Table of Contents

  1. Initial Eligibility
  2. Dependent Eligibility
  3. Lag Month
  4. Continuing Eligibility
  5. Rollback Eligibility Benefit
  6. Losing Coverage
  7. COBRA / Short Hours
    1. Qualifying Events and Maximum Coverage Period
    2. Qualifying Events and Maximum Continuation Period
    3. COBRA Coverage Costs (Effective 3/1/2023 - 2/28/2024)
    4. Short-Hours Self-Payment
  8. Other Eligibility Provisions

Eligibility

Eligibility for employees is based on hours worked for which an employer makes a contribution on your behalf to the Fund. You will become initially eligible on the first day of the benefit month corresponding to the eligibility month in which you first accumulate at least 125 credited hours. Your benefit coverage will start on your initial eligibility date. Please make sure that the Fund Office has your current address so information can be sent to you.

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  • Dependent Eligibility

    Your dependents become eligible for coverage on the same date that you become eligible. If you acquire other dependents after your coverage starts, their coverage will start on the day they become your dependents. The Plan will cover your children through age 25, regardless of student status.

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  • Lag Month

    Because the Fund office needs to process the contributions sent in by your employer, there is a lag month between each month in which you fulfill the eligibility requirements and the month during which you receive coverage. So, if you work 125 credited hours for initial eligibility in December, your coverage will begin February 1st.

    For Utility/REA employees your employer reports in advance of the upcoming month.

  • Continuing Eligibility

    After you establish initial eligibility, you must have at least 125 credited hours per month to remain covered. As with initial eligibility, there is a lag month; thus, working 125 credited hours in March will continue your coverage for the month of May.

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  • Rollback Eligibility Benefit

    The Rollback Eligibility Benefit helps to keep you covered during months when you work less than 125 credited hours. Under this rule, you will still be eligible as long as you have an average of at least 125 hours per month going back for a period of up to 12 months.

    This rule does not apply for Utility/REA employees.

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  • Losing Coverage

    Your eligibility will end when both your credited hours for that month and your monthly average under the Rollback Eligibility Benefit fall below the 125 hour minimum. When you lose eligibility you may be able to continue coverage for a limited time by making payments under the Plan's Short-Hours Self-Payment program, or under COBRA. If you qualify under total disability rules, you may also be able to continue coverage.

  • COBRA / Short Hours

    A law known as COBRA allows you and/or your dependents to self-pay for continued coverage under a set of defined "Qualifying Events." Participants must apply and make monthly self-payments in strict compliance with the rules in order to be covered under the COBRA provision.

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    • Qualifying Events and Maximum Coverage Period

      You and/or your dependents can make COBRA self-payments for up to 18 months if your coverage terminates due to one of the following Qualifying Events:

      • A reduction in your hours; or
      • Termination of your employment (including retirement)

      If you or a covered dependent is disabled (as defined by the Social Security Administration) on the date that the qualifying event occurs (or becomes disabled within 60 days after COBRA coverage starts), you can extend the 18-month COBRA coverage period up to a total of 29 months. Note that the COBRA self-payment may be higher for the extra 11 months of coverage.

      Your dependents can make COBRA self-payments for up to 36 months if their coverage terminates due to one of the following Qualifying Events:

      • Your divorce or legal separation from your spouse; or
      • A child's failure to meet the definition of a dependent; or
      • Your death.

      If a second qualifying event occurs during an 18-month COBRA coverage period (such as a divorce or a child losing dependent status), your dependents can extend coverage up to a maximum of 36 total months of COBRA coverage.

      Divorced or legally separated spouses of retirees can make COBRA self-payments for the lesser of 36 months or until the spouse attains age 65.

      Please notify the Fund office immediately if a Qualifying Event occurs.

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    • Qualifying Events and Maximum Continuation Period
      1. Loss of benefits caused by reduction in work
      2. Loss of benefits caused by termination of employment except for gross misconduct
      3. Loss of benefits caused by death of participant
      4. Loss of benefits caused by divorce
      5. Loss of benefits caused by child losing dependent status

      * COBRA can be extended to 29 months if the covered person is disabled prior to or in the first 60 days of COBRA coverage.

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    • Short-Hours Self-Payment

      The Short-Hours Self-Payments option allows active employees who are currently covered under the Plan to continue their coverage even if they do not meet the normal hours-worked requirement for a specific month. If you do not have 125 hours in a particular eligibility month, and your previous hours are not enough to satisfy the Rollback Eligibility Benefit, you can make a short hours self-payment to continue your eligibility for coverage. The amount of your payment is determined by subtracting your credited hours in the eligibility month from 160 hours, and multiplying the difference by the current employer contribution rate. You can make up to 6 consecutive monthly self-payments after that, you must re-establish your eligibility based on credited hours worked, or continue coverage via COBRA.

      REA/Utility members do not have this option.

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