ELIGIBILITY AND PLAN LEVEL SELECTION
When a member establishes eligibility, he/she will be enrolled in the default Medical Plan, which is the Indemnity Plan Level C. If the eligible member does not want to remain in the Indemnity Plan Level C; an enrollment form must be submitted within 90 days after establishing eligibility, wherein the member selects the desired Medical Plan and Plan Level for the next 12 months. The member has the option of lowering the Plan Level during the year as many times as needed. However, the member can only select a higher Plan Level after he or she has been enrolled in their initial or current Plan Level for 12 consecutive months. An Enrollment Form must be submitted selecting the new Plan Level prior to the eligibility month. The Plan Level change will not be done automatically. If the member does not have sufficient credits to remain eligible at the Plan Level selected. In such event he/she will lose coverage. The Plan Level Change will not be granted if requested after coverage is terminated. (If there is a difference between the hours you have worked and the contribution your employer has made towards your benefits, you may have to submit check stubs to the Trust Fund Office.)
If a member loses coverage and has bank hours and/or elects COBRA, then returns to work with no lapse or lapse in coverage, the initial eligibility requirements don’t apply if the member re-instates coverage within six (6) months.
In addition, if a member, through COBRA, maintains the full package of benefits in which he participated immediately before the COBRA “Qualifying Event”, any Reserve Benefit Credits in the Bank will be carried forward for a maximum of six months. Any hours the member works during that six month period will be added to the hour bank helping the member regain eligibility under the bank rules. In the event the member does not accumilate the hours requires to regain eligibility within the six month period, the member will loose the remaining Reserve Benefit Credits in the hour bank balance. However, your COBRA rights will continue.
The member will have the opportunity to change Medical Plans and to upgrade Plan Levels if he/she has been enrolled in their initial Medical / Dental Plan or current Plan Level for 12 consecutive months.
Having three Plan levels enables you to select an affordable level of coverage for the year ahead based on the hours you expect to work. The three Plan levels have the same Major Medical benefit options, e.g., an Indemnity PPO Plan or one of two HMOs. In addition to the amount payable by the Indemnity PPO Plan for covered services, or the HMO’s member co-pay amounts if you choose an HMO, the main differences in the three Plan levels are the availability and amount of Dental coverage provided, and the availability of Vision, Chiropractic, and Substance Abuse Detoxification benefits. (For further details, a Plan Comparison Chart is available from the Trust Fund Office.)
Coverage will become effective once:
- you have submitted a completed enrollment form; and
- you have worked enough hours to become eligible.