Life Events

If you get married while you’re an active employee or a retiree, your new spouse is eligible for healthcare coverage on the date of your marriage—once you provide the Fund with the required proof or documentation. To cover your new Spouse under the Plan, you need to notify the Fund Office of your new marriage within 30 days of the marriage date.

If your new spouse is already covered under another group medical plan or Medicare, you must report the other coverage to the Fund Office. Benefits your spouse receives under this Plan will be coordinated with his or her other coverage and paid after any benefits payable under that plan. For more information on Coordination of Benefits, please refer to the Coordination of Benefits section in your Summary Plan Description (SPD) 

Once newly married, you may also want to update the Beneficiary Information for your Life and AD&D Insurance.

Quick Tips: If You Get Married
  • Notify your employer and the Fund Office.
  • Provide the Fund Office with the required documentation.
  • Make sure your beneficiary information is updated.

Your natural born child is eligible for coverage on the date of his or her birth. To add your new child as a dependent under your plan you need to provide the Fund Office with a complete Dependent Addition Form and:

  • The birth date, including a copy of your new child’s birth certificate;
  • A copy of your child’s other medical insurance information, if he or she is covered under another plan.

If you adopt a child, or have a child placed with you for adoption, that child’s coverage begins on the date he or she is placed with you, as long as you are responsible for health care coverage, and your newly adopted child meets the Plan’s definition of a dependent. You’ll need to notify the Fund Office of the adoption and provide the following information:

  • A complete Dependent Addition Form;
  • The birth date, effective date of adoption or placement for adoption;
  • A copy of the birth certificate and adoption papers; and
  • A copy of your child’s other medical insurance information, if he or she is covered under another plan

Stepchildren are eligible for coverage under the plan on the date of your marriage, as long as they are living in your home and dependent on you for support. Once you provide any required information—such as a complete Dependent Addition Form, the date of your new marriage, a copy of your spouse’s divorce decree, or your marriage certificate—coverage for your child will begin. The child must also meet the dependent eligibility requirements on  your Summary Plan Description (SPD) .

If you and your spouse get legally divorced, your spouse will no longer be eligible for coverage as a dependent under the Plan. Your spouse may choose to continue coverage through COBRA for up to 36 months. To obtain COBRA coverage, you or your spouse must notify the Fund Office within 60 days of the divorce or legal separation date. He or she must also enroll for COBRA Continuation Coverage. For more information on COBRA coverage see the COBRA Coverage section of your Summary Plan Description (SPD)

 Quick Tips: If you get divorced

  • If you legally divorce, you will need to provide the Fund Office with:
    • a copy of your separation or divorce decree,
    • a copy of any Qualified Medical Child Support Order, if you have children for whom you don’t have custody.
  • You may also want to review your beneficiary designation for your Life and AD&D Insurance, if eligible. If you need to change or add a beneficiary you need to fill out the Beneficiary Designation form and return it to the Fund Office. 

Definition of Eligible Dependent Child

An “Eligible Child” under the Plan is any one of the following individuals:

  • Anyone who has not reached his/her 26th birthday, does not have access to health care coverage through his or her employer, and is the employee’s:
    • Natural child;
    • Adopted child or child placed for adoption;
    • Foster child;
    • Child who is named as an alternate recipient in a child support order, if the Plan determines the support order to be a Qualified Medical Child Support Order (QMCSO);
    • Step-child who was born to the spouse or who was legally adopted by the spouse before the marriage of the employee and that spouse;
  • Any child listed above, at any age, who is permanently and totally disabled and incapable of selfsustaining employment by reason of a medically determined physical or mental impairment that is expected to last for a continuous period of 12 or more months or result in death, and if:
    • Such incapacity began before the child reached age 26,
    • The child is dependent on the employee for at least 50% of his/her financial support and maintenance in each calendar year,
    • The child maintains a principal residence with the employee during each calendar year, and
    • The employee provides proof of such incapacity for the child when the Trustees request such proof.

If your eligibility under the Active Plan ends, it can be reinstated by meeting the initial eligibility requirements described in your Summary Plan Description (SPD). When your coverage ends, you may be eligible to continue coverage by

If Your Child Loses Eligibility

Generally, your child is no longer eligible for coverage when he or she gets married, is not dependent on you for support, or the day he or she reaches age 26.  You must notify the Fund Office [Link to Contact/hours page] within 60 days of the date your child is no longer eligible for coverage. Your child may elect to continue coverage by making COBRA self-payments for up to 36 months. For more information on COBRA, refer to you Plan’s Summary Plan Description (SPD).

Health Insurance Marketplace

If you lose coverage under the Plan you may be able to purchase comparable medical coverage through your State’s or the Federal government’s Health Insurance Marketplace. Visit www.healthcare.gov for more information.

If you’re an active employee and unable to work due to a non-work-related disability, you may eligible for a weekly Accident and Sickness Income Benefit until you recover, or you receive benefits for 26 weeks (the maximum number of benefit weeks for one period of disability)—whichever happens first. If you become disabled due to an injury that is covered by Accidental Death & Dismemberment (AD&D) Insurance, you may also be eligible for an AD&D Insurance benefit.

Additionally, you may be credited with 27 hours for each full week of disability—up to 700 hours during any consecutive 12-month period. If your eligibility ends while you’re disabled, your benefits may continue for up to 18 months.

 If you are out of work due to a work-related disability, you may be eligible for workers’ compensation benefits. Contact your employer to file a workers’ compensation claim. The Fund does not provide coverage for work-related disabilities.

Once your disability ends, you need to notify the Fund Office.

Quick Tips: If You’re Unable to Work Due to a Non-Work-Related Disability:

  • Notify your employer and the Fund Office.
  • Provide the Fund Office with proof of your disability.
  • Apply for the Weekly Accident and Sickness Income Benefit and the AD&D Benefit, if applicable.

Active Employees

If you’re eligible for coverage on the date of your death, your beneficiary will receive a Life Insurance Benefit. If you’re an active employee and your death is caused by an accident, your beneficiary will also be eligible to receive an Accidental Death & Dismemberment (AD&D) Insurance benefit. You beneficiary must contact the fund office and provide the required information to receive these benefits.

If you die while you’re an active employee, coverage for your eligible dependents will continue until your reserve accumulation account is exhausted. Then, coverage may continue under the Retiree Plan of Benefits, or COBRA Continuation Coverage. Remember, you must waive COBRA to elect any self-payment option.

You may want to review your beneficiary designation(s) for your Life and AD&D Insurance to make sure it is up-to-date. If you need to change your beneficiary information, you must to fill out the Beneficiary Designation form and return it to the Fund Office.

 Quick Tips: In the event of your death,  your spouse or beneficiary should:

  •  Notify the Fund Office.
  •  Provide the Fund Office with a copy of your death certificate.
  •  Apply for your Life Insurance (and AD&D Insurance, if applicable).
  •  If your dependents want to continue coverage under the Plan, enroll for self-pay continuation coverage or COBRA Continuation Coverage.

Retirees

If you are a retiree and die, your surviving dependents can continue coverage through self-payments. If the self-payments are discontinued for any month, or if your dependent does not elect to make self-payments when first eligible, your dependent will not be eligible to continue coverage by making self-payments.

Pre-funded Retiree Allowance
If you are eligible for the Pre-Funded Retiree Allowance, and are an active participant and die, your eligible surviving spouse can receive the Allowance that you would have received had you lived and retired. The Allowance is based on your quarters of service at the time of your death. Your dependents can continue coverage under the Active Plan until their costs deplete your reserve accumulation account. At that point, your dependents can continue coverage in the Pre-Medicare Retiree Plan. Your spouse can elect one of the options under the Pre-Funded Retiree Allowance, which will offset the cost of coverage. See the Pre-Funded Retiree Allowance booklet for more information. 

 

COBRA Continuation Coverage is available to you and other members of your family when you lose your group health coverage. The right to COBRA Continuation Coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA Continuation Coverage can become available to you when you would otherwise lose your group health coverage.

COBRA Continuation Coverage is a continuation of Plan coverage when coverage would otherwise end because of a qualifying event. Specific qualifying events are listed in your Summary Plan Description (SPD). The Fund offers COBRA Continuation Coverage to each person who is a qualified beneficiary. You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of a qualifying event.

If you have a newborn child, adopt a child, or have a child placed with you for adoption while COBRA Continuation Coverage is in effect, you may add the child to your coverage. To do so, you must notify the Fund Office of the birth or placement and provide a completed Enrollment Form and other necessary documentation, such as a birth certificate. Children born, adopted, or placed for adoption have the same COBRA rights as a spouse or dependents who were covered by the Plan. Like all qualified beneficiaries with COBRA Continuation Coverage, continued coverage depends on timely and uninterrupted payments on their behalf.

This is a summary of your COBRA Continuation Coverage rights. For additional information refer to you Summary Plan Description (SPD) .

If your eligibility ends because you enter or are drafted into active military service, the last employer you worked for before leaving for military service is responsible for making the required contributions on your behalf to continue coverage for you and your dependents during your absence. Your right to continue coverage (except Life Insurance, Accidental Death & Dismemberment and Weekly Disability Benefits) depends on the length of your absence from employment.

If you leave employment to enter qualified military service for less than 31 days, you and your dependents will continue to be covered under the Plan in the same way you were before you left. If you leave employment to enter qualified military service for 31 days or more, you may elect to continue coverage under the Plan for you and your dependents until the earlier of:

  • The end of the 24-month period beginning on the date you elected to continue coverage under USERRA when leaving employment to enter military service; or
  • The date your reemployment rights under USERRA expire.

Once your eligibility ends because of military service, it can be reinstated if you make an application for reemployment within the time required by Federal law. Eligibility for you and your dependents will be reinstated on the day you return to work.

The Family and Medical Leave Act (FMLA) allows you to take up to 12 weeks of unpaid leave for serious illness, to care for a child after birth, adoption, or placement for adoption, or to care for your seriously ill spouse, parent, or child. FMLA requires employers to maintain health coverage for the length of the leave. The Act also states that if you take a family or medical leave, you may not lose any benefits that you had accrued before your leave.

  •  To be eligible for FMLA benefits, you must:
  •  Work for a contributing employer who is covered under FMLA;
  •  Have worked for the employer for at least 12 months;
  •  Have worked at least 1,250 hours over the previous 12 months; and
  •  Work at a location where at least 50 employees are employed by the employer within a 75-mile radius.

If you believe that you are entitled to FLMA leave, please contact your employer, not the Fund Office because eligibility is determined by your employer.

How FMLA Works With COBRA

Taking a family or medical leave is not considered a COBRA qualifying event (see your Summary Plan Description (SPD) to find out what is considered a COBRA qualifying event). If you return from leave within 12 weeks, there will not be a loss of coverage. If you do not return from leave, that is considered a COBRA qualifying event (a reduction in hours causing a loss of coverage). You will then have an additional 18 months (or 36 months, if applicable) of continued coverage under COBRA.

Prepare for retirement by following some simple steps to ensure a smooth transition of benefits. 

When you retire, you may be eligible for coverage under the Non-Medicare Retiree Plan of Benefits or the Medicare Retiree Plan of Benefits, if you meet the eligibility requirements.

If you choose coverage under the Pre-Medicare Retiree Plan, you must waive your right to COBRA Continuation Coverage. See the section titled Non-Medicare Retirees in yourSummary Plan Description (SPD) for more information on retiree coverage.

Non-Medicare Retiree Benefits

In general, benefits under the Pre-Medicare Retiree Plan are the same as those for active employees, except you will no longer be eligible for the following benefits:

  • Life Insurance
  • AD&D Insurance
  • Accident and Sickness Weekly Income Benefits

When you retire, you may be eligible for coverage under theRetiree Plan of Benefits, if you meet the eligibility requirements described in your Summary Plan Description (SPD). Generally, benefits under the retiree program are the same as those for active employees, except that retirees are not eligible for Life Insurance, AD&D Insurance, or Accident and Sickness Weekly Income Benefits. If you choose coverage under the retiree medical benefits program, you waive your right to COBRA Continuation Coverage.

Medicare Retiree Benefits

If you are eligible for Medicare and otherwise meet the eligibility requirements for retirees, you will receive benefits under the Medicare Retiree Plan of Benefits.

Once your eligibility has ended, your coverage will be reinstated if you start working again for an employer that contributes to the Fund. See your Summary Plan Description (SPD) for more information. If you return to work following a military leave of absence, your coverage will be reinstated as described in your Summary Plan Description (SPD)

Retirees

Once you retire and start making self-payments toward retiree coverage, you cannot regain eligibility in the Active Plan, even if you return to work. Your retiree coverage under the Plan will end if you stop making self-payments, even if you return to work.

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© Iron Workers Tri-State Welfare Fund. The information on this Web site presents selected highlights of the Iron Workers Tri-State Welfare Fund. The actual Plan provisions of the Plan are in the Plan’s legal document. In the event of a conflict between the wording on the site and the legal documents, the legal documents will govern. The Trustees reserve the right to amend, modify, or discontinue all or part of the Plan at any time.