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Welfare Fund

Eligibility Rules

 



Who is Eligible for Coverage?
All participants covered by a Collective Bargaining Agreement between their Employer and the Enterprise Association Metal Trades Branch Local Union 638 will be eligible to participate in the Plan.  

When Does My Coverage Become Effective?
Participants will become eligible for coverage in the Welfare Fund on the first day of the second month following the first month his/her employer makes the required contractual contribution.  

Example: You are hired by an employer in September 2014 and reported on the employer’s September report with sufficient contributions.  Your coverage would start on November 1, 2014.

 
The contractual contributions levels required to obtain coverage are as follows:
  • - MCA Service Contractors/Independent Contractors
    • - at least 100 hours per month
  • - Parkchester North, Parkchester South, Parkchester Management and Peter Cooper Village/Tishman Speyer
    • - at least 130 hours per month
  • - Reciprocal

  • - Within Local 638’s jurisdiction
    • - at least 100 hours per month
  • - Outside Local 638’s jurisdiction
    • - at least 130 hours per month

How Often Is My Coverage Reviewed?  
Eligibility for coverage in the Welfare Fund is reviewed on a monthly basis.

How Do I Maintain Coverage?
Participants will continue to be covered as long as their employers make the required monthly contributions on the participant’s behalf (see necessary contribution levels in answer to “When Does My Coverage Become Effective?”).

When Will a Participant’s Coverage Terminate?
A participant’s coverage in the Welfare Fund will terminate on the last day of the second month after the last month for which you are reported. 

Example: You are last reported by an employer for the month of September 2014.  Your coverage would end on November 30,  2014.

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. The Federal laws allow a plan to charge a 2% surcharge for continuation coverage.  The Welfare Fund will charge those electing COBRA coverage 102 percent of the Fund’s cost of coverage.

If your loss of coverage is due to insufficient hours, you and your qualifying dependents may continue coverage for up to 36 months.  Participants considering COBRA coverage must request the extended coverage in writing within 60 days from the date the participant is notified of the right to continue coverage.

If a spouse and dependents lose coverage due to the death of an active or retired participant, COBRA continuation coverage is available for up to 36 months.  

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 either divorced, 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.

For more details about COBRA, please see the section entitled “Continuation of Coverage - COBRA” that appears later in this booklet.  Complete details concerning the COBRA coverage are available from the Fund Office.  The government website for general information is as follows: http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html.

It is mandatory that you report a divorce to the Fund Office immediately upon entry of a divorce decree or judgment.  You will be instructed to submit a full copy of your divorce decree or judgment. If your divorce decree or judgment is not yet available from the court or municipal clerk, you will be required to complete a pre-printed affidavit.  The Fund Office cannot accept your verbal notification; you must submit your divorce decree or judgment or complete an affidavit for the divorce to be recognized by the Fund Office.  

Please note:  You will be financially liable for the costs the Welfare Fund should incur due to your non-timely notification or failure to notify the Fund of your divorce.   


How Can I Become Covered Again?
Once your coverage terminates, in order to become covered again, you must satisfy the requirements set forth in the answer to the question, “When Does My Coverage Become Effective?”

What Happens If An Active Participant Becomes Temporarily or Partially Disabled and Unable to Work?
If an active participant, while covered under the Welfare Fund, becomes temporarily or partially disabled and unable to work, the participant and all eligible dependents will continue to be covered during the period in which the participant is disabled up to a maximum of twelve months so long as the participant’s disability continues and the participant applies for and meets all of the necessary requirements. This is called the Disability Status Program (DSP). As a prerequisite to the DSP application process;
  • - You must be covered in the Welfare Fund at the time of your injury or illness.
  • - You must have a minimum of 10 Years of Credited Service in the Metal Trades Branch Local 638 Pension Fund at the time of injury or illness.
  • - You must be covered in the Welfare Fund for no less than 48 months of the 60 months prior to the date of injury or illness.
  • - Your completed DSP application must be received within thirty (30) days of the injury or illness.
  • - You must provide proof of Disability.  The application must be accompanied by a letter from the attending physician detailing the injury or illness.  Proof of disability may include copies of Disability or Workers’ Compensation payments and/or an Independent Medical Examiner (IME) conducted at the request of the Welfare Fund by Professional Evaluation Group (PEG).
If the participant is still disabled after twelve months, the participant may continue health benefits for themselves and their dependents by making the required COBRA payment for a maximum period of up to thirty-six months. (Please refer to the COBRA section of this booklet for details.)

Disabled participants who elected to continue their health benefit by making the required COBRA payment, and who subsequently qualify for Medicare during such thirty-six month period, shall lose their coverage under COBRA rules.  However, they will be permitted to continue to make COBRA payments for their dependents for the remainder of the self-payment period. 

Please contact the Fund Office at (212) 465-8888 option no. 4 for more information.  


What Happens If I Enter the Uniformed Services?
The Uniformed Services Employment and Reemployment Rights Act of 1994 (“USERRA”) applies to a person who performs duty, voluntarily or involuntarily, in the Uniformed Services as well as the reserve components of the Uniformed Services.  If you are drafted, activated from reserve status or enlist into the Uniformed Services of the United States (which includes the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service Commissioned Corps, the Army National Guard, and the Air National Guard or any other category designated by the President in time of war or national emergency), your coverage as an active participant will terminate in accordance with regular eligibility rules (see “When Will a Participant’s Coverage Terminate?”).

Your qualified dependents will maintain coverage in the Welfare Fund throughout your service as long as you were covered the day before your service commenced.  Although this dependent coverage is not required under USERRA, the Trustees have extended coverage as an additional benefit.

As a participant, if you worked 1 hour within 90 days immediately prior to entry into service as a covered participant on the date of your entry, the following is applicable:
  • - If you are on active military duty for 30 days or less, you will continue to receive medical coverage under this Plan.  
  • - If you are on active duty for more than 30 days, USERRA permits you to continue medical, prescription and dental coverage for you and your dependents at your own expense for up to 24 months provided you enroll for coverage.  This continuation of coverage operates in the same way as COBRA.  (Please refer to the COBRA section of this booklet for details.)  In addition, your dependents may be eligible for health care under the Civilian Health & Medical Program of the Uniformed Services (TRICARE).  This Plan will coordinate coverage with TRICARE if your dependents are enrolled in COBRA with the Welfare Fund (see the “Coordination of Benefits” section of this booklet).
  • - You should carefully review the benefits, costs, provider networks, and restrictions of the TRICARE plan as compared to USERRA or COBRA to determine whether TRICARE coverage alone is sufficient or if temporarily continuing the Plan’s benefits under USERRA or COBRA is the best choice.  
  • - When you return to work after receiving an honorable discharge (you must provide proof of such including Form DD-214), your full eligibility will be reinstated on the day you return to work with a participating employer for no less than two calendar quarters plus the quarter in which you return to active employment provided that you comply with the time limits set forth herein.  The time limits for returning to work are as follows:     
    • - Less than 31 days of Service:  1 day after discharge (allowing for 8 hours of travel).
    • - 31 to 180 days:  14 days from the date of discharge, if the period of military service was 31 days or more, but less than 181 days (provided that you either returned to work or applied for employment with a participating employer).
    • - 181 days or more:  90 days from the date of discharge, if the period of military service is more than 180 days (provided that you either returned to work or applied for employment with a participating employer).

If you are hospitalized or convalescing from an injury resulting from active duty, these time limits may be extended for up to two years.  Please contact the Fund Office for more details.

Please note:  You must provide oral or written advance notice to the Welfare Fund that you are leaving your job for service in the Uniformed Services (unless such notice was precluded by military necessity or otherwise impossible or unreasonable.)