health & Welfare Plan holds an open enrollment period. If you are eligible to enroll in the Plan but are not currently enrolled, you will automatically receive open enrollment information.  Health & Welfare coverage for Retired and Widow participants who elect to enroll in the Plan during this open enrollment period will not begin until April 1 but you must pay the required fees for January through March.  Any charges incurred between January 1 and March 31 will not be covered.

Open Enrollment Form, click here.                                Retiree Plan Options and Fees, click here.

Retiree Health & Welfare Plan Monthly Fees

DISABILITY PENSIONERS ONLY

(Until age 65 – then Regular rates apply)

Retiree Health & Welfare Plan Monthly Fees

**The “M” Plan is restricted to Medicare participants who enroll in Medicare HMOs. The participant must submit evidence of coverage from the HMO with enrollment. The Fund pays limited benefits.

Plan “M” Information

The Board of Trustees currently offers Plan “M” for Medicare Retirees only.

Plan “M” allows you to select, and enroll in, any Medicare HMO of your choice in the area where you live. The Fund will then provide benefits only for:

  • Hearing Aids
  • Chiropractic Care
  • Dental Care
  • Death Benefits

At this time you can participate in Plan “M” at a lower monthly fee of $68.00 per person ($135.00 per couple). You must also pay the Medicare HMO’s fee, if there is any fee, directly to the HMO.

Important: If you join a Medicare HMO in your area and enroll in Plan “M”, you must obtain all your medical and hospital care from the Medicare HMO. The Fund’s Plan “M” will cover only those benefits listed above.

You cannot enroll in a Medicare HMO if:

  • You reside outside the service area of the HMO
  • You have End-Stage Renal Disease (ESRD)
  • You do not have Part B Medicare
  • You are currently receiving Medicare Hospice benefits

If you want to select Plan “M”, you must complete an Authorization Form and return it to the Fund Office with written confirmation from the Medicare HMO of the effective date of your coverage with them. Your monthly fee will be reduced on the first day of the month following receipt of your authorization form and the written HMO confirmation.

Plan “M” Questions and Answers

  1. How can I find a Medicare HMO in my area? You can get the names of the HMO plans in your area that have Medicare contracts by calling any Social Security Administration office or by calling Medicare at (800) MEDICARE (633-4227). All plans that contract with Medicare have an open enrollment period at least once a year.
  2. What if I cannot locate a Medicare HMO which serves my area of the country? If there are no Medicare HMOs available in your area, you cannot select Plan “M”. You would have to remain in the Fund’s Fee-for-Service Plan.
  3. I want to enroll in a Medicare HMO. When should I terminate my coverage in the Fund’s Fee-for-Service Plan? You should not ask the Fund Office to change your monthly fee until you have been formally approved by the HMO and have an effective date for your new coverage.
  4. I am a Medicare retiree and want to join an HMO but my spouse is not Medicare age. You may join the HMO and enroll in Plan “M” for $68.00 per month. Your spouse may join an HMO or remain in the Fund’s fee-for-service plan but the monthly fee for her coverage would be $394.00. The total monthly fee would be $462.00.
  5. I am a Medicare retiree and I have serious medical problems. What are my options?You could join a Medicare HMO and enroll in Plan “M”. However, you would be limited to the physicians in the HMO and any exclusions or limitations of the HMO.If you require specialized medical care and you like your current physicians, you may prefer to remain in the Fund’s fee-for-service plan.
  6. I have end-stage renal disease (ESRD) requiring kidney dialysis. Can I still enroll in a Medicare HMO? No, you cannot enroll in the HMO if you currently have ESRD. However, if, after joining the HMO, you are determined to have ESRD, the HMO is required to provide or arrange for your care.
  7. What happens if I enroll in Plan “M”, join a Medicare HMO and later find I want to change to another Medicare HMO? You may simply enroll in the other Medicare HMO. You will then be automatically dis-enrolled from the first Medicare HMO Plan.
  8. What if I enroll in Plan “M”, join a Medicare HMO but don’t like the HMO and want to return to the Fund’s fee-for-service plan? Once you have enrolled in Plan “M” you have 90 days to change your mind. Once the 90 days is over, you must remain in that plan until the Health & Welfare Fund’s Open Enrollment which is held once each year in December.To return to the Fund’s Fee-for-Service Plan, you must do both of the following:
    • Provide a written statement that you want to withdraw from the HMO to your local Social Security Office or the HMO administrative office.
    • Provide a written statement to the Fund Office of your intentions so you can be removed from Plan “M” and your monthly fee can be increased.

    The change would take effect the first day of the month following the month your request is received by the Fund office and the HMO or Social Security Office.

  9. What happens to my Medicare card if I join an HMO? By enrolling in a Medicare HMO, you transfer the administration of your Medicare benefits to the HMO. You will use the I.D. card the HMO provides. Should you decide to drop out of the HMO, the HMO will transfer you back to Medicare.
Pages: 1 2 3 4 5 6 7