Self Pay Portal

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Eligibility

Eligibility

Active Eligibility

Initial Eligibility (For New Employees)

You will become Eligible for benefits on the first day of the eligibility quarter after you accumulate 350 contribution hours within a nine-month period. Eligibility quarters are June through August, September through November, December through February and March through May. Contribution hours are the hours you work for which an Employer contributes to the Fund on your behalf. Hours from all contributing employers count toward Eligibility.

Continuing Eligibility

You continue eligibility based on the number of hours your work for which an Employer contributes to the Fund on your behalf. You need to have 350 hours in a benefit quarter, 700 in the last 2 benefit quarters, 1,050 in the last 3 benefit quarters or 1,400 hours in the last 4 benefit quarters to continue coverage in the corresponding eligibility quarter.

Benefit QuarterEligibility Quarter
January through MarchJune through August
April through JuneSeptember through November
July through SeptemberDecember through February
October through DecemberMarch through May

Dependent Eligibility

Your dependents become eligible when you become eligible and they meet the Fund’s definition of a dependent.

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.
See the  Summary Plan Description (SPD) more information about active eligibility.

Retiree Eligibility

When you retire, you may continue coverage under the Pre-Medicare Retiree Self-Pay Program if:

  • You are at least age 52;
  • You do not have enough hours left in your Reserve Accumulation Account to pay for a quarter of coverage (By electing the Retiree Plan of Benefits, you forfeit any excess Reserve Accumulation Account hours.);
  • You are receiving some form of retirement benefits;
  • Before retiring, you were eligible for benefits by virtue of Contribution Hours under this Plan for some part of each of the last ten (10) calendar years; and
  • For the quarter immediately prior to retiring, you were eligible for benefits under this Plan by virtue of any combination of the following: Contribution Hours, Reserve Accumulation Account hours, and Self-Pay Contributions.

Pre-Medicare Retirees

If you are covered under the Tri-State Welfare Fund benefits (either by your employment or by self-payment), you and your eligible spouse may self-pay for the Medical coverage available under the Iron Workers Tri-State Pre-Medicare Retiree Welfare Plan. You must self-pay monthly for this coverage.

Medicare Eligible Retirees

If you are covered under the Tri-State Welfare Fund benefits (either by your employment or by self-payment), you and your eligible spouse may self-pay for the Medicare options available under the Iron Workers Tri-State Medicare Retiree Welfare Plan. You must be entitled to Medicare and self-pay monthly for this coverage.

Pre-Funded Allowance

If you are active on, and earned at least one Quarter of Service, after your effective date and retire, you may be eligible to continue Eligibility with the Retiree Pre-Funded Allowance. You must waive COBRA Continuation Coverage in order to receive the Allowance, which is used as a discount toward the quarterly self-pay rate for the Pre-Medicare Retiree Plan of Benefits, or the Medicare Advantage Plan. The allowance is applied toward the quarterly self-pay rate for your and your dependents’ coverage.

Pre-Funded Allowance Effective Dates
Local 444 January 1, 2004
Local 465 January 1, 2005
Local 498 January 1, 2019
Local 111, 112, and 380 January 1, 1999

To be eligible for the Retiree Pre-Funded Allowance, you must be:

  • At least age 62 and have 40 Quarters of Service; or
  • At least age 52 and have 60 Quarters of Service; or
  • Totally and permanently disabled with at least 60 Quarters of Service. 

FAQ's

See your eligibility status and current number of contribution hours by logging into the  My Benefits Portal. There, you can also see your work history and past contribution hours. For more information about the required contribution hours for continued eligibility, see your  Summary Plan Description.
You can continue eligibility for yourself and your Dependents by using any reserve contribution hours you have accumulated. If you run out of reserve hours, you can self-pay in order to continue coverage. Your self-pay options include:
  • The Active Self-Pay Program
  • COBRA continuation coverage
  • The Pre-Medicare Retiree Plan
  • The Medicare Retiree Plan
For more information on continuing coverage, see your  Summary Plan Description.

To become eligible for the Active Plan, you currently need 350 contribution hours within a nine-month period.

Management or supervisory Employees require at least 160 contribution hours at the hourly contribution rate required in that worker’s local union.

Learn more about eligibility requirements here. See your eligibility status at the  My Benefits Portal.

Your coverage in the Active Plan begins on the first day of the Benefit Quarter after you meet the initial eligibility requirements of the Active Plan of Benefits.

Learn more about eligibility requirements here. See your eligibility status at the My Benefits Portal.

You are required to accumulate enough hours in a three-month period, or a Benefit Quarter, in order to continue eligibility in the Active Plan. Each Benefit Quarter is “linked” to the eligibility quarter that starts three months later. So if you accumulate enough contribution hours in one Benefit Quarter to continue eligibility, the eligibility status applies to the future Benefit Quarter. [For example, the Benefit Quarter that runs from January to March is “linked” to the eligibility quarter that runs through June to August.] When you accumulate the required amount of hours (currently 350 for one Benefit Quarter), you become eligible for the entire length of the linked or corresponding eligibility quarter. For more information on Benefit Quarters and continuing eligibility, see your  Summary Plan Description. To see your currently eligibility status, visit the My Benefits Portal.
If you fail to accumulate enough contribution hours in one Benefit Quarter (currently 350), the Fund will look back at previous Benefit Quarters to see if you have accumulated enough hours. The Fund will consider the current and previous three Benefit Quarters when determining eligibility. However, when looking back at previous Benefit Quarters, the required number of contribution hours must still add up to a multiple of 350. [For example, you only accumulated 300 hours from October through December (one Benefit Quarter). However, you accumulated 400 hours from July through September (the previous Benefit Quarter). Your total accumulated contribution hours equals 700, which is as if you had accumulated the required 350 hours for each of the two Benefit Quarters. You will be eligible for the Active Plan from March through May of the following year.] You may also use reserve hours or you may self-pay to continue eligibility. For more information on Benefit Quarters and continuing eligibility, see your  Summary Plan Description. To see your currently eligibility status, visit the My Benefits Portal.
  • For each of the first 500 excess contribution hours you work during a year, you receive one reserve hour.
  • For each two excess contribution hours after the first 500, you receive one reserve hour. You may have up to 750 reserve hours in your reserve accumulation account at any one time.
  • Your reserve hours can be used to continue your benefits, if needed.
For more information on Benefit Quarters and continuing eligibility, see your  Summary Plan Description. To see your currently eligibility status, visit the  My Benefits Portal.
If you and/or your spouse are covered under the Fund and another group health plan (such as a spouse’s employer’s plan, a different Fund’s plan or Medicare), the Fund will coordinate benefits between the two plans. The order of which plan pays benefits first depends on different factors, such as who is claiming benefits and who is considered an active employee under the Fund. To learn more about coordination of benefits, see your  Summary Plan Description
If you become disabled after the initial eligibility period, you have different options of remaining covered under the Active Plan. Depending on the circumstances, you may be eligible for:
  • Weekly Accident and Sickness Income Benefit
  • Accidental Death & Dismemberment (AD&D) Insurance
  • Disability hours (29 per week, up to 700 per 12-month period)
  • Workers’ compensation benefits (for work-related disability)
For more information on disability benefits, see your  Summary Plan Description.
If you meet the initial eligibility requirements and if you are unable to work because of an accident or illness when benefits should become effective, the Weekly Accident and Sickness Benefit coverage will be delayed until you return to active employment. You and your Dependents will be eligible for all other Plan benefits on the effective date. For more information on Benefit Quarters and continuing eligibility, see your  Summary Plan Description. To see your currently eligibility status, visit the My Benefits Portal.
If you’re unable to work due to a non-work-related disability:
  • Notify the Fund Office and your employer.
  • 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.  Contact the Fund Office for a claim form.
For more information about what to do if you become disabled, see the  Summary Plan Description.