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Retiree Medical Coverage

Participant Eligibility
You are eligible for retiree medical coverage if:

  1. you were eligible for Welfare Fund benefits for three of the five Plan years immediately before your retirement; and
  2. (a) you have 25 years of pension credit at the time you retire, or (b) you have 20 years of pension credit at the time you retire AND had 12 years of pension credit as of January 1, 2008.

Please note that you MUST elect retiree medical coverage BEFORE you receive your first pension check. Failure to elect retiree coverage prior to receiving your first pension check is considered a rejection of the coverage, and that rejection may not be reversed. An exception to this rule may apply in a situation where you have other health insurance coverage. If this is your situation, please contact the Fund Office for more information.

Dependent Eligibility
If you qualify and elect coverage for yourself, you may also elect coverage for your dependents at the time of your retirement. Eligible dependents include:

  1. your spouse to whom you are legally married or your same-sex partner if your relationship is legally recognized as a marriage or civil union in the state or jurisdiction where the marriage or civil union was performed.

    Effective January 1, 2015, same-sex civil union coverage for partners who live in a state or jurisdiction that permits same-sex marriage will be eliminated. Thus, all Plan participants in a civil union who are currently covering a same-sex partner under the Plan that lives in a state that allows same-sex marriage will need to be married by December 31, 2014 in order to continue coverage of the same-sex partner. A copy of the certified marriage certificate must be provided to the Plan within 60 days of the date of marriage. If no marriage certificate is received by the Plan, the same-sex partner’s coverage will be terminated effective December 31, 2014. When coverage is terminated, COBRA continuation coverage will not be offered,

  2. unmarried dependent children (until the end of the calendar year in which they turn age 26),
  3. unmarried dependent children age 26-29 have the ability to purchase our insurance at a cost equal to 100% of the full premium rate for individual coverage, if they have no other insurance, and
  4. unmarried mentally or physically incapacitated children over the age of 26 who are incapable of self-sustained employment and dependent on you for support. (Please note that proof of incapacity MUST be provided no later than 60 days after the child turns age 26.)

Coverage for dependents is subject to various documentation requirements. Please see the Summary Plan Description or call the Fund Office for details.

Coverage Changes after your Retirement Date
Generally speaking, you may only make changes with respect to the enrollment of dependents at the time you first elect retiree medical coverage.

However, if you originally declined coverage for a dependent because the dependent had other health insurance coverage, and your dependent later loses that coverage for reasons other than failure to pay premiums or termination of coverage for cause, your dependent may be eligible for enrollment after your initial election. In such case, you MUST request enrollment within 60 days after the other coverage for your dependent ends, submit valid documentation verifying the loss of other coverage, and pay any additional premium that might be required.

If you are a retiree already enrolled in the Plan, and you acquire a new family member as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll that new eligible family member in the Plan. You must request enrollment in the Plan within sixty (60) days after the marriage, birth, adoption, or placement for adoption, submit valid documentation verifying the new family member(s), and pay any self-pay premium required by the Plan. Please see the Summary Plan Description for details.

Please note that if your coverage is terminated either voluntarily, or due to non-payment of your self-pay premium, you will not be permitted to resume coverage in the future.

Medicare Coverage
If you are eligible for Medicare Coverage at the time you retire and qualify for the Fund’s retiree medical coverage, you will have Medicare as your primary coverage carrier, and the Fund as your secondary coverage carrier. Please note that you MUST have Medicare Part B in place before you retire, and you should contact Medicare and make your application three months before your anticipated retirement date. You can start the process by calling 1-800-MEDICARE.

If you retire before you are eligible for Medicare coverage, you will be covered by Tier I, II or III “Active” coverage until you become eligible for Medicare. The Tier that you qualify for will be the highest Tier for which you had coverage in 3 of the 5 Plan years prior to retirement. (Please note that years prior to 7/1/2005 are considered to be Tier III for this purpose.) In this case, you are obligated to apply for Medicare Part B a few months before you become eligible. For those of you who took an early retirement pension, that would mean age 65. If you are receiving a disability pension you may become eligible for Medicare after you have been receiving Social Security Benefits for a period of two years. It is your responsibility to know when you become eligible, and to apply for Medicare so that it is in place on the date you become eligible for Medicare coverage.

With regard to your dependents, if you become Medicare eligible before they are eligible, they will continue to have the Fund as their primary coverage carrier. If they later become Medicare eligible, they have the same obligation to make sure that Medicare Part B coverage is in place on the date of their eligibility. Also, if you are not Medicare eligible, and your dependent is or becomes eligible before you, he/she will have Medicare as the primary coverage carrier and the Fund as secondary coverage carrier effective on the date he/she becomes Medicare eligible. You will continue to be covered by the "Active" Tier coverage until you become eligible or otherwise lose coverage under the Welfare Fund.

Dependent Coverage after the Death of the Retiree
If you die before you have received 60 monthly pension payments, your enrolled dependents will continue to be covered until they have been covered to 60 months from the time of your retirement. In this event, the self-pay premium will be waived.

News, Notes and Links

  • ER Alternatives: What are your options?
  • For a full description of the Plan rules regarding retiree medical coverage, please see the Summary Plan Description and any applicable Plan Amendments and Clarifications.
  • Please note that nothing on this website is intended to interpret, extend or change in any way the provisions expressed in the Summary Plan Description and any other Plan documents. If you have any questions regarding your particular situation, please contact the Fund Office for more information.

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