Eligibility

Who is Eligible for Coverage?

Three groups of participants are eligible to participate in the Steamfitters’ Industry Welfare Fund. These are:

1. Any journeyman steamfitter, apprentice or trainee whose employment is covered by a collective bargaining agreement between Enterprise Association Local Union 638 and an employer obligated to contribute to the Steamfitters’ Industry Welfare Fund;

2. A salaried official of Enterprise Association Local Union 638 on whose behalf contributions are being made to the Welfare Fund by the Union; or

3. An employee of the Steamfitters’ Industry Educational Fund and related funds on whose behalf contributions are made to the Welfare Fund.

When Does My Coverage Become Effective?

You are covered on the first day of the second calendar quarter following any period of four or less consecutive calendar quarters in which you are paid for 750 hours by an employer obligated to contribute to the Welfare Fund.

For Example:

• You start work in covered employment in January.
• Between January 1 and June 30 you are paid for 750 hours in covered employment.
• You allow for the waiting period of one calendar quarter – from July 1 to September 30.
• Your coverage becomes effective on October 1.

Note, however, that you do not have to meet the requirement of 750 paid hours in a particular calendar quarter. If you are paid in covered employment for a total of 750 hours in any four consecutive calendar quarters or less, you will qualify for coverage.

For Example:

You start work in covered employment in January.

January 1 to March 31 You are paid for 270 Hours April 1 to June 30 You are paid for 0 Hours July 1 to September 30 You are paid for 350 Hours October 1 to December 31 You are paid for 130 Hours

Total Paid hours 750

You allow for the waiting period of one calendar quarter from January 1 to March 31.

Your coverage becomes effective on April 1.

How Do I Maintain Coverage?

Once your initial coverage begins, it lasts for at least one year from the time it started. Therefore, your hours are reviewed at the end of each calendar quarter. You will continue to be covered as long as you are paid for 750 hours in covered employment during every four consecutive calendar quarters.

If you are not paid for the required 750 hours within four consecutive calendar quarters, your coverage will terminate at the end of the next calendar quarter.

What Happens If I Lose Coverage?

A federal law, commonly referred to as COBRA, requires that group health plans offer participants and their families whose coverage would otherwise end, the opportunity for a temporary extension of health coverage called "Continuation Coverage" at their own expense.

If your loss of coverage is due to insufficient hours, you and your qualifying dependents may continue coverage for up to 18 months. In certain disability situations, coverage may be available for an additional 11 months for a total of 29 months of continued coverage.

Spouses of deceased employees upon re-marrying, divorced or legally separated spouses and dependent children who are no longer covered when they reach the age specified in the Plan may extend coverage for up to 36 months. If you become divorced or legally separated or your children no longer qualify as dependents, you must notify the Fund Office in writing within 60 days to protect their COBRA rights.

The Welfare Fund will charge those electing COBRA coverage up to 102 percent of the Fund’s cost of coverage, except that for the extended coverage available only to disabled employees, the cost will be 150 percent of the cost of coverage.

Employees covered by COBRA must request the extended coverage in writing within 60 days from the date the employee is notified of the right to continue coverage.

Complete details concerning the COBRA coverage are available from the Fund Office.

How Can I Become Covered Again?

Once your coverage terminates, in order to become covered again, you must follow the procedures described in the answer to the question, "When Does My Coverage Become Effective?"

What Happens to My Coverage When I Retire?

When you retire from the Steamfitters’ Industry Pension Fund, your coverage will continue for yourself and your eligible dependents if you were entitled to those benefits on the day before the date of your retirement. If you fail to meet this requirement, your coverage will be reinstated at your retirement if you were covered for at least 20 of the 40 calendar quarters immediately prior to the effective date of your retirement.

Can I Lose or Gain My Coverage After I Retire?

If you retire with coverage, you will always retain your coverage whether or not you return to work. However, if you do return to work you will always be considered a retiree in the Welfare Fund and will only be eligible for retiree benefits (ie: no life insurance or accidental death and dismemberment insurance; Medicare becomes primary for retired participants age 65 or over, etc.)

If you retire without coverage, but return to work you can become covered if you meet the regular coverage requirements (see the answer to "When Does My Coverage Become Effective?"). However, you only are eligible for retiree coverage. Upon your re-retirement you must meet the normal requirements for Welfare Fund coverage (see the answer to "What happens to My Coverage When I Retire?").

What Happens to My Health Coverage If I Return to Work after Age 65?

If you return to work in covered employment, you will be considered a retired participant (Medicare is your primary coverage) until such time as you meet the 750 hours rule (see "When Does My Coverage Become Effective?"). When you do meet the 750 hour rule you will be considered an active participant. At that point, the Welfare Fund will be primary for you and all dependents until you either stop working in covered employment or do not meet the 750 hour rule. Participants returning to work are not eligible for the one year rule for initial coverage since coverage is not starting, but rather is continuing with only a primary-secondary insurer change.

What Happens to My Coverage If I Become Disabled?

If you become disabled, your coverage will continue if you meet the requirements for the Welfare Fund’s Disability Status Program as prescribed by the Trustees. To meet these requirements:

• You must be unable to practice the trade of steamfitting because of a temporary or partial disability;
• You must have been insured for at least 10 of the 40 calendar quarters immediately preceding the date on which your application for disability status, together with the requisite supporting data, is received by the Fund Office;
• You must have earned a minimum of five years of credited service in the Steamfitters’ Industry Pension Fund and have earned a year of service in one of the three years immediately prior to the year of the disability (this requirement is waived for all classes of apprentices);
• Your combined family income (you and your spouse) after the onset of your disability must not exceed $80,000 per year as reported on your most recent income tax returns; and
• You must submit to any and all medical examinations prescribed by the Trustees.

Your application for the Disability Status Program must be received within 30 days of the onset of the disabling condition. Applications received after the 30 day filing period will be rejected. The 30 day filing period applies even if your coverage remains effective in accordance with the standard eligibility requirements.

If you qualify for the Disability Status Program, you will continue to be covered so long as this disability continues, but no longer than the period equal to one half of the years of credited service you have earned in the Steamfitters’ Industry Pension Fund through the year of disability. If you recover from your disability and return to work or are deemed medically able to return, your coverage remains in effect until the end of the second calendar quarter following the quarter in which such disability status terminates. Work specifically includes any employment under the temporary heat or air conditioning provisions of the collective bargaining agreement.

For Example:

If your disability ended on November 20, during the calendar quarter ending December 31, your insurance would remain in effect until June 30.

If you do not qualify for the Disability Status Program, or have used up your maximum period of disability status, your coverage may be extended only for expenses relating to your disabling condition for a period of twelve months under the following circumstances:

*You are totally disabled when either your coverage or eligibility for the Disability Status Program terminates;

• You are not covered by any other group health plan which would provide similar benefits; and .
• You are not eligible for Medicare

Contact the Fund Office for more information.

What Is The 40-Year Eligibility Rule?

When you attain 40 years of credited service in the Steamfitters’ Industry Pension Fund, you are permanently covered under the Welfare Fund as of the first of the year after the year in which you obtained your 40th year of credited service, regardless of any other eligibility requirements, provided that you were covered for at least 20 of 40 calendar quarters immediately preceding the date on which you acquired 40 years of credited service.

What Happens If I Enter The Armed Forces?

If you are drafted or activated from reserve status into the Armed Forces of the United States and you were covered on the date of your entry, your life insurance coverage will continue until six months after your discharge. However, this coverage will stop at the beginning of your next term of military service if you voluntarily reenlist during peacetime. No other participant benefits will remain in effect during your military service since the U.S. Government provides its military personnel with insurance coverage and medical care. Your coverage for health and welfare benefits will be fully reinstated upon your discharge and will continue for at least six months after your discharge.

The Steamfitters’ Industry Welfare Fund will continue health benefits for your eligible dependents during the above periods.

Are All Of My Family Members Eligible For the Plan’s Protection?

Your legal spouse is eligible for coverage through the Welfare Fund. Your spouse will lose coverage on the first of the month immediately following the month that a divorce or legal separation is effective.

Your unmarried children will be considered qualifying dependents and eligible for coverage through the Welfare Fund in accordance with the following:

A) the child has not completed the end of the calendar year during which they became 19, or

B) the child has completed the end of the calendar year during which they became 19, but has not completed the end of the year during which they became 23, is primarily dependent on you for financial support and attends an accredited institution of higher education or other institution offering degree or certificate upon program completion on a full-time, day student basis as his or her principal activity. (The term "full-time student" will mean being registered for not less than 12 course credits per semester. If the institution establishes full-time status by a method other than semester credit hours, the Fund reserves the right to determine whether the student qualifies as a dependent.), or

C) children who complete the end of the calendar year during which they became 19 remain covered if they are incapable of self-support because of mental illness, developmental disability, mental retardation or physical handicap provided the incapacitating condition started before dependent status would otherwise have ended. Proof of incapacitation must be submitted to the Welfare Fund Trustees as often as requested and an independent examination must be allowed if so requested by the Trustees. If your child is employed where other group coverage of a non-contributory nature is available, the Welfare Fund provides secondary coverage only.

The term "children" will include:

• your own or legally adopted children,
• children in your custody while awaiting final legal adoption,
• your stepchildren who are primarily dependent upon you for financial support, and
• any other children related to you by blood or marriage who live with you in a regular parent-child relationship and are primarily dependent upon you for financial support.

It is essential that any changes in family status (marriage, birth, death, adoption, etc.) be reported in writing to the Fund Office. Failure to do so can delay or prevent payment of your claims.

What Happens To My Family’s Coverage If I Die?

If you should die (for all deaths on or after July 1, 1999) while covered in the Fund, the coverage for your spouse and qualifying dependents will continue until:

• your spouse remarries, or
• your non-spouse dependents reach the end of the calendar year in which they turn 19 (or 23 when attending an accredited institution of higher education), or
• your dependents remain incapable of self-support because of mental illness, developmental disability, mental retardation or physical handicap.

Health coverage for surviving spouses and qualified non-spouse dependents is provided in accordance with all applicable coordination of benefit regulations. Health coverage includes only hospital, medical, prescription drug, dental, vision care, hearing care and Medicare Part B reimbursement benefits.