Retiree Health & Welfare
Health & Welfare Plan
Retiree Eligibility Requirements
In order to qualify for Retiree Eligibility, a Participant must meet ALL of the following requirements:
- 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;
- 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;
- 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;
- Has refrained, at all times after retirement, from any employment for a non-contributory employer if that employer performs Operating Engineer work;
- 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;
- 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;
- 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;
- 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.
Open Enrollment for Retiree Eligibility
During December each year, the Plan holds an open enrollment period for Retiree Eligibility. If you are eligible to enroll in the Plan and are not currently enrolled, you will automatically receive open enrollment information.
Every eligible Retiree receives an eligibility card from the plan they are enrolled in. This card is issued when coverage under the Retiree program begins and upon any change that pertains to their enrollment (benefit plan change, address change, new dependent, etc.). There is no expiration date on the card because eligibility is determined on a monthly basis.
If you believe your eligibility record is incorrect, please inform the Fund Office as soon as possible to correct the information. If you do not receive an eligibility card, please contact the Fund Office.
Termination of Retiree Eligibility
Retiree Eligibility will be terminated on the earliest of the following dates:
- 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. 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.
- 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.
- The last day of any month for which the required premium has not been received by the Fund Office.
- 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.
- 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.
- 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).