* Administering Health, Pension and Vacation Benefits For the Men and Women Who Help Build the Southwest *
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|
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.
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:
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.
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.
The following dependents may be enrolled under the Plan:
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 30 days of the date of a new marriage or the date of birth of a child. 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.
Enroll your spouse within 31 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 31 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.
Your newborn will be covered by the Plan from their date of birth as long as you enroll the newborn within 31 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.
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.
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 31 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.
The Plan will cover your child from the date of adoption or placement for adoption if you enroll the child within 31 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.
If you are the legal guardian of a child the Plan considers that child eligible for coverage. You must enroll the child within 31 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.
For Non-Bargaining employees, paid premium coverage for a dependent’s eligibility terminates at the end of the last day of the calendar month in which he/she turns 26. Please refer to the Non-Bargaining section in the Employer Resources Tab of this website or contact the Administrative Office for eligibility requirements.
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:
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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