Retiree Health & Welfare
Health & Welfare Plan
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. Notices will be mailed prior to the member losing eligibility and the response is time sensitive. Click here to make a payment online.
*Based on the current employer contribution rates as of July, 2020
Whether you have quarterly or monthly eligibility, your Active Eligibility will terminate on the day you enter full-time military service unless such service was in response to a call to active duty in the Reserve Armed Forces of the United States. (See Extended Eligibility for Military Service in the next section.)
Extended Eligibility for Military Service
If you are a member of the Reserve Armed Forces of the United States and you are called to Active Military Duty, you must notify the Fund Office, in writing, within 60 days from the date of the call to duty.
The written notice must include:
- Your name
- Social Security Number
- Operating Engineers Identification Number (OEID), or Local 12 Registration Number
- The date you are required to report for duty and a copy of the military order
If the notice is made timely, the hours in your Reserve Hours Account shall remain available to provide eligibility when you are discharged from the service, provided you make yourself available and actively seek employment with a contributing employer within 90 days after discharge or recovery from disability that commenced while on active duty.
Eligibility for your dependents will also continue until 90 days after your discharge from duty. Upon discharge from duty, you must contact the Fund Office and provide a copy of your discharge papers.
See also COBRA Continuation Coverage.
Extended Eligibility for Disability
If an Active Employee is prevented from maintaining eligibility because he is unable to perform his regular and customary duties due to an illness or injury, he and his qualified dependents may be entitled to an extension of eligibility. This extension is at no cost to the Employee and the Employee’s Reserve Hours Account is not affected.
For Active Employees with quarterly eligibility, the extension is for a period of three consecutive Eligibility Quarters, provided the Employee remains disabled during this period and that the number of hours for which contributions were made on behalf of the Active Employee during the Work Quarter in which the Active Employee was disabled when added to the number of hours in the Active Employee’s Hours Account totals at least 200 hours. The extension starts with the first Eligibility Quarter following the Work Quarter in which the Employee becomes disabled.
For Active Employees with monthly eligibility, the extension is for the month following the month in which he becomes disabled or, if greater, the number of months of eligibility in his Reserve Hours Account, provided the Employee remains disabled during this period.
- Mr. Smith has eligibility from February 1 through April 30 and becomes Totally Disabled on March 5. Because he was eligible at the time the disability occurred, he qualifies for a disability extension. Because his disability occurred during the Qualifying Work Quarter of January through March, the disability extension would be granted for the period of three Eligibility Quarters from May through January.
- Mr. Jones’ employer makes contributions on a monthly basis. He worked in February and March which provided Active Eligibility for April and May, and becomes Totally Disabled on April 5. Since he was eligible at the time the disability occurred, he qualifies for a disability extension for June. If he had hours in his Reserve Hours Account, he may be entitled to additional months of disability extension.
Extension of Medical Benefits due to Disability
After the Extended Eligibility for Disability extension is exhausted, any eligible individual, Employee or Dependent, who lost eligibility due to Total Disability will be eligible for reimbursement of covered expenses related to the disabling injury or illness until the earliest of:
- The date the Total Disability ends
- The end of the 12-consecutive month period from the date eligibility was lost, or
- The date the Employee becomes covered as a Retired Employee
If this extension applies to a Dependent child, stepchild, legally adopted child, or child placed with the Active Employee for adoption, benefits will be payable until the earlier of the date on which the Total Disability ends, or the 36-consecutive month period from the date eligibility was lost.
See also COBRA Continuation Coverage.
Benefits on account of pregnancy are limited to the benefit that would have been payable if eligibility had not been lost and will not be payable for any covered expenses incurred more than 90 days after the pregnancy terminates.
This extension is only for treatment of the disabling illness or injury. Any expenses for unrelated illness or injury or for other family members will not be covered. Work-incurred injuries or illnesses do not qualify for this extension.