Disability Crediting & Waivers
If you become disabled, the Welfare Plan has provisions that may help you by: (1) crediting you with earnings for the purposes of determining future medical coverage eligibility, and (2) waiving your self-pay premium payments. The lifetime maximum for disability crediting and waivers is 104 weeks.
If you are disabled and would like more information regarding these provisions, please contact the Fund Office.
Required Proof of Disability
To qualify for up to 104 weeks of disability crediting and waivers, you must submit proof of your disability to the Fund Office on a monthly basis. Proof of disability means copies of documentation that prove you are receiving benefits from:
- Social Security Disability,
- State Disability,
- Long Term Disability,
- Workers’ Compensation, or
- demonstrate that you have spent 21 or more consecutive days as an inpatient in a hospital or other facility for which the Fund provided coverage.
If you have exhausted State Disability benefits but have not yet received a Social Security Disability Award or qualified for Long Term Disability, you may be able to continue receiving disability crediting and waivers if you provide other evidence of your ongoing disability.
Disability Crediting
For every week that you are eligible for disability crediting, we credit you with “covered earnings” (the calendar year earnings amount that is used to determine your eligibility for Welfare coverage in the following Plan year) equal to 1/52nd of the amount necessary to qualify you for the applicable Tier. The applicable Tier is the Tier you would be eligible for based upon your covered earnings in the 52 weeks prior to your date of disability.
Disability Self-Pay Waivers
For any month in which you were eligible for disability crediting, you may also be eligible to have your self-pay premium waived. You must apply and be approved for a self-pay premium waiver; please contact the Fund Office for more information. Please note that if you elected to buy up to Tier III, you are still responsible for paying the applicable buy-up premium even if you are granted a self-pay premium waiver.
Please remember that the Welfare Plan currently provides for a lifetime maximum of 104 weeks of disability credits and waivers. If you do not need the disability earnings credits to qualify for Welfare benefits, you may not want to use up your weeks just to receive self-pay waivers. Disability credits are more important as a means to continue your benefits if you become disabled, than as a way to reduce your self-pay premium. Disability credits are a kind of insurance, and you should use them carefully, and only when you need them.
Exception to the 104-week Maximum Rule
If you are totally and permanently disabled and have applied for a Social Security Disability benefit, and you have enough pension credits to qualify for retiree medical coverage and are eligible to receive a disability pension from the Local One Pension Fund, you may be able to receive up to an additional 52 weeks of disability crediting while you are waiting for a determination on your Social Security disability application. Please call the Fund Office for further information if you are in this situation.
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