Who is Eligible for Coverage?
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.
When Does My Coverage Become Effective?
Participants will become eligible for coverage in the
Welfare Fund on the first day of the second month following
the first month his/her employer makes the required
|Example: You are hired by an employer in
February 2009 and reported on the employer's
February report with sufficient contributions. Your
coverage would start on April 1, 2009.
The contractual contributions levels required to obtain
coverage are as follows:
- MCA Service Contractors/Independent Contractors
- one hour or more per month
[Please Note: Partcipants covered through an agreement
with Gilmour Pipe Supply Co., Inc. are not eligible for
prescription drug benefits.]
- Parkchester North, Parkchester South, Parkchester
Management and Peter Cooper Village/Tishman Speyer
- at least 150 hours per month
Within Local 638's
- at least 100 hours
Outside Local 638's
- at least 150 hours
- Residential Agreement Contractors
- at least 150 hours per month
Residential Journeyman are covered for all health
benefits. Residential Helper/Apprentices and 1st Year
Helpers are only covered for Hospital and PPO benefits.]
How Often Is My Coverage Reviewed?
Eligibility for coverage in the Welfare Fund is reviewed
on a monthly basis.
How Do I Maintain Coverage?
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?")
When Will a Participant's Coverage Terminate?
A participant's coverage in the Welfare Fund will
terminate on the last day of the second month after the last
month you are reported for.
|Example: Your are last reported by an employer
for the month of April 2009. Your coverage would end
on June 30, 2009.
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. 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
If a spouse and dependents lose coverage
due to the death of an active or retired participant (which
is considered "insufficient hours"), COBRA continuation
coverage is available for up to 36 months.
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
Complete details concerning the COBRA
coverage are available from the Fund Office.
How Can I Become Covered Again?
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
What Happens to My Coverage When I Retire?
Health coverage for a retiree is made available only for
the period from Age 62 through the first of the month you
become 65 (thereafter Medicare becomes available on a
Please read the following two
sub-sections for details.
Participants that Retire
Prior to Age 62:
If you retire prior to Age 62, you
must continue your health coverage under COBRA until you
attain Age 62. If you are covered under COBRA when you
become Age 62, you will become eligible for health and life
insurance under the Welfare Fund. If you fail to maintain
your coverage under COBRA until you reach Age 62, you will
forfeit any retiree coverage. Further, if you exhaust your
36 months of coverage under COBRA prior to Age 62, you will
not be eligible for retiree coverage.
Participants that Retire on
or after Age 62:
If you retire and receive a benefit
from the Pension Fund and were covered the day before your
pension effective date (by virtue of employment or COBRA)
you will be eligible for health and life insurance coverage.
All coverage in the Welfare Fund for retired participants
and the dependents of retired participants will terminate as
of the first of the month that the dependent or retired
participant becomes 65. However, an eligible dependent, who
has not yet attained age 65 and who loses coverage based on
the retired participant's loss of coverage may elect to
continue health coverage through COBRA.
What Happens if An Active Participant Becomes
Temporarily Disabled and Unable to Work?
If an active covered participant becomes temporarily
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 six months in any twelve month period providing the
participant furnishes timely notice and medical proof of
such disability. If the participant is still disabled after
six 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
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.
What Happens if I Enter the Uniformed Services?
If you are drafted, activated from reserve status or
enlist into the Uniformed Services of the United States
(which includes the Army, Navy, Marine Corps, Air Force,
Coast Guard, Public Health Service commissioned corps, the
Army National Guard and Air National Guard), your coverage
as an active participant will terminate in accordance with
regular eligibility rules (see "When Will a Participant's
Coverage Terminate"). However, if you were a covered
participant on the date of your entry, the following is
- If you are on active military duty for 30 days or
less, you will continue to receive medical coverage in
accordance with the Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA).
- If you are on active duty for more than 30 days,
USERRA permits you to continue medical, prescription and
dental coverage for you and your dependents at your own
expense for up to 24 months provided you enroll for
coverage. This continuation of coverage operates in the
same way as COBRA. (Please refer to the COBRA section of
this booklet for details.) In addition, your dependents
may be eligible for health care under the Civilian
Health & Medical Program of the Uniformed Services
(TRICARE). This Plan will coordinate coverage with
TRICARE if your dependents are enrolled in COBRA with
the Welfare Fund (see the "Coordination of Benefits"
section of booklet.).
- When you return to work after receiving an honorable
discharge, your full eligibility will be reinstated on
the day you return to work with a participating
employer, based upon time spent on military duty
according to the following schedule:
- At the beginning of the full regularly scheduled
working period on the first calendar day following
discharge (plus travel time and additional eight
hours) if the period of service was less than 31
- 14 days from the date of discharge, if the
period of military service was 31 days or more, but
less than 181 days (assuming you either returned to
work or applied for employment with a signed
- 90 days from the date of discharge, if the
period of military service is more than 180 days
(assuming you either returned to work or applied for
employment with a signed employer).
If you are hospitalized or convalescing from an injury
resulting from active duty, these time limits may be
extended for up to two years. Please contact the Fund Office
for more details.
Are All Of My Family Members Eligible For the
Your legal spouse is eligible for coverage through the
Welfare Fund. Your spouse will lose coverage on the day
after the date of a divorce or legal separation is
children will be considered qualifying dependents and
eligible for coverage through the Welfare Fund in accordance
wiht the following:
- the child has not completed the end of the calendar
year during which they became 19, or
- the child has completed the end of the calendar year
during which they became 19, but has not completed the
end of the year during which they became 23, is
primarily dependent on you for financial support and
attends an accredited institution of higher education or
other institution offering degree or certificate upon
program completion on a full-time, day student basis as
his or her principal activity. (The term "full-time
student" will mean being registered for not less than 12
course credits per semester. If the institution
establishes full-time status by a method other than
semester credit hours, the Fund reserves the right to
determine whether the student qualifies as a
- children who complete the end of the calendar year
during which they became 19 remain coverd if they are
incapable of self-support because of mental illness,
developmental disability, mental retardation (as defined
in the mental hygiene law) or physical handicap provided
the incapacitating condition started before dependent
status would otherwise have ended. To continue coverage
beyond age 19, an "Affidavit of Dependency for Mentally
or Physically Handicapped Children", which includes
proof of incapacitation from the dependent's physician
or physicians, must be submitted. Proof of
incapacitation must be submitted to the Trustees as
often as requested. An independent examination must be
permitted if the Trustees so request. In addition, proof
of dependent status from the Internal Revenue Service
income tas filings must be made available to the
Trustees as often as so requested. The affidavit must be
filed with the Trustees prior
to date such a child attains age 19 in order to qualify
for continuance of coverage.
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:
- your own or legally adopted children,
- children in your custody while awaiting final legal
- your stepchildren who are primarily dependent upon
you for financial support, (an Affidavit of Dependency
must be completed), and
- any other children related to you by blood or
marriage who live with you in a regular parent-child
relationship and are primarily dependent upon you for
financial support (an Affidavit of Dependency must be
Excluded: Parents, grandparents, nieces,
nephews or grandchildren, even though they may reside in the
participant's household and be dependent upon the
participant for support and maintenance, are not
covered under the Pan.
|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
What Happens To My Family's Health Coverage If I
Upon the death of a covered participant, active or
retired, the coverage for the surviving spouse and any
dependent(s) terminates as of the member's death date. (see
answer to "What Happens If I Lose Coverage?" regarding
dependent COBRA coverage for dependents of deceased