Eligibility for Health Benefits

The number of hours needed to qualify for eligibility under the Active Plan increased from 300 hours to 360 hours beginning January 1, 2015. This means beginning with the January through March 2015 work quarter, you will need a total of at least 360 hours (work hours and/or reserve hours) worked for contributing employers in order to qualify for coverage for the next eligibility quarter as shown in the chart below.

If you work more than 360 hours during a work quarter, the excess hours will be credited to your reserve account. The current reserve account maximum is 720 hours. You will be eligible during an eligibility quarter whenever the hours worked by you (if any) in the work quarter ending immediately prior to such eligibility quarter, plus the hours in your reserve account, total at least 360 hours. Check your work hours and eligibility on MemberXG.

Work Quarter Eligibility Quarter
If you have at least 360 hours by the close of the following 3 months: You have coverage during the next following 3 months of:
January, February, March May, June, July
April, May, June August, September, October
July, August, September November, December, January
October, November, December February, March, April

Special Rule for First Time Participants

The number of work hours required for initial eligibility by participants that have never been covered under the Active Plan will be 300 hours in a work quarter. After initial eligibility has been established, the work hour requirement will revert to the normal 360 hours for any subsequent eligibility quarter. 

Hours Buy Back

Participants who lose eligibility due to a lack of reported work hours or reserve bank hours have the option to self-pay the amount of contributions needed to meet the minimum number of reported hours to maintain eligibility for one quarter.

The following conditions apply:

  1. This provision does not apply to those who are establishing initial eligibility.
  2. The participant is allowed to pay for up to a maximum of 60 hours multiplied by the current Health & Welfare contribution rate to maintain eligibility.
  3. This self-payment is offered only 1 time per calendar year upon initial loss of coverage.
  4. Payment must be received within the eligibility quarter to which it applies.

If you qualify for the Hours Buy Back, a letter will be sent to your address on file with information regarding the number of hours required to keep eligibility for the next quarter and the amount due.  Payment must be made by cashiers check or money order.

Due to the difficulties imposed by the COVID-19 situation, payment in the form of personal check will be accepted through December 31, 2020.

Eligibility Dates for Dependents

Your eligible dependents will become covered on the date your coverage is effective or on the date you acquire the dependent, whichever is later, providing all documents required for eligibility are received and approved by the Trust.

Who are Eligible Dependents?

The following dependents may be enrolled under the Plan:

  • Your Lawful Spouse
  • Your Children
    Your children include your biological children, stepchildren, legally adopted children, children placed for adoption, and children by virtue of legal guardianship. Your children are eligible dependents covered under Medical, Prescription, Dental, and Vision benefits to the age of 26 whether they are married or unmarried. For Dependent Life Insurance, children (they must be unmarried) are covered up to age 19 or up to age 23 if they are full-time students.
  • Your Disabled Children
    Your unmarried child who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than twelve months, can be covered as a dependent after age 26 while such condition exists, provided such dependent was an eligible dependent under the Plan at the time coverage would otherwise terminate due to age and you provide more than 50% of the child’s support. This provision does not apply to Dependent Life Insurance. Appropriate documentation must be provided to the Administrative Office within 60 days of the dependent’s termination date and periodically as requested by the Administrative Office.
  • Your Children Covered by a Qualified Medical Child Support Order (QMCSO)
    A child covered by a QMCSO will be considered an eligible dependent for coverage. For information on the Plan’s procedures regarding QMCSO’s contact the Administrative Office.
  • Your registered Domestic Partner and/or the eligible children of a Domestic Partner
    You may enroll your Domestic Partner and the Domestic Partner’s eligible children if you complete and return the Domestic Partner Enrollment Affidavit, a copy of your Domestic Partnership Registration with a Government Agency, the completed Medical and Dental Enrollment Forms and birth certificates for the children enrolled. You will also be required to pay the appropriate federal taxes due for the health premiums of the Domestic Partner and the Domestic Partner’s children each month in order to maintain coverage. The first 2 months of tax payments are due at the time of enrollment. See the Life Events page for more information.

Who is not an Eligible Dependent?

  • If you are divorced or legally separated from your spouse, your ex-spouse and any children enrolled by virtue of marriage are not eligible for coverage under the Plan. Participants must submit a copy of the final Divorce Decree or court approved Legal Separation to the Administrative Office within 30 days of the event. Otherwise participants will be responsible for any costs the Trust incurs on behalf of a former spouse and/or their children.
  • Any spouse or child that is eligible under the Trust as an employee (carpenter or special class employee) cannot also be eligible as a dependent. Nor can children be covered as dependents of more than one employee (carpenter or special class employee) under the Trust.

Coverage for Dependents

To add or drop coverage for dependents you must submit an Enrollment Change Form for the Plan that you are enrolled in. Participants must also provide a copy of the Certified Marriage Certificate from the Hall of Records for your spouse, a copy of a Certified Birth Certificate from the Hall of Records for your children, and Page 1 and the Signature Page (or a copy of the Certificate of Electronic Filing) of your most recent Federal Income Tax Return that was filed with the IRS.  This Federal Income Tax Return must list the Social Security Numbers of your dependents. New dependents must be added within 90 days of the date of a new marriage or the date of birth of a child for coverage to be effective as of the date of marriage or birth. If you get married in a same-sex marriage, the same rules as adding a spouse mentioned above apply.

If you want to designate your new spouse as your beneficiary on your Life Insurance and/or other forms of insurance, you need to fill out a new Designation of Beneficiary Form and submit it to the Administrative Office.

Enrolling a Spouse

Enroll your spouse within 90 days from the date of marriage. Provide a Certified Marriage Certificate from the Hall of Records, and Page 1 and the Signature Page (or a copy of the Certificate of Electronic Filing) of your most recent Federal Income Tax Return. If you enroll your spouse after 90 days, your spouse will be covered on the first of the month following the date the Administrative Office receives the enrollment form and the required documents.

Please note: A copy of your final divorce decree or legal separation must be submitted to the Administrative Office to remove an ex-spouse before a new spouse may be enrolled.

Enrolling a Newborn

Your newborn will be covered by the Plan from their date of birth as long as you enroll the newborn within 90 days of their birth date and provided the required documents are submitted to the Administrative Office. If you enroll the newborn after 90 days from their date of birth, the newborn will be covered on the first of the month following the date the Administrative Office receives the enrollment material for the child.

Pregnancy of Dependent Daughter

If your covered dependent daughter becomes pregnant, only the Kaiser HMO Plan will cover the related prenatal and delivery services. Pregnancy services are not covered while insured under the Anthem PPO Medical Plan except as required by federal law for routine prenatal and postnatal visits. The grandchild is not an eligible dependent, and services related to the birth of the grandchild are not covered under the Kaiser HMO Plan or the Anthem PPO Medical Plan.

Acquiring a Child Through Marriage

If you acquire a child through marriage you must provide the Administrative Office with a copy of the child’s Certified Birth Certificate from the Hall of Records within 90 days of the date of the marriage. The name of the spouse who is eligible to participate must appear on the Birth Certificate. Coverage for the child will be effective on the first day of the month after you provide the required documentation.

Important Notice about Changes in Your Family

If there is a change in your family status (for instance, if you get divorced), you must complete a family status form and mail it along with any required documentation to the Administrative Office within 31 days of the event. Otherwise, coverage is delayed or, in the case of divorce, you will be responsible for any costs the Trust incurs on behalf of ineligible dependents including but not limited to, your former spouse and any step-children after divorce from the parent of the step-children.

Adopting a Child

The Plan will cover your child from the date of adoption or placement for adoption if you enroll the child within 90 days. If you enroll the child after 90 days from the date of the adoption or placement, the child will be covered on the first of the month following the date the Administrative Office receives the enrollment material for the child. If you are unable to get the required paperwork to the Administrative Office within the 90-day period due to circumstances beyond your control, notify the Administrative Office immediately in writing to request an extension.

Legal Guardianship of a Child

If you are the legal guardian of a child the Plan considers that child eligible for coverage. You must enroll the child within 90 days from the date the legal guardianship is granted. The Trust requires the legal guardianship paperwork that appoints the participant, or the spouse of participant, as the legal guardian of the child.

The child for whom the active participant or spouse is the court appointed Legal Guardian prior to the age of 18 and has a domestically enforceable court order granting Legal Guardianship for the child where the meaning of such order is that the participant or participant’s spouse has legal responsibility for custody and maintenance of the child.

Non-Bargaining Health Coverage and Dependents

For Non-Bargaining employees, contact your employer to add or change dependents.  Your employer will be required to provide the correct enrollment documentation and any additional premiums due.  Paid premium coverage for a dependent child’s eligibility terminates at the end of the last day of the calendar month in which he/she turns 26.

Military Services

If an eligible participant enters full-time active duty in the Uniformed Services of the United States his eligibility under the Trust will cease.  However, such participant can submit a written election to continue health coverage on a self-pay basis. The election must be submitted to the Administrative Office within 60 days of entering the Uniformed Services full-time.

The maximum period such a participant and the participants’ dependents can continue coverage under this provision is the lesser of: 

  • The 24-month period beginning on the date the eligible participant’s Uniform Services absence begins; or
  • The period ending the day after the date on which the eligible participant fails to apply for or return to work for a contributing employer, as determined under Section 4312(e) of the Uniformed Services Employment and Reemployment Rights Act of 1994.

Those eligible participants that elect to continue health coverage for themselves during Uniformed Services absence and/or their dependents must pay for the continuation coverage. Payment shall be in the same amount and form as that made for COBRA continuation coverage. Please note that Life Insurance and Accidental Death and Dismemberment coverage cannot be continued.

The participant must notify the Administrative Office of his entry into full time active duty in the Uniformed Services of the United States within 90 days of such entry. If notification is timely given, the participant will be reinstated as a regular eligible participant as of the first day of reemployment, provided he/she returns to work for a contributing employer within 90 days from his/her discharge from full-time active duty. An active participant that loses eligibility as a result of entering the Uniformed Services shall have the hours in his/her reserve account preserved until the active participant returns to work, provided he/she is reemployed by a contributing employer within 90 days from their date of discharge.

Note: Dependents who enter the Uniformed Services cannot continue their benefits because they are ineligible for benefits under the Trust.

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