Eligibility & Enrollment FAQs

Refer to Active Participant eligibility for details.

Refer to required hours for details.

If you do not work the required number of hours, you will lose your eligibility for coverage.  For example, if you do not work the required hours in August, you will not have coverage in October. Your eligibility can also terminate for reasons other than a lack of required hours, such as due to termination or layoff, or if you do not pay your contribution to premium in a timely manner.

If your eligibility ends because you failed to earn the required hours, or due to termination or layoff, you may elect COBRA Continuation Coverage. You will receive a COBRA election notice in the mail. You will also receive an Application for Reinstatement of Eligibility form that allows you to request reinstatement of your eligibility/extended eligibility if your lack of hours was due to:

• Vacation
• Approved family leave
• A military leave of absence
• Disability for which you received state disability or workers compensation benefits

If you were on vacation, complete the applicable portion of the Application for Reinstatement form and return it to the Fund within 30 days. If you are on approved family leave, complete the applicable portion of the Application for Reinstatement of Eligibility form and attach a copy of the approval letter from your employer.

Active Participants may use state disability check stubs to extend their eligibility for benefits for up to six months and may use workers’ compensation proof of benefit payment to extend eligibility for up to 12 months. If you were on state disability or workers’ compensation, complete the applicable part of the Application for Reinstatement of Eligibility form and submit it to the Fund with proof of payment from the state or the insurance carrier.

To elect COBRA Continuation Coverage, complete and return the COBRA election form by the deadline shown on your COBRA election letter.
COBRA Continuation coverage requires a monthly premium. COBRA premium rates are based on the type of coverage elected and the family members enrolled. The first premium payment must be received within 45 days from your election date. Subsequent payments are due on the first day of the month of coverage and will not be accepted more than 31 days after the due date.

Failure to make a timely COBRA premium payment terminates your eligibility for COBRA Continuation Coverage.

Coverage terminates on the last day of the month in which your employment ends. You will be sent a COBRA notice and an Application for Reinstatement of Eligibility form. To elect COBRA coverage, follow the instructions noted above. Keep a copy of your COBRA election form for your records.

Participants experience a break in service when there is a termination or layoff from employment and no hours are worked for a period of 120 days or longer.

If you have a break in service (i.e., you do not return to the industry within 120 days following termination or layoff), you will be considered a new hire and will be subject to all new hire eligibility provisions. This means you will need to re-establish initial eligibility.

However, if you respond to a recall from a layoff, you will maintain your plan status (e.g., Platinum Plus, Platinum, Gold or Silver) provided you return to work at the same employer within 12 months of your layoff date.

If you choose not to enroll in coverage when you become eligible and/or during the annual Open Enrollment period, you will not have benefits coverage. Your next opportunity to enroll will occur during the annual Open Enrollment period (with coverage effective on January 1 of the following year). For example, if you became eligible on April 1, 2017, and you declined coverage, your next opportunity to enroll will occur during annual Open Enrollment in the fall of 2017. If you enroll during Open Enrollment, your coverage will be effective on January 1, 2018.

There are some exceptions to this rule. If you or a dependent lose health plan coverage through another source (e.g., your spouse’s employer’s plan) or if you acquire a new dependent, you may be able to enroll in the Fund’s plan if you meet the requirements for a special enrollment.  Refer to Making Changes/Life Events for more information.

To enroll in medical coverage, complete an enrollment form and return it to the Fund Office by the deadline noted in your enrollment materials. If you are close to completing your waiting period for initial eligibility and have not received an enrollment package, contact the Fund Office immediately. Refer to Enrollment for more information.

Active Participants can cover their natural child, step-child, legally adopted child (or child placed for adoption), or a foster child placed by court order or government agency. These individuals may be covered up to age 26, and the child’s coverage ends at the end of the month in which he or she turns age 26.

Different limiting age rules apply for a child of retirees, a foster child not placed by a court order or government agency, or a child of a domestic partner. Refer to Dependent Eligibility in the Active Eligibility and Retiree Eligibility  sections of this site for more details.

Your child’s coverage would also terminate any time your coverage terminates (for example, if you did not work the required hours to continue your eligibility).

If your child’s coverage terminates, the child may elect COBRA Continuation Coverage.

To enroll your certified domestic partner and his/her children, you will need to complete and return specific documentation to the Fund Office. You will also be required to pay federal taxes on the value of the coverage provided to your registered domestic partner and his/her children unless they qualify as your dependents for tax purposes under the Internal Revenue Code.

Contact the Fund Office to request a complete information package on domestic partner coverage, which will include specific tax information and all necessary paperwork for enrolling your domestic partner and/or his/her children.

The Fund’s medical plans coordinate with other employers’ health care plans to ensure that those other plans share some of the cost of benefits for working families. If your spouse’s or domestic partner’s employer offers health care coverage, he/she must enroll for employee-only coverage in that employer’s plan(s) that are comparable to those available from the Fund, even if payment of a premium is required. If your working spouse or domestic partner does not enroll in his/her employer’s coverage, benefits paid for his/her health care under the Fund’s plan will be substantially reduced.

This rule does not affect coverage for your eligible dependent children. Only your spouse or domestic partner is required to enroll in other available coverage (Learn More).

Refer to the claims and appeals procedures booklet for information on appealing a claim decision.

Active Participants pay a contribution towards the cost of their coverage. This amount is deducted automatically from your paycheck on a weekly basis.

• If you choose to enroll in Employee-Only coverage, your contribution is $8.00 per week ($7.00 per week for Plan B Participants.
• If you choose to enroll your children, your contribution for you and your children is $11.50 per week ($10.50 per week for Plan B Participants).
• If you are eligible to enroll your spouse/domestic partner and choose to do so, your contribution is $16.00 per week ($15.00 per week for Plan B Participants). (your payment is the same whether or not you enroll your children).

You must sign an enrollment form to permit your employer to withhold the amount of your premium contribution from your paycheck.

Yes. In fact, automatic payroll deductions for your plan elections are required. To set up your deduction, complete an enrollment form and return it to the Fund Office by the deadline noted in your enrollment materials.

Your employer forwards the deducted amounts to the Fund.

Not always. Amounts may be adjusted for periods when deductions are not taken from your wages (for example, when you are not scheduled to work because of a vacation or other reason).

Yes. Deductions taken in the current month pay for coverage in that month.

If your account has a balance and you still have active coverage, your deductions will be reduced until that balance has been used. For example, if your coverage level changes retroactively from “Family” to “Single” your deductions will be reduced or stopped until the balance is used. If you terminate your coverage and still have a balance, your Employer can refund directly to you any money deducted from your wages that should not have been deducted.

No. You are not allowed to drop your coverage except during annual Open Enrollment or in certain limited circumstances. For Open Enrollment changes, you must contact the Fund Office on or before December 31 of that same year to cancel your payroll deductions and drop your coverage for the following year.

Yes. You may enroll during the next annual Open Enrollment or, possibly earlier, if you have a qualified life event. Refer to Making Changes/Life Events. Your payroll deductions will begin during the first complete payroll period in the month after the date the Fund Office receives your enrollment form.

If you cease to be eligible to participate in the Fund or if your job classification is changed to one that is not covered under the Collective Bargaining Agreement, contact the Fund Office or your Union Local immediately. Your payroll deductions will be cancelled, and you may be offered COBRA Continuation Coverage.

There are certain circumstances that allow you to change your benefits elections outside of the annual Open Enrollment period. For example, if you or a dependent lose health plan coverage through another source (e.g., your spouse’s employer’s plan) or if you acquire a new dependent, you may be able to enroll in the Fund’s plan. Refer to Making Changes/Life Events or contact the Fund Office for more information.

Copies of your recorded, county marriage certificate, domestic partner registration, divorce, and birth certificate are required to enroll your dependents in coverage and/or make coverage election changes in support of these life events during the plan year.

If you request enrollment within 120 days after you acquire a new dependent, your spouse/domestic partner’s or dependent child’s coverage will be retroactive to the date you gained the new dependent (provided you were eligible at the time). If you request enrollment more than 120 days after the event, and no later than the end of that year’s Open Enrollment period, your dependent’s coverage will take effect the first day of the month after the Fund Office receives your enrollment forms. Contact the Fund Office if you have questions.

In the event you have a baby, be sure to submit a copy of the hospital birth certificate to the Fund Office as soon as possible after the baby’s birth – i.e., within 120 days. This will ensure the baby’s coverage is in effect retroactive to his or her birth date. Then, be sure to provide a copy of the recorded county birth certificate to the Fund Office within six months of the birth date. If the county birth certificate is not received within six months, the child’s coverage will be terminated.