Who is Eligible for Coverage?

Three groups of participants are eligible to participate in the Steamfitters’ Industry Welfare Fund. These are:

1. Any journeyman steamfitter, apprentice or trainee whose employment is covered by a collective bargaining agreement between Enterprise Association Local Union 638 and an employer obligated to contribute to the Steamfitters’ Industry Welfare Fund;
2. A salaried official of Enterprise Association Local Union 638 on whose behalf contributions are being made to the Welfare Fund by the Union; or
3. An employee of the Steamfitters’ Industry Educational Fund and related funds on whose behalf contributions are made to the Welfare Fund.

When Does My Coverage Become Effective?

You are covered on the first day of the second calendar quarter following any period of four or less consecutive calendar quarters in which you are paid for 1000 hours by an employer obligated to contribute to the Welfare Fund.

For Example:

• You start work in covered employment in January.
• Between January 1 and June 30 you are paid for 1000 hours in covered employment.
• You allow for the waiting period of one calendar quarter – from July 1 to September 30.
• Your coverage becomes effective on October 1.

Note, however, that you do not have to meet the requirement of 1000 paid hours in a particular calendar quarter. If you are paid in covered employment for a total of 1000 hours in any four consecutive calendar quarters or less, you will qualify for coverage.

For Example:

How Do I Maintain Coverage?

Once your initial coverage begins, it lasts for at least one year from the time it started. Therefore, your hours are reviewed at the end of each calendar quarter. You will continue to be covered as long as you are paid for 1000 hours in covered employment during every four consecutive calendar quarters.

If you are not paid for the required 1000 hours within four consecutive calendar quarters, your coverage will terminate at the end of the next calendar quarter.

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.

If your loss of coverage is due to insufficient hours, you and your qualifying dependents may continue coverage for up to 18 months. In certain disability situations, coverage may be available for an additional 11 months for a total of 29 months of continued coverage.

Spouses of deceased employees upon re-marrying, 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 divorced or 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.

The Welfare Fund will charge those electing COBRA coverage up to 102 percent of the Fund’s cost of coverage, except that for the extended coverage available only to disabled employees, the cost will be 150 percent of the cost of coverage.

Employees covered by COBRA must request the extended coverage in writing within 60 days from the date the employee is notified of the right to continue coverage.

Complete details concerning the COBRA coverage are available from the Fund Office.

Once your coverage terminates, in order to become covered again, you must follow the procedures described in the answer to the question, "When Does My Coverage Become Effective?"

What Happens to My Coverage When I Retire?

When you retire from the Steamfitters’ Industry Pension Fund, your coverage will continue for yourself and your eligible dependents if you have 20 years of credited service and were entitled to those benefits on the day before the date of your retirement or be covered for at least 20 of the 40 calendar quarters immediately prior to the effective date of your retirement.

In order to qualify for regular pension retiree lifetime health coverage, a participant must have:

1. earned 20 years of credited service in the Steamfitters' Industry Pension Fund, and
2. worked at least a total of 30,000 aggregate life-time hours in the construction trades division and
3. be covered in the Welfare Fund the day before the pension effective date or 20 of 40 quarters immediately prior to the pension effective date

"Disability Pension" Retiree Health Coverage Eligibility

In order to qualify for any type of disability pension retiree lifetime health coverage, a participant must have:

1. earned 15 years of credited service in the Steamfitters' Industry Pension Fund, and
2. worked at least a total of 22,500 aggregate life-time hours in the construction trades division, and 
3. be covered in the Welfare Fund the day before the pension effective date or 20 of 40 quarters immediately prior to the pension effective date.

"Early Pension" Retiree Health Coverage Eligibility (age 55-59)

In order to qualify for early pension retiree lifetime health coverage, a participant must have:

1. earned 30 years of credited service in the Steamfitters' Industry Pension Fund, and
2. worked a total of at least 30,000 aggregate life-time hours in the construction trades division, and
3. be covered in the Welfare Fund the day before the pension effective date or 20 of 40 quarters immediately prior to the pension effective date.

In order to qualify for early pension retiree limited health coverage (coverage for participant or dependents only until the earliest of age 65 or Medicare eligibility; if participant coverage terminates, coverage for all dependents simultaneously terminates), a participant must have:

1. earned 20-29 years of credited service in the Steamfitters’ Industry Pension Fund, and
2. worked at least a total of 30,000 aggregate life-time hours in the construction trades division, and
3. be covered in the Welfare Fund the day before the pension effective date or 20 of 40 quarters immediately prior to the pension effective date.

General Rule for All Types of Retiree Health Coverage

Your retiree health coverage status is determined (that determination may include “no coverage” if you do not meet the criteria) as of the date of your retirement. Furthermore, your coverage status remains intact and unalterable after your date of retirement regardless of any future employment activity.

As a consideration to concerns about construction industry  employment, at the first quarterly review in which your aggregate hours fall below 1,000, but exceed 799 hours, you will be granted a one quarter automatic “extension” of your eligibility. This “extension” will occur only once in your career. Thereafter, you must have or exceed 1,000 hours on a four rotating quarter basis to gain or maintain health and welfare coverage.

Can I Lose or Gain My Coverage After I Retire?

If you retire with coverage, you will always retain your coverage whether or not you return to work. However, if you do return to work you will always be considered a retiree in the Welfare Fund and will only be eligible for retiree benefits (ie: no life insurance or accidental death and dismemberment insurance; Medicare becomes primary for retired participants age 65 or over, etc.).

If you retire without coverage, but return to work you can become covered if you meet the regular coverage requirements (see the answer to "When Does My Coverage Become Effective?"). However, you only are eligible for retiree coverage. Upon your re-retirement you must meet the normal requirements for Welfare Fund coverage (see the answer to "What happens to My Coverage When I Retire?").

What Happens to My Health Coverage If I Return to Work after Age 65?

If you return to work in covered employment, you will be considered a retired participant (Medicare is your primary coverage) until such time as you meet the 1000 hours rule (see "When Does My Coverage Become Effective?"). When you do meet the 1000 hour rule you will be considered an active participant. At that point, the Welfare Fund will be primary for you and all dependents until you either stop working in covered employment or do not meet the 1000 hour rule. Participants returning to work are not eligible for the one year rule for initial coverage since coverage is not starting, but rather is continuing with only an insurance change. Empire MediBlue Freedom PPO, Medicare Advantage Plan (which includes prescription drug coverage through Express Scripts) or the Empire EPO and Express Scripts. No changes to the vision, hearing or Metlife dental plan.

What Happens to My Coverage If I Become Disabled?

If you become disabled, your coverage will continue if you meet the requirements for the Welfare Fund’s Disability Status Program as prescribed by the Trustees. To meet these requirements:

You must be unable to practice the trade of steamfitting because of a temporary or partial disability;

You must have been insured for at least 10 of the 40 calendar quarters immediately preceding the date on which your application for disability status, together with the requisite supporting data, is received by the Fund Office;

You must have earned a minimum of ten years of credited service in the Steamfitters’ Industry Pension Fund and have earned a year of service in one of the three years immediately prior to the year of the disability (this requirement is waived for all classes of apprentices);

Your combined family income (you and your spouse) after the onset of your disability must not exceed $106,925 per year as reported on your most recent income tax returns; and

You must submit to any and all medical examinations prescribed by the Trustees. 

Your application for the Disability Status Program must be received within 30 days of the onset of the disabling condition. Applications received after the 30 day filing period will be rejected. The 30 day filing period applies even if your coverage remains effective in accordance with the standard eligibility requirements.

If you qualify for the Disability Status Program, you will continue to be covered so long as this disability continues, but no longer than (3) three years from the date of your disability through the year of disability. If you recover from your disability and return to work or are deemed medically able to return, your coverage remains in effect until three quarters past the quarter in which you are eligible to return to work in.

What Is The 40-Year Eligibility Rule?

When you attain 40 years of credited service in the Steamfitters’ Industry Pension Fund, you are permanently covered under the Welfare Fund as of the first of the year after the year in which you obtained your 40th year of credited service, regardless of any other eligibility requirements, provided that you were covered for at least 20 of 40 calendar quarters immediately preceding the date on which you acquired 40 years of credited service.

What Happens If I Enter The Armed Forces?

If you are drafted or activated from reserve status into the Armed Forces of the United States and you were covered on the date of your entry, your life insurance coverage will continue until six months after your discharge. However, this coverage will stop at the beginning of your next term of military service if you voluntarily reenlist during peacetime. No other participant benefits will remain in effect during your military service since the U.S. Government provides its military personnel with insurance coverage and medical care. Your coverage for health and welfare benefits will be fully reinstated upon your discharge and will continue for at least six months after your discharge.

The Steamfitters’ Industry Welfare Fund will continue health benefits for your eligible dependents during the above periods.

Are All Of My Family Members Eligible For the Plan’s Protection?

Your legal spouse is eligible for coverage through the Welfare Fund. Your spouse will lose coverage on the first of the month immediately following the month that a divorce or legal separation is effective.

Your unmarried children will be considered qualifying dependents and eligible for coverage through the Welfare Fund in accordance with the following:

1. the child turns age 26, or
2. children who become age 26 remain covered if they are incapable of self-support because of mental illness, developmental disability, mental retardation or physical handicap provided the incapacitating condition started before dependent status would otherwise have ended. Proof of incapacitation must be submitted to the Welfare Fund Trustees as often as requested and an independent examination must be allowed if so requested by the Trustees. If your child is employed where other group coverage of a non-contributory nature is available, the Welfare Fund provides secondary coverage only.

The term "children" will include:

It is essential that any changes in family status (marriage, birth, death, adoption, etc.) be reported in writing to the Fund Office. Failure to do so can delay or prevent payment of your claims.

What Happens To My Family’s Coverage If I Die? 

If you should die (for all deaths on or after July 1, 1999) while covered in the Fund, the coverage for your spouse and qualifying dependents will continue until:

•    your spouse remarries, or
•      your non-spouse dependents reach age 26, or\
•    your dependents remain incapable of self-support because of mental illness, developmental disability,
•    mental retardation or physical handicap.

Health coverage for surviving spouses and qualified non-spouse dependents is provided in accordance with all applicable coordination of benefit regulations. Health coverage includes only hospital, medical, prescription drug, dental, vision care, hearing care and benefits.