Retiree Health & Welfare
Health & Welfare Plan
Frequently Asked Questions
How do I become eligible for benefits?
An Active participant must be reported by a signatory employer for 200 hours or more during a qualifying work quarter, or on a monthly basis.
When does Active Eligibility End?
Active eligibility will terminate on the last day of an Eligibility Quarter if the hours worked for Contributing Employers during the most recent complete Work Quarter, plus the hours in your Reserve Account, do not equal 200 hours or more.
If you are eligible on a month-to-month basis, your eligibility will end on the last day of the second month after the month in which you were last reported. If you have a Reserve Hour Bank, your eligibility will be maintained until that expires. For example, a member whose last month of work is July would be reported to the Fund during the month of August and eligibility would be established for September.
If you enter full-time active duty with the Armed Forces of the United States, your eligibility will terminate upon entrance to active duty if you do not follow certain provisions described here.
Eligibility will be terminated and Reserve Hours forfeited for any Active eligible who is in collusion with his employer to deliberately under-report the hours actually worked, or required to be reported to the Fund, or who works for a non-contributing employer in a covered classification. Upon discovery of either of these incidents, the Reserve Hour Bank will be suspended. Unless the Active member works 200 hours or more for which contributions are made or are required to be made to the Fund within a work quarter in the next four consecutive work quarters, the Reserve Hours will be forfeited permanently. However, any canceled hours may be reinstated if the Board of Trustees receives satisfactory proof that the Active Employee was continuously on the out-of-work list of the Union in each work quarter during which no contributions were made on his behalf.
Do I have to enroll? Do I have to take a physical?
Enrollment in the Plan is automatic once you satisfy all the eligibility requirements. No proof of good health is required. Existing illnesses or injuries are not excluded from coverage, except for treatment for alcohol and drug detoxification and counseling.
If I don’t have 200 hours reported in a qualifying work quarter but I do have 200 hours reported in a three-month period, can you shift my hours to make me eligible?
No. Eligibility can only be established by being reported in the appropriate quarter. No shifting of hours is permitted.
If my hours are short for a work quarter, how can I maintain Active Eligibility?
The Reserve Account can provide extended eligibility to supplement your hours if you have not been reported for enough hours to make you eligible.
For the quarterly eligibility system, all hours reported over 400 in a work quarter go into the reserve. The maximum reserve is 500 hours which can provide for six months. An Active quarterly participant uses 200 hours from his Reserve Hour Bank to be eligible for one quarter
For participants on the monthly system, each month of reporting provides a reserve of 15 hours, with a maximum reserve of 500 hours. An Active monthly participant uses 83 hours from his Reserve Hour Bank to be eligible for one month.
If an Active Member on hourly eligibility falls short of continuing eligibility for a given Eligibility Quarter by 50 or fewer hours, that member will have the option to buy-up the shortfall in hours at the same hourly contribution rate his or her employer would have paid ($11.85 in California and $11.95 in Nevada*). For example, if a member only worked 180 hours in a Qualifying Work Quarter in California, he or she would have the option to pay $237.00 (20 X $11.85*) to the Fund and continue their eligibility for the next quarter.
The Fund Office will automatically offer this option to every member, each quarter who falls short of continuing their eligibility by 50 or fewer hours.
*Based on the current employer contribution rates as of July, 2020.
I have been a member in good standing for 15 years and my eligibility has terminated. Can I receive additional reserve hours based on the number of years I have participated in the plan?
No. Past years of service have no bearing on the Reserve Hour Bank.
What happens when unused hours remain in my reserve hour bank?
Any unused hours in your Reserve Hour Bank will remain in your account for four consecutive eligibility quarters (one year). These hours can be combined with future hours reported on your behalf to extend your eligibility. If no hours are reported during these four consecutive quarters, the Reserve Hours Bank is forfeited.
What happens if I become disabled during a work quarter and my hours are short?
If the eligible Active member becomes disabled and because of that disability is prevented from maintaining his eligibility, he may be entitled to disability credit. Based on the information received from the treating physician, disability credit can extend his full benefits for himself and his family for 3 to 6 months. Click here for more information.
Are my dependents eligible immediately?
All Active dependents are eligible for Health & Welfare benefits as soon as the participant becomes eligible. A spouse becomes eligible on the date of marriage, children on the date of birth or adoption. The only exception is that a baby is not eligible for the life insurance benefits until he or she is 14 days old. Dependents of Retirees are not eligible for Health & Welfare benefits until the Retiree enrolls them in the Plan and pays the appropriate fee. New dependents (spouse or child) must be added within 31 days of marriage or birth of the child, or they cannot be added to the Plan until Open Enrollment.
Are step-children covered?
Yes, step-children are covered on the same basis as other dependent children. Coordination of benefits with another group insurance carrier may be a factor with step-children. As each situation is unique, please get in touch with the Fund Office with any questions.
I have lost eligibility. What is COBRA and what are Qualifying Events?
COBRA stands for the CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT of 1985.
COBRA requires that employees have the right to continue their health coverage by paying a monthly fee if they lose coverage under the Plan because of a “qualifying event.”
Who is entitled to COBRA Continuation Coverage?
Under the law, only “qualified beneficiaries” are entitled to COBRA continuation coverage. A qualified beneficiary is any individual who was covered under the Plan on the day before the qualifying event by virtue of being, on that day, an eligible employee or retiree, a spouse of an eligible employee or retiree, or the dependent child of an eligible employee or retiree.
If you have a newborn child, adopt a child or have a child placed with you for adoption (for whom you have financial responsibility) while your COBRA continuation coverage is in effect, you may add this child to your coverage. You must notify the Fund Manager in writing, within 60 days of the birth or placement in order to add the child to your coverage. Of course, adding a child to your COBRA coverage may cause an increase in your COBRA premiums.
A spouse who becomes your spouse during a period of COBRA continuation coverage is not a qualified beneficiary, but you may add such a spouse to your coverage during the period you remain eligible for COBRA continuation coverage.
Each of your family members has a separate right to elect COBRA continuation coverage even if you do not. Therefore, it is important that your spouse and all dependents read this section of this website. Like all qualified beneficiaries with COBRA coverage, their continued coverage depends on the timely and uninterrupted payment of premiums on their behalf.
COBRA coverage is not available if the member or dependent is covered by any other group insurance. COBRA coverage is also not available if the person has Medicare. (EXCEPTION: WIDOWS – SEE SELF-PAYMENT PLAN FOR WIDOWS, page 36 of the benefit book).
COBRA coverage is also not available to a Retired participant unless he has returned to work as an Active participant in the Plan.
When does COBRA Continuation Coverage end?
COBRA continuation coverage will terminate on the last day of the maximum period of coverage unless it ends earlier for any of the following reasons:
- The plan you have chosen is terminated, in which case you may have the opportunity to change to another medical plan offered under the Fund.
- You or your dependents fail to make the monthly premium payments on time.
- The person receiving coverage becomes covered by another group health plan (as an employee, spouse or dependent) that does not contain any exclusion or limitation regarding a pre-existing condition.
- The person receiving the coverage becomes entitled to Medicare benefits after the date of election of COBRA.