eligibility_pageIf you are a bargaining unit employee, you will become eligible as an active employee on the first day of the month for which a contribution is received on your behalf, unless your Collective Bargaining Agreement states differently, in which case eligibility will start on the first day of the month designated in the agreement.

If you are a non-bargaining unit employee, you will become eligible on the first day of the second month of your employment, provided the participating employer made the required 2 months’ pre-payment for coverage before the first day of the month of coverage.

Dependent Eligibility

Coverage for dependents begins on the date you become eligible or on the date the dependents are acquired, if later. In the case of adoption, a child shall become eligible on the date of placement for adoption or the date financial responsibility by the Plan participant is assumed.
Your eligible dependents include:

As a result of the Affordable Care Act, children under age 26 are eligible for coverage, whether a student, married or unmarried. An adult child will not be eligible for coverage if they have or are eligible for employer-sponsored coverage, or if the child is age 26 or older — unless he or she is incapable of self-sustaining employment by reason of mental retardation or physical handicap, per the Plan’s rules. See your Summary Plan Description for more information.

If you do not immediately notify the Administrative Office and claims and/or premiums are paid on behalf of an ineligible dependent, you and/or the dependent is responsible for reimbursing the Trust for such claims and/or premiums, including attorney’s fees, interest, and reasonable collection costs.


Loss of Coverage

Bargaining Unit Employees

You will cease to be eligible for benefits on the earliest of the following:

  • the first day of the month for which any required contribution is not received on your behalf;
  • the date the Plan terminates; or
  • the date you enter into full-time military duty with the armed forces of any country, unless precluded by law. See below for more information on coverage you may receive during a military leave or refer to your Summary Plan Description.

If loss of eligibility occurs, coverage may continue if you are entitled to any extension of benefits, make self-payments in accordance with the rules in effect on the date of loss of your active eligibility, or elect coverage under COBRA if you qualify. For more information or refer to your Summary Plan Description.

Non-Bargaining Unit Employees

You will cease to be eligible on the earliest of the following:

  • the last day of the month following the month the last employer contribution was made on your behalf;
  • the date the Plan terminates;
  • the date the participating employer no longer contributes on behalf of its bargaining unit employees, or;
  • the date you enter into full-time military duty with the armed forces of any country, unless precluded by law. See below for more information on coverage you may receive during a military leave or refer to your Summary Plan Description.

Dependents

Coverage for your dependents will end on the earliest of the following dates:

  • the date your coverage ends;
  • the date the dependent enters full-time military service;
  • the date the Plan terminates or coverage for dependents ends; or
  • the date the dependent no longer meets the Plan’s definition of an eligible dependent (for example, reaches age 26 or becomes eligible for employer-sponsored coverage).

If, however, an unmarried child is incapable of sustaining employment by reason of mental retardation or physical handicap on the child’s termination date, the Plan will continue coverage for the child as long as your coverage remains in force and the incapacity continues. Refer to your Summary Plan Description for complete details.

A dependent who has lost coverage may be able to continue health care coverage under COBRA. For more information visit the COBRA benefits page or refer to your Summary Plan Description.


Plan Enrollment & Coverage

Enrollment

You must elect coverage and complete enrollment forms in order to be covered. This includes choosing a medical and dental plan.

Your options for a medical and dental plan depend on three things:

  • what options have been negotiated for you in the Collective Bargaining Agreement,
  • where you live—to be eligible for a prepaid medical plan (an HMO) or a prepaid dental plan, you must live in the HMO’s or prepaid dental plan’s service area, and
  • how long you have been eligible for benefits through the Fund. When you first become eligible, your only option is to be covered under an HMO and a prepaid dental plan, provided you live in the HMO’s and prepaid plan’s service areas.

Coverage During A Family/Medical or Military Leave

Family or Medical Leave—If you qualify for a leave of absence from your employer in accordance with the provisions of the Family and Medical Leave Act of 1993 (FMLA) and the employer makes contributions to the Fund on your behalf, coverage may continue uninterrupted. Contact your employer for details of the requirements and benefits under the Family and Medical Leave Act.

Military Leave—On the date you enter full-time active duty with the armed forces of the United States, your eligibility for benefits will terminate. (Your coverage will be provided by the armed forces.) If you return to work with a contributing employer to the Plan within the time period required by law, you will be reinstated for benefits on the first day of your re-employment.

If you or an eligible dependent enter into full-time active duty with the armed forces of the United States, you may elect to continue your coverage by submitting a written election to continue coverage to the Administrative Office, within 60 days after entering the armed services. For more information on COBRA Continuation of Health Care Coverage or contact the Administrative Office.

Claims and Eligibility

For Claims and Eligibility information
please contact
Corcoran Administrators at
(714) 898-2200 or
(800) 499-8121