Birth or Adoption
To enroll your dependent child under the health plan, complete a Family Update Form.
You should submit the completed enrollment form with the appropriate supporting documentation
to the Fund Office within 30 days of the event.
Your natural child is eligible for coverage on the date of his or her birth. If you adopt a child, have a
child placed with you for adoption, or acquire a stepchild through marriage, he or she will be
eligible for coverage on the date of placement or marriage, as long as you are responsible for
healthcare coverage and your child meets the Plan’s definition of a dependent child.
You should submit the completed enrollment form with the appropriate supporting documentation to the
Fund Office within 30 days of the event.
When you marry, your spouse is eligible for healthcare coverage as of the date of your marriage.
If you are unable to work as a result of a non-work related injury or illness and you are under the care of a
physician, you may be entitled to the weekly Disability Benefit. To apply, submit a completed Disability
Claim Form to the Fund Office. Once approved for the weekly Disability Benefit, you will be responsible to
periodically complete the Supplementary Disability Form.
If you have recently moved, please complete a Change of Address Form.
Loss of Employment/Coverage
If coverage is lost due to lack of sufficient employer contributions and balance in your Dollar Bank,
then you may have the option to self-pay or elect to continue coverage under COBRA for up to 18 months.
Please contact the Fund Office with questions relating to your eligibility.
If you and your spouse get a divorce or legal separation, your spouse will no longer be eligible for coverage.
Your spouse may elect to continue coverage under COBRA for up to 36 months upon divorce or legal separation.
You or your spouse must notify the Fund Office within 60 days of the divorce or separation date for your
spouse to obtain COBRA continuation coverage. You must also submit a copy of the divorce decree to
the Fund Office.
If you exhaust your Active eligibility, you may become eligible for coverage as a Retired Employee by meeting the following requirements:
- You must be at least age 55 and have at least 10 Years of Service. For this purpose, a Year of Service means a calendar year in which you have at least 500 hours of work for which Employer contributions are made to the Fund or a Predecessor Fund.
- You must have at least 60 months of continuous eligibility immediately preceding the commencement of retiree coverage under this Fund or a Predecessor Fund. For the purpose of this provision, eligibility continued through self-contributions will be included.
- You must waive your right to COBRA Continuation Coverage.
If you are a Retired Employee, your coverage will commence on the first day of the month following the month in which your Dollar Bank is exhausted, provided you make the required self-contribution charged by the Trustees.
As a Retired Employee, coverage for you and your Eligible Dependents is based on age, as follows:
- You and any Eligible Dependent under age 65 may continue coverage under the Regular Plan or the Reduced Plan.
- You and any Eligible Dependent age 65 or older will be covered under the Medicare Supplement Plan.
Please contact the Fund Office for your retiree options for continuing health coverage.
You may designate anyone as a beneficiary for the Death Benefit which is payable for the loss of your life while eligible for the Regular Plan of benefits. You designate a beneficiary by submitting a Beneficiary Designation Form to the Fund Office.
If you die while eligible for benefits, your surviving spouse and other Eligible Dependents may remain eligible for benefits by applying the unused portion of your Dollar Bank (including yet-to-be Posted Contributions due for work prior to your death) to the Required Contribution necessary to maintain eligibility for benefits. If the Dollar Bank at any point does not have the full amount of the Required Contribution for a month, your surviving spouse may use your HRA, if available, to continue eligibility for benefits. Otherwise, your surviving spouse may make one self-contribution to bring the Dollar Bank up to the Required Contribution amount to continue eligibility for benefits for only that month. After eligibility for benefits has terminated, your surviving spouse or any Eligible Dependent may make the required premium payment for COBRA Continuation Coverage, if your surviving spouse or Eligible Dependent is a Qualified Beneficiary. However, if your surviving spouse is employed and covered under a group benefits plan through his or her employment, coverage through this Plan will not be available.
Dependents covered for benefits will continue to remain covered under the provisions of the Plan so long as your surviving spouse remains eligible and as long as your dependents continue to be Eligible Dependents as defined in this Plan.
If you have no surviving spouse or if your surviving spouse dies before the Dollar Bank balance is exhausted, the remaining amount in your Dollar Bank will be forfeited.
If you are a Retired Employee or Totally Disabled Employee, your surviving spouse may continue coverage by making self-payments, provided he or she was covered by this Plan immediately prior to your death. However, if your surviving spouse is employed and covered under a group benefits plan through employment, coverage will not be available.