Retiree Health & Welfare
Health & Welfare Plan
Active Eligibility
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Active Eligibility is based on your work for employers who have an agreement with Local 12 requiring contributions to the Health and Welfare Fund.
Quarterly Eligibility
For most Participants, eligibility is on a quarterly basis. If you have 200 or more hours reported on your behalf during a qualifying Work Quarter, you are eligible for the following Eligibility Quarter.
Note: There is a one-month lag period between Qualifying Work Quarters and Eligibility Quarters.
The Qualifying Work Quarters and Eligibility Quarters are:
| Qualifying Work Quarter If you work 200 or more hours during: |
Lag Month Eligibility Quarter | You Will Be Eligible for Coverage During: |
|---|---|---|
| January, February, March | April | May, June, July |
| April, May, June | July | August, September, October |
| July, August, September | October | November, December, January |
| October, November, December | January | February, March, April |
Eligibility can only be earned by hours reported in the appropriate quarter. No shifting of hours from one quarter to another is permitted.
Monthly Eligibility
For some Participants, eligibility is on a monthly basis. For each month you work (Work Month) for an employer who has a special agreement calling for monthly eligibility, you earn one Eligibility Month.
Examples of the Work and Eligibility Months for the first three work months of the year are:
| Work Month If you work during: |
Lag Month | Eligibility Month You will be eligible for coverage during: |
|---|---|---|
| January |
February
|
March
|
| February |
March
|
April
|
| March |
April
|
May
|
For participants on monthly eligibility under the terms of a Principal Employee Program Participation Agreement (PEPPA), there are a few different rules from all others on monthly eligibility:
- The eligibility for the participant and any eligible dependents will be terminated at the end of the month for which the full flat rate employer contribution and report form was not timely received.
- Such terminated eligibility will not be reinstated until after:
- All delinquent payments and reports are properly filed
- Proper reports and payments are timely submitted for three consecutive months thereafter
- The Reserve Hours Account will not be available to participants whose eligibility has been terminated for delinquent employer contribution reports and payments.
Reserve Hours Account
The Reserve Hours Account provides extended eligibility if you do not have enough hours to earn eligibility. Hours in the Reserve Hours Account can be used to provide up to six months of eligibility depending on the number of hours in the Participant’s Reserve Hours Account and the number of hours needed for eligibility.
For Participants with quarterly eligibility, all hours reported over 400 in a Work Quarter go into the Reserve Hours Account, up to a maximum of 500 hours. Should a Participant work less than 200 hours in a qualifying work quarter, hours will be withdrawn from the Participant’s Reserve Hours Account as necessary to bring the Participant’s hours up to 200.
For Participants with monthly eligibility, each month of reporting provides 15 hours into the Reserve Hours Account, up to a maximum of 500 hours. For each month of extended eligibility needed, 83 hours are withdrawn from the reserve. (See restrictions for those covered under a Principal Employee Program Participation Agreement (PEPPA).)
Unused hours will remain in your Reserve Hours Account for four consecutive Eligibility Quarters for Participants with quarterly eligibility or for 12 consecutive calendar months for Participants with monthly eligibility. If no hours are reported during this period, the Reserve Hours Account is forfeited.
However, any forfeited 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 Local 12 in each Work Quarter (or work month for those on monthly eligibility) during which no contributions were reported on his behalf.
Collusion with an Employer
The Reserve Hours Account will be forfeited for any Employee who is in collusion with an employer to deliberately under-report the hours actually worked, or required to be reported to the Fund, or who works in a covered classification for an employer that does not contribute to the Fund. Upon discovery of either of these incidents, the Reserve Hours Account will be suspended, and the Employee will have 60 days to file a request for reconsideration.
Eligibility Card
Every Active Employee receives an eligibility card from the plan they are enrolled in. They will receive an eligibility card upon initial enrollment in the Plan and upon any change that pertains to their enrollment (benefit plan change, address change, new dependent, etc.).
Termination of Active Eligibility
Quarterly Eligibility
Your Active Eligibility will terminate on the last day of an Eligibility Quarter if you have fewer than 200 hours reported during the most recent Work Quarter plus the hours in your Reserve Hours Account combined.
Monthly Eligibility
If you are eligible on a monthly basis, your Active Eligibility will terminate on the last day of the second month after the month in which you were last reported. If you have sufficient hours in your Reserve Hours Account, your eligibility will continue until the reserve is exhausted. For example, a Participant whose last month of work is July (which would establish eligibility for September) will have his Active Eligibility terminated on September 30th unless sufficient hours are available in his Reserve Hours Account. (See restrictions for those covered under a Principal Employee Program Participation Agreement (PEPPA).)
Revised 07/2020