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).
To be eligible initially, you must have accumulated balance in your Dollar Bank equivalent to 40 hours on your Eligibility Determination Date. Your Eligibility Determination Date is the first day of the month where the Trustees look to see if your Dollar Bank balance has reached the minimum required amount to buy a month’s coverage, as set by the Trustees.
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). On an annual basis, the Board of Trustees determines the Dollar Bank minimum balance requirement. Contact the Fund Office to find out the minimum balance applicable to you.
Reminder! Track your Dollar Bank balance and eligibility status through the Member Dashboard.
Participants Working Under a Participation Agreement
A Participation Agreement is the negotiated contract between the Fund and your Employer, allowing for your participation in the 4th District IBEW Health Fund. It is used to provide coverage for those who are not working under the terms of a Collective Bargaining Agreement. You are eligible for coverage based on the payment of required contributions to the Fund on your behalf and based on your employment class, as indicated below:
- Office staff of a contributing Employer do not have a Dollar Bank, but have an HRA account. Additionally, participants employed by a contributing Employer who is an owner (sole proprietor), or 5% or greater shareholders in a corporation, partnership or limited liability company have access to an HRA account.
- IBEW and non-IBEW employees of a Local Union, affiliated JATC or IBEW Federal Credit Union have a Dollar Bank and HRA account.
- IBEW alumni employees working for an affiliated National Electrical Contractors Association (NECA) Chapter, a trade council, labor-related governmental agency or similar organization have a Dollar Bank and HRA account.
Eligible Dependents Include:
- Your legal spouse, provided you are not legally separated or divorced. This means your current legal spouse as recognized by federal law and the state in which you reside.
- Your children (biological, legally adopted, children placed for adoption and stepchildren) until the date they reach age 26.
- Children covered pursuant to a Qualified Medical Child Support Order (see below).
- Children for whom you have legal guardianship.
- Your disabled children age 26 and older, provided they are disabled under the terms of the Plan and are dependent on you for principal support and unable to earn their own living due to their disability.
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.
If you are enrolled in the Building Trades Plan or the Flexible Choice Plan and your Dollar Bank balance is not sufficient to purchase a month’s coverage, you can continue coverage for yourself and your dependents by making self-contributions. The amount you pay in self-contributions and the limit of self-contributions you can make depend on your Dollar Bank balance.
If Your Dollar Bank Balance is Not Sufficient to Purchase a Month’s Coverage on an Eligibility Determination Date
You may make a self-contribution to continue coverage as long as your Dollar Bank balance is at least 40 times the hourly contribution rate. Your self-contribution equals the difference between the required amount and the balance in your Dollar Bank. If you do not make the required self-contribution or your Dollar Bank balance is less than 40 times the hourly contribution rate, the balance in your Dollar Bank will roll forward to the next month. The balance in your Dollar Bank continues to roll forward until (whichever occurs first):
- The month you make the required self-contribution to purchase coverage;
- The month your Dollar Bank balance reaches the required minimum amount, as determined by the Trustees, for coverage without self-contribution, and coverage is provided; or
- The date that 12 months elapse from the last Dollar Bank activity.
If Your Dollar Bank Balance is ZERO on an Eligibility Determination Date
You may make a self-contribution to continue coverage. Your self-contribution equals the required monthly amount set by the Trustees. You may make up to 30 consecutive self-contributions to purchase coverage in this manner. You can purchase an additional three months of coverage under COBRA continuation coverage, as described under the “COBRA Continuation Coverage” subsection of the “Other Information You Should Know” section. The total number of consecutive months allowed under self-contributions and COBRA continuation coverage combined is 18 months.
Failure to make the required self-contribution when due will result in termination of coverage. Late contributions will not be accepted. Once coverage terminates, you can only reinstate coverage by requalifying as an eligible active participant.
Instead of making a self-contribution, if your Dollar Bank balance is zero on an Eligibility Determination Date, you can select the Flexible Choice Plan (in lieu of continuing coverage under the Building Trades Plan) either through self-contributions or COBRA continuation coverage. If you make this election, you will be required to reject continuation of your coverage under the Building Trades Plan in writing.
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. You will be provided the necessary form by the Administration Office when COBRA continuation is available to you.
When Coverage Begins
If You Work Under a Collective Bargaining Agreement
If you are a bargaining unit or new employee, benefits are effective on the first day of the benefit month if your Dollar Bank balance on the first day of the previous month is at least the minimum required. Eligibility continues on a month-to-month basis. For example:
- 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.
If your Dollar Bank balance is not sufficient to continue benefits for the next month, you may continue coverage by making self-payments.
If You Work Under a Participation Agreement
If you are subject to a Participation Agreement, you will have no Dollar Bank credits. You become eligible for coverage based on the payment of required contributions to the Fund on your behalf. Coverage takes effect on the first of the month following the receipt of the required monthly contribution amount by your Employer. Contributions are due on the 15th day of the Payroll Month—the month the Fund must receive contributions, paid by your Employer on your behalf—for coverage in the following Benefit Month. Eligibility continues on a month-to-month basis. For example:
- December 1: Charles started working.
- December 15 (Payroll Month): Charles’ Employer contributes the required monthly amount to the Fund for Charles’ coverage.
- January (Benefit Month): Charles is eligible for coverage for this month.
Return From Military Leave
In general, three months of coverage will be provided at no cost for bargaining unit participants returning to covered employment after serving in the military. After this three-month period, a member may use his or her Dollar Bank account to cover the cost of coverage if the Fund receives insufficient contributions on the member’s behalf. Under the Family and Medical Leave Act of 1993 (FMLA), new provisions apply that offer extended coverage. Click here to learn more.