Eligibility

Who’s Eligible

You and your dependents must meet the Plan’s eligibility requirements to be eligible for benefit coverage. Eligibility requirements vary depending on whether you are a salaried or hourly employee (see sections below). Also, if you are a new employee, please note that the Plan has special coverage rules for pre-existing conditions.

New and Bargaining Unit Employees

• Eligibility for Bargaining Unit Employees

  Bargaining Unit Employees. You are eligible for benefits based on the amount in your Dollar Bank. You become eligible for benefits after the minimum required amount has been credited to your Dollar Bank (without self-payment).

  Dollar Bank Minimum Balance Requirement. Effective for the September 2010 Benefit Month, the Dollar Bank minimum balance requirement for coverage without self-payment increased to $834. (Effective June 1, 2010, the recommended employer contribution rate increased to $5.95 per hour worked.)

  Reminder! Track your Dollar Bank balance and eligibility status through the Member Dashboard.

• Eligibility for New Employees

  If you are new to the Fund and don’t have the minimum required Dollar Bank balance, you may become initially eligible for coverage by:

  • Accumulating a balance in your Dollar Bank of at least $238 (40 hours X $5.95 per hour) on the eligibility determination date and making a self-payment (beginning with the September 2010 benefit month)

  or

  • Requesting a credit (or loan) to your Benefit Credit Bank. This is a loan that is repaid with contributions made to your Dollar Bank for work in covered employment. To request a credit, you must:
    • Have never been eligible for coverage under the Fund;
    • Be associated with a Local Union affiliated with the Fund;
    • Begin working or be available for work under a Collective Bargaining Agreement covering participants of the Local Union you belong to; and
    • Complete and execute an agreement that provides repayment of the credit.

  The deposit (or credit) to the Benefit Credit Bank is the amount required to purchase coverage through the Fund for three months. Benefits are effective on the first day of the benefit month. Eligibility continues on a month-to-month basis. If your Dollar Bank balance is not sufficient to continue benefits for the fourth month, you may continue coverage by making self-payments.

• If You Lose Eligibility

  If you are no longer eligible for coverage, you may make a self-payment to your Dollar Bank to reinstate coverage if your Dollar Bank balance is at least $238 (40 hours X $5.95 per hour). If you do not make the required self-payment, the balance in your Dollar Bank will be carried forward. After an additional contribution to the Dollar Bank is received, you have the opportunity to make a self-payment for the difference, if any, between the required amount ($834) and your Dollar Bank balance. (Note: The option to make a self-payment to purchase coverage is only offered after a deposit to your Dollar Bank.) The balance in the Dollar Bank is “rolled forward” until the earlier of:

  • The month you make the required self-payment to purchase coverage;
  • The month your Dollar Bank balance reaches $834 (the required minimum for coverage without self-payment) and coverage is provided without self-payment;

  or

  • The date your Dollar Bank has been inactive for 12 months. (Your Dollar Bank balance is forfeited after a 12-month period without a deposit.)

  If you are eligible for coverage when your Dollar Bank balance falls below the required $834 level, you have the option to:

  • Pay the required difference (with no minimum balance required); or
  • Roll forward your Dollar Bank balance.

  If you do not make the required self-payment, you will be ineligible for coverage. However, if you make a partial self-payment to maintain your eligibility, you have the option to either elect COBRA or make a full self-payment for the next month, assuming no further deposits to your Dollar Bank.

  COBRA. Under the federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may elect to continue certain benefits provided by the Plan in the event your or your eligible dependent’s coverage would otherwise end.

  You may continue your medical, prescription drug, dental, vision, and life insurance benefits for 18 months, 29 months, or 36 months, if applicable. The length of the time for which the benefits elected may be continued is based upon the ‘qualifying event’ that causes the loss of benefit eligibility. Qualifying events include:

  • Termination of your employment or a reduction in your hours of work;
  • Your death;
  • Your entitlement for health care coverage under Medicare;
  • Your divorce or legal separation; and
  • Your child’s loss of dependent status under the Plan.

  In order to elect continued coverage under the regular self-payment program, you must reject the COBRA continuation option in writing. Click here for full details about COBRA Continuation Coverage.

When Coverage Begins

• December 1: Charles started working.
• January: Contributions from his employer(s) are received by the Fund and credited to his Dollar Bank.
• February 1: Charles’ Dollar Bank balance is reviewed for eligibility and it has the minimum required balance to be eligible for coverage.
• March 1: Charles is eligible for benefit coverage for that month.

Return From Military Leave

Salaried Employees

If you are a salaried employee, you become eligible for benefits based on the payment of required contributions to the Fund on your behalf.

When Coverage Begins. Benefits are effective on the first day of the benefit month following the payment of the required monthly amount by your employer. Eligibility continues on a month-to-month basis.

If You Lose Eligibility. If you cease working for your employer, you may make COBRA payments to purchase continuation coverage.

Return From Military Leave. In general, three months of coverage will be provided at no cost for salaried participants returning to covered employment after serving in the military. Under the Family and Medical Leave Act of 1993 (FMLA), new provisions apply that offer extended coverage. Click here to learn more.

Your Dependents

• Dependent Eligibility and Extended Student Coverage

  Eligible Dependents Include:

  • Your legal spouse, provided you are not legally separated or divorced
  • Your children (biological, legally adopted and stepchildren) under age 19, or up to age 25 if a full-time student enrolled in an accredited school. Coverage for adopted children begins when the child is initially placed in your home for adoption
  • Your disabled children over age 19, provided they are disabled under the terms of the Plan.

  To qualify as a dependent, your child must share your residence for more than one-half of the calendar year and you must provide at least one-half of his or her support during the calendar year. Grandchildren, nieces, nephews, siblings, etc., are not eligible for coverage unless you have initiated the adoption process.

  Surviving Spouse and Children. If you should die while you are eligible for coverage, benefits for your eligible dependents will continue without payment until the end of the Benefit Month during which the second anniversary of your death falls or until your spouse’s remarriage, whichever occurs first.

  This survivor benefit continuance applies only to active participants, and covers dependents covered on the date of your death and any of unborn children once they meet the definition of “dependent” above. An individual dependent’s coverage under this survivor benefit continuance will terminate at the earliest of:

  • the end of the Benefit Month described above;
  • the date the individual no longer meets the definition of a “dependent;” or
  • the date the individual becomes eligible for Medicare.

  Qualified Medical Child Support Orders. In certain circumstances, a court may order a non-custodial parent to provide health care coverage on behalf of his or her child. This is accomplished through the use of a Qualified Medical Child Support Order (QMCSO). The Plan has adopted procedures to determine whether a medical child support order meets all of the elements required by law. Any participant or beneficiary may obtain a copy of the procedures, without charge, by contacting the Fund Office at 1-304-525-0331 or 1-888-466-9094.

  Extended Student Coverage

  The Fund will extend the child’s coverage for up to one year, if the Fund receives a written certification from your covered child’s treating physician indicating that:

  • the child is suffering from a serious illness or injury; and
  • a leave of absence (or other change in enrollment) from a postsecondary institution is medically necessary, and the loss of postsecondary student status would result in a loss of health coverage under the Plan.

  This maximum one-year extension of coverage will begin on the first day of the medically necessary leave of absence (or other change in enrollment) and end on the date that is the earlier of (1) one year later, or (2) the date on which coverage would otherwise terminate under the terms of the Plan. Contact the Fund Office at 1-304-525-0331 or 1-888-466-9094 for more information.