INITIAL ELIGIBILITY - With respect to all coverages, an active employee must have accumulated a minimum of 500 hours to be eligible for any coverage. Coverage is effective on the first day of the second month in which this eligibility requirement is satisfied AND a completed appropriate enrollment form is received by the Administrative Office. However, if no completed appropriate enrollment form is received by the Administrative Office as of the first day of the second month after the minimum hours requirement has been met, the eligible employee will be defaulted into employee-only coverage under the Self-Funded Medical Plan. No change can be made to that default election until the next open enrollment for that employee, subject to the rules for the HIPAA Special Enrollment rights.
RESERVE ACCOUNT - A separate reserve account will be maintained for each person showing an accumulation of hours worked for Participating Employers.
After qualifying for Initial Eligibility, a charge for coverage shall be 125 hours per month against the person's accumulated reserve hours, until insufficient hours remain in their reserve. Hours worked in one month shall not apply toward coverage in the next month, but in the second following month.
MAXIMUM RESERVE - Each person may accumulate a reserve not to exceed 750 hours, and shall have no claim for hours reported in excess of 750 hours.
RESIDUAL HOUR CREDITS - Where a person has not earned credits or had coverage for a period of twelve months or more, any residual hours (less than 125 hours) shall be forfeited; and thereafter, should the person again perform work covered by the Collective Bargaining Agreement, or through the National Reciprocity Plan as applicable, they shall be required to reestablish eligibility under the "INITIAL ELIGIBILITY" provision.
NON-BARGAINING UNIT EMPLOYEES - Officers, Business Representatives, and other Employees of the Union, employees of NECA and other Employees of Employers that the Trustees have agreed to allow to be covered pursuant to the terms and conditions of an executed participation agreement for whom the required contributions are made, are covered by the terms of this Plan.
DEPENDENT ELIGIBILITY - Your Spouse, Domestic Partner, and eligible dependent children (as defined below) are eligible for dependent coverage under this Trust Fund.
DEFINITION OF ELIGIBLE DEPENDENT CHILDREN
Your “dependent children” under the age of 26. The term “dependent children” includes your or your Domestic Partner’s son, daughter, stepson, stepdaughter or eligible foster child, or a child who has been adopted or placed for adoption with you or your Domestic Partner. To receive coverage under the Plan, these dependent children must not be eligible for other employer-sponsored health coverage (other than coverage of a parent).
Your or your Domestic Partner’s dependent children age 26 or over who are permanently and totally disabled prior to attaining age 26 and who continue to be claimed as your tax dependent. Generally the dependent child: (1) must be unable to engage in any substantial gainful activity by reason of a physical handicap or mental impairment, (2) must live with you for more than one-half of the year, and (3) does not provide over one-half of his or her own support for the year. Proof of such disability and dependency must have been furnished by you to the Plan or Trust within 31 days of the child’s 26th birthday. Subsequent demand of proof of the child’s disability and dependency may be required from time to time upon request. In addition, the Plan may contract with (and pay for) an outside provider to determine the existence of a permanent and total disability.
Your dependent child under the age of 26 who is an “alternate recipient” under a qualified medical child support order. In general, a child is an alternate recipient if he or she is recognized under a special court order (called a “medical child support order”) as having a right to coverage under the Plan. A medical child support order is “qualified” if it meets the legal requirements specified in Section 609 of the Employee Retirement Income Security Act (“ERISA”).
Note: No individual can ever be deemed a covered dependent unless they are the Spouse, Domestic Partner, or eligible dependent child (as defined above) of the covered employee or retiree, as provided herein. Moreover, you are required to provide any information required by the Trust to substantiate any individual’s status as a “dependent” under the Plan. Such information may be required upon enrollment and anytime during the period when the dependent is enrolled in the Plan. Information requested by the Trust may include, but is not limited to, information to substantiate the individual’s status as a dependent, such as a birth certificate or marriage certificate. Any failure to timely provide information requested by the Trust can result in the retroactive termination of the individual’s coverage under the Plan.
For a newborn child or adopted child, coverage is effective on the date of birth or the date of adoption or placement for adoption with the condition that an enrollment form is completed and received by the Administrative Office within 60 days of the date of birth or the date of adoption or placement of adoption. If the prescribed enrollment form is not received by the Administrative Office within the 60-day period, the effective date will be the first day of the month following the month in which the enrollment form is received.
Coverage for a new Spouse or Domestic Partner is effective the first day of the month following the month in which an enrollment form is completed and a copy of the marriage certificate or Domestic Partner registration form is received by the Administrative Office.
Coverage for a step child or a foster child is effective the first day of the month in which the enrollment form is received and approved by the Trustees.
For dependent children, coverage is effective for the dependent on the date you meet the initial and continuing eligibility requirements.
Dependents of retired employees shall mean your eligible dependents as defined above. However, with regards to your Spouse or Domestic Partner, he/she must have been covered under the Plan as of the date of your retirement. For additional information about such Spouse’s or Domestic Partner’s coverage, see page 9 under the section entitled “Survivor Benefit.”
QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSO) - If the child of a covered employee is an "alternate recipient" under a qualified medical child support order, the Plan will provide benefits in accordance with the applicable requirements of such order. In general, such child is an alternate recipient if recognized under a special court order (called a "medical child support order") as having a right to coverage under the Plan. A medical child support order is "qualified" if it meets the legal requirements specified in Section 609 of the Employee Retirement Income Security Act (ERISA). Additional information regarding QMCSO is available upon request from the Administrative Office.
FAMILY AND MEDICAL LEAVE ACT (FMLA) - Under the Family and Medical Leave Act of 1993 (FMLA), you may be entitled to family or medical leave as follows:
1. If you are eligible to take, and elect FMLA leave, coverage under this Plan pursuant to FMLA will continue until the earlier of:
- the date you notify your employer that you do not intend to return to work at the end of the FMLA leave; or
- the end of the required FMLA leave period.
2. Continued participation in the Plan while on leave is at your option. Contributions will continue to be paid on your behalf while you are on the required FMLA leave; however, you will be required to make the same contribution you made as an actively-at-work employee, if any. If you do not elect to continue benefits under this provision during the FMLA leave, coverage will be reinstated without regard to any preexisting condition limitations if you return to active-at-work status on or before the end of the required FMLA leave.
3. The Trust Fund does not determine if you meet the requirements for leave under this law. You must contact your employer to find out if you are eligible for FMLA.
MILITARY SERVICE - Under the Uniformed Services Employment and Reemployment Act of 1994 (the Act), a covered employee who enters the Uniformed Services (as defined in the Act) shall be provided continuation coverage and reinstatement rights in accordance with the Act, provided the applicable premium is paid in a timely manner. Such covered employee may elect to continue coverage, on a self-pay basis, for the lesser of: the 24-month period beginning on the date the absence from employment begins; or the day after the date on which the individual fails to apply for or return to employment in accordance with applicable provisions of the Act. This period will run concurrently with COBRA continuation coverage period. The employee’s rights and obligations with respect to continuing coverage under the Act are the same as the employee’s rights under COBRA continuation coverage, including but not limited to the election and payment procedures, except: (1) if the individual is absent for fewer than 31 days, the employer will pay its part of the cost of coverage as if the individual had worked during the period of absence and (2) if the employee becomes covered by another group health plan or entitled to Medicare during the Act’s maximum coverage period, the continuation coverage under the plan elected by the "qualified beneficiary" (as defined in COBRA) will not be terminated early (i.e., before the end of the maximum coverage period). Call the Administrative Office for more details on Uniformed Services Employment and Re-Employment Rights Act (USERRA).
TEMPORARY DISABILITY COVERAGE - An employee covered by the Trust Fund who becomes temporarily disabled while eligible and thereafter receives Workers Compensation or Unemployment Disability Compensation (UDC) for that disability may request in writing to the Trustees that they be placed on the Temporarily Disabled list. The request must be made within thirty (30) days of the receipt of Workers Compensation, UDC or when an employee's reserve hours are depleted. Upon the written approval of the Trustees, such person shall have their Health and Welfare coverage provided on their behalf by the Trust Fund for a period beginning no earlier than the first month in which Workers Compensation or UDC has been received, or when the employee's reserve hours are depleted. Coverage shall continue for a period not to exceed twelve (12) months or until recovery, whichever occurs first. If an employee recovers within the twelve month period, the employee shall not be eligible for Temporary Disability Coverage again until the employee has returned to covered employment or has registered for immediate employment and twelve consecutive months have elapsed since the last month for which the Trust Fund provided the employee Temporary Disability Coverage. This provision shall not apply if the employee has applied for total and permanent disability retirement from the Social Security Administration.
If, after 12 months of Temporary Disability Coverage under the Trust Fund have elapsed and you are still disabled, you may be eligible to continue your coverage by self-payment through COBRA. The number of months you used under this Temporary Disability Coverage will count towards your COBRA continuation coverage. For example, a qualified beneficiary may continue coverage through COBRA up to 29 months if they are disabled, with the Temporary Disability Coverage, a qualified beneficiary may only continue 17 more months by self-payment through COBRA for a total of 29 months of coverage through the Trust Fund. See the section on COBRA for more information about this right.
Owners and Non-Bargaining Unit employees are not eligible for Temporary Disability coverage.
PERMANENT DISABILITY - Persons who prior to age 62 become permanently and totally disabled while covered under a collective bargaining agreement, and who meet all of the eligibility requirements as set forth above, except for not having attained age 55, shall be covered as Retirees, based upon the following:
1. Receipt of an award of 100% disability from the Social Security Administration.
2. The employee was covered as required for the month in which it is determined s/he became permanently disabled.
3. Coverage shall begin in the month in which the Social Security Disability award is rendered.
4. Certification of total disability may be required periodically by the Board of Trustees of the Retiree Plan for Retiree coverage to continue.
SURVIVOR BENEFITS - Eligible dependents under the Redwood Empire Electrical Workers Health and Welfare Plan will become eligible for coverage in this plan on the death of the insured if, at the time of death, the insured could have otherwise qualified for benefits. Benefits will continue with respect to Dependents of Persons who completed at least 10 years of service (a year is defined as 8 months of eligibility in the 12 months of a calendar year). The duration of coverage will be one-half year for each year of service with a maximum continuation of 10 years. Dependents may also be eligible to continue coverage by self-payment through COBRA. Benefits shall terminate on the date the surviving spouse remarries or is eligible for coverage under any other group type plan.