Retiree Eligibility
There are three classes of retired participants under the Plan, as follows. Your classification will determine the benefits you are eligible for and the amount of your payments for coverage.
Class I
In general, to be a Class I participant, you must retire from an employer that continues to contribute to the Plan for retiree coverage. You are eligible for benefits as a Class I participant if:
- you retire and receive a Social Security Disability award or a pension award from a Qualified Pension Plan that contracts with your contributing employer;
- employer contributions were made on your behalf for 24 of the last 36 months immediately before your retirement date; and
- you worked at least 120 months under a collective bargaining agreement for one or more participating employers for which your employer(s) contributed at least 120 months of contributions to the Trust Fund for Class I coverage.
You do not have to meet the 120-month requirement if you worked for participating employers who continuously contributed to the Trust for retiree benefits from the date the benefit was negotiated until the date of your retirement.
Class II
In general, to be a Class II participant, you retire from an employer that does not continue to contribute to the Plan for retiree coverage. You are eligible for benefits as a Class II participant if:
- you retire and receive a Social Security Disability award or a pension award from a Qualified Pension Plan that contracts with your contributing employer;
- employer contributions were made on your behalf for 24 of the last 36 months immediately before your retirement date; and
- your employer at the time of your retirement is either contractually required to contribute to the Plan on behalf of active employees or no longer has a contractual obligation to contribute to the Plan and is no longer active in the trade.
Alternatively, you are eligible as a Class II participant if:
- you are a retired employee who would otherwise be eligible as a Class I or Class II participant but your former employer no longer contributes for retiree coverage;
- you would otherwise be eligible as a Class I retiree but do not have at least the 120 months of contributions; or
- you are the surviving spouse of a deceased Class I or Class II retired employee and, except for the death of the retiree, continue to meet the definition of a dependent.
Class III
In general, to be a Class III participant, you retire from an employer that never contributed to the Plan for retiree coverage. You are eligible for benefits as a Class III participant if:
- you retire on or after May 1, 1997 and receive a Social Security Disability award or a pension award from a Qualified Pension Plan that contracts with your employer;
- employer contributions were made on your behalf for 24 of the last 36 months immediately before your retirement date; and
- your employer at the time of your retirement is either contractually required to contribute to the Plan on behalf of active employees or no longer has a contractual obligation to contribute to the Plan and is no longer active in the trade.
Alternatively, you are eligible as a Class III participant if you are the surviving spouse of a deceased Class III retired employee and, except for the death of the retiree, continue to meet the definition of a dependent.
Dependent Eligibility
Your (the retired employee’s) legal spouse is an eligible dependent, provided you show a certified copy of your marriage license to the Administrative Office. Your spouse’s coverage begins the date coverage begins.
If you get married after you retire, your spouse will become eligible for coverage within 30 days of the day that you marry, provided you show a certified copy of your marriage license to the Administrative Office.
Children, yours or your spouse’s, are NOT eligible for coverage under the Plan.
Change in Your Spouse’s Dependent Status
You must immediately notify the Administrative Office, in writing, if your spouse dies, your marriage is dissolved, or any other event that would make your spouse no longer eligible for coverage. Changing your beneficiary for death benefits is not acceptable notification of divorce or death.
If you do not immediately notify the Administrative Office and claims and/or premiums are paid on behalf of your ineligible dependent, you and/or your dependent are responsible for reimbursing the Trust for such claims and/or premiums, including attorney’s fees, interest, and reasonable collection costs, if any. The Trust may recover these amounts from future payments due for you or your spouse, through legal action, or otherwise as determined by the Board of Trustees. You may also be required to reimburse the Trust and/or any provider for the value of any benefits provided.
Maintaining Eligibility
To maintain eligibility for benefits as a retired employee, you must:
- demonstrate that your income is below the level that would disqualify you from getting a pension under the I.A.M. National Pension Fund or the pension plan that qualified you for a benefit from this Plan by submitting a copy of the applicable portion of your federal income tax form; and
- make the required payments on a timely basis.
Enrollment
You must elect coverage, complete enrollment forms, and make the required payment to be covered. You must apply for coverage within 180 days of the date you retire.
| Available to | Options | |
|---|---|---|
| Medical | If you live in California: you, and your legal spouse If you are in Class I, but you do not live in California: you, and your legal spouse | If you are under 65, your choice of plans: Kaiser HMO (low option or high option) If you are over 65, your choice of plans: Kaiser Senior Advantage (Medicare Advantage plan, low option or high option) |
| Mental Health and Substance Abuse Treatment | If you are not in a Kaiser plan or are not Medicare-eligible: you, and your legal spouse | If you are in a Kaiser plan, or are eligible for Medicare, any such benefits will be provided through your medical plan. |
| Dental | If you live in California: you, and your legal spouse | Prepaid CIGNA DHMO dental coverage (like an HMO for dental care) |
| Vision | If you are a Class I participant: you, and your legal spouse | Exams, lenses, and frames at specified intervals through EYEMed |
| Medicare | You or your spouse at age 65 | Check your materials from Kaiser for provisions governing Medicare eligibility. |
Filing a Claim
When you use participating providers, you will pay any amount due at the time of your visit, and you will not have to file a claim. You will only need to file a claim if and when you receive covered services from providers from outside networks.