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.
Participants will become eligible for coverage in the Welfare Fund on the first day of the second month following the month his/her employer makes the required contractual contribution.
As soon as your divorced is signed by the judge and entered into court, you are responsible for submitting a complete copy of the judgement of divorce together with the Stipulation agreement to the Welfare Fund. It is important that you do so in a timely manner as if there are any claim expenses incurred by the Fund after your divorce date, you will be held responsible.
Health coverage for a retiree is made available beginning at age 62. If you retire prior to age 62, you must continue your health coverage under COBRA until you attain age 62. If you exhaust your COBRA prior to reaching age 62 you will not be eligible for retiree coverage. If you retire on or after age 62, you will be eligible for retiree coverage.
Your retiree health coverage is based on the qualifications met as of the day of your retirement.
Pre-Medicare coverage is available to members who have a minimum of 15 years of credited service as defined by the Metal Trades Pension Fund and are covered the day before your pension effective date. Coverage is provided to you up until age 65, unless you qualify for Medicare earlier.
Effective 1/1/2024, Lifetime Coverage is available if you have earned at least 25 years of service as defined by the Metal Trades Branch Pension Fund; and were covered in the Welfare Fund for a minimum of 48 months out of 60 months prior to your retirement date (via employment, COBRA, etc); and were covered in the Welfare Fund the day immediately prior to your retirement. You will be eligible for continued coverage through our Advantage plan upon your enrollment into Medicare at age 65, unless you qualify earlier.
If a member retires with Pre-Medicare Retiree Coverage, the member and their dependents will be covered until the first of the month in which that dependent or retired participant reaches age 65. If a spouse has not reached age 65 when the coverage terminates, they will be offered COBRA. All dependent children are covered up until age 26. If they are not yet 26 at the time the coverage terminates, they will be offered COBRA.
If a member retires with Lifetime Retiree Coverage, only the spouse is eligible to continue coverage beyond the member’s Medicare effective date. Dependent children will terminate as of the member’s Medicare effective date and will be offered COBRA.
A participant’s coverage in the Welfare Fund will terminate on the last day of the second month after the month for which you are no longer reported or reported for less than the required amount of hours.
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.
Dependent children are covered under your health coverage until the end of the month that they attain age 26.
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.
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.
Eligibility for coverage in the Welfare Fund is reviewed on a monthly basis.
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?”).
You are required to submit a copy of your marriage certificate, [not your license] and a copy of your spouse’s social security card directly to the Welfare Fund. You can upload these documents securely by logging on to your member portal.
The baby will automatically be covered for 30 days with Empire after the birth. It is your responsibility to provide the Welfare Fund with a copy of the baby’s birth certificate and a copy of the baby’s social security card. You can upload these documents securely by logging on to your member portal.
