C o n n e c t i c u t C a r p e n t e r s H e a l t h F u n d P
l a n
Working For You
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Your future health depends on the good habits you
build today. If you feel great now, you probably want to keep it that way. If
you’re not feeling good, it’s to your advantage to get well fast. And that’s
where Building a Healthier Future comes in. It’s your guide
to the health benefits provided to you by Connecticut Carpenters Health Fund.
The
book has been designed to be easy for you to read and use. There are many
benefits and each one has a section of its own with symbols to let you know
if you’re covered under that benefit. This way, you can find the benefits
that apply to you quickly and easily. Who’s Eligible? Carpenters
who are:
Certain
workers in the Connecticut offices of the:
Dependents
of eligible carpenters and office workers:
*
Notify the Health Fund Office by your child’s 19th birthday if he
or she is disabled. Note:
Please see the Medical Benefits section of this book for information on the
effect of pre-existing conditions on your eligibility for medical coverage. |
How
Do You Qualify for Coverage?
If
you’re working for a contributing employer under a collective bargaining
agreement or participation agreement, there are two ways you can get coverage:
- Your employer pays all.
You’re eligible to participate in active benefits
paid for by your employer on the March first after Employer Contributions were
made on your behalf in the previous calendar year for at least 1,200 hours. If
Employer Contributions have not been received you can use up to 611 hours of
Pay Stub Credit in a calendar year to establish your eligibility.
- You pay some.
Once you’re employed or working under an agreement,
if you have Employer Contributions for at least 400 hours in the previous
calendar year you may make Buy-In Contributions to get coverage as of March
first.
A
Bit of Information
If you decide not to make Buy-In Contributions and
later marry, have or adopt a child or lose other coverage you had, you may have
another chance to buy in. Call the Health Fund Office.
The
Hours Bank is an account that keeps track of your excess hours that can be used
for future eligibility in any year. Hours are deposited in the bank if they
exceed 1,500 hours of Employer Contributions in any year after 1997.
You
can also receive up to 611 hours of Pay Stub Credit for hours worked for which
Employer Contributions haven’t been received. Proof of hours worked can
include:
·
original
pay stubs, or
·
original
W-2 forms or other evidence of work, and/or
·
a
written statement from a job steward or foreman verifying your work, and/or
·
written
confirmation from a fund which is a party to a reciprocal agreement with the
Health Fund.
Hours
in the bank must always be applied before pay stubs will be credited unless you
need to reach 400 hours in the previous calendar year. In that case, pay stub
hours will be credited before hours in the bank are applied.
For
every year after you’re first eligible, you need 1,200 hours of Employer
Contributions per calendar year to stay eligible for the following year
beginning March first. If you have less than that and you are employed or
working under an agreement, you can use up to 800 hours that have been
accumulated in the Hours Bank if you had at least 400 hours of Employer
Contributions in the previous year.
Active
— Initial Eligibility If
you’re working for a contributing employer under a collective bargaining
agreement or participation agreement, you may use the Initial Eligibility
Rule if you have never been covered by the Health Fund, or have been without
Health Fund coverage for at least one year, and: ·
had less than 400 hours worked in the previous calendar year, and ·
have never been offered eligibility. You
may establish initial eligibility on the first of the month after Employer
Contributions are due on the 400th hour worked in the current
calendar year if you make Buy-In Contributions. Buy-In Contributions enable
you to pay for coverage yourself. Note:
The Health Fund Office will calculate Buy-In Contributions, hours in the bank
and Pay Stub Credit for you in determining eligibility. The Hours Bank is not
available to office or millcabinet members, and no employee has a vested
right to hours in the bank. To get Pay Stub Credit, proof of hours worked
must be received in the Health Fund Office by February fifteenth for annual
eligibility and by the fifteenth of the month after Employer Contributions were
due for initial eligibility. Millcabinet
Shop
Your
employer chooses to provide annual or month-to-month coverage for his or her
whole shop. Here’s how month-to-month coverage works: you’re eligible to
participate in active benefits paid for by your employer after at least 160
hours of Employer Contributions were made on your behalf. You’ll continue to
be eligible each month that an Employer Contribution was made on your behalf
in the previous month. You’ll continue to be eligible every month if Employer
Contributions for 160 hours are made on your behalf in the previous month. Your
coverage ends on the last day of the month that is 30 days after you
terminate your employment or become ineligible for Employer Contributions. A Bit of Information There’s a special immediate eligibility rule for
employees of new employers. If your employer elects to use it, we’ll provide
you with a copy. Office
If you work full-time in the Connecticut office of the Pension Fund, the New England Regional Council of Carpenters, one of the local unions, the Connecticut Carpenters Apprentice and Training Fund or the Carpenters Labor Management Program, you’re first eligible on the first of the month after you’ve worked for 30 days and Employer Contributions for 160 hours have been made on your behalf in the previous month. You’ll continue to be eligible every month if Employer Contributions for 160 hours are made on your behalf in the previous month. |
Your
coverage ends on the last day of the month which is 30 days after you terminate
your employment or become ineligible for Employer Contributions.
A
Bit of Information
Under the Family and Medical Leave Act of 1993
(FMLA), your employer is obligated to continue your medical coverage when
you’re on a leave of absence under the FMLA’s provisions. To continue your
coverage under the Health Fund, your employer must continue hourly
contributions on your behalf at 40 hours per week for each week you’re on
approved leave. Contact the Health Fund Office if you’re planning to take a
leave under FMLA so that it is aware of your employer’s responsibility to make
contributions during your absence. Please note: The Board of Trustees does not
have the authority to force your employer to continue making contributions on
your behalf while you’re on leave. If you need assistance contact the Wage and
Hour Division of the U.S. Department of Labor (DOL).
Retired
You’re
eligible for retirement benefits under the Health Fund if you:
·
are
at least 55 years old and receiving a retirement benefit from Connecticut
Carpenters Pension Fund or Social Security, and
·
have
been employed in covered employment — with at least 200 hours of Employer
Contributions — during six of the seven years immediately before you
requested retiree benefits, or
·
are
at least 65 years old and have been covered by the plan for disabled members continuously
up to age 65.
You
must also:
·
have
stopped work in the carpentry trade or craft, and
·
have
completed, signed and returned an election form to the Health Fund Office, and
·
pay
the required monthly payment to the Health Fund Office on time.
Once
you’ve retired, you can’t return to Active Member status — you’ll remain in the
retired plan.
If
you’re a retired carpenter or widow over age 65 or on Social Security
Disability your health benefits coordinate with Medicare parts A and B. You
have some flexibility in selecting the coverage you want. Please see the Coverage
chart on page 10.
Disabled
If
you’re an Active Member and eligible for Health Fund benefits when you become
disabled you’ll continue to be eligible for benefits up to age 65 if:
·
you’re
totally and permanently disabled and eligible for Social Security disability
benefits,
·
you
notify the Health Fund Office within 90 days after Social Security tells you in
writing that it will pay you disability benefits,
·
you
apply for Waiver of Premium from the insurance company that provides life
insurance benefits to you through the Health Fund, unless you’re between ages
62 and 65, and
·
you
provide certification of continued disability when the Health Fund Office requests
it.
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You’ll
receive 23˝ hours of credit for each of the first 26 full calendar weeks
you’re totally unable to work because of non-work related sickness or injury
while you’re actively employed in covered employment. You must give a
physician’s statement certifying your condition to the Health Fund. Disability
hours credit won’t be granted to you if you’re covered under the Disabled
Member plan, any self-pay plan or COBRA, or if your inability to work is
caused by a work-related illness or injury. Note:
You must use up active eligibility hours before the Health Fund begins to pay
your disability coverage. A Bit of Information If you become disabled and you want coverage for
your dependents, you must request coverage at the time you first become
eligible for disability benefits — you can only cover your dependents
later on if you get married or have or adopt a child. Losing
Eligibility Eligibility for you and
your dependents stops under the plan for Active Members on the earlier of any
of the following dates or events: ·
the last day of
February when you fail to meet the 1,200-hour requirement if you’re entitled
to annual eligibility, or the last day of the month which is at least 30 days
after you terminate employment or are no longer entitled to have 160 hours of
Employer Contributions made on your behalf if you’re entitled to monthly
eligibility ·
on the last day
of the month for which timely payment has been made, if you fail to make
timely payment of Buy-In Contributions or payments to a self-pay plan ·
you become
eligible for coverage under a Health Fund retiree plan ·
the Connecticut
Carpenters Health Fund Plan is terminated ·
coverage is
terminated for cause Eligibility for your
dependents stops on the last day of the eligibility period — either annual or
month-to-month — in which you die. Eligibility for your
dependents other than your spouse stops on the last day of the month
following the month in which he or she: ·
reaches age 19
(if not a full-time student), ·
reaches age 23
(if a full-time student) ·
ceases to be a
full-time student, ·
marries, or ·
is or was
disabled and ceases to be dependent on you for support. |
What
If You No Longer Qualify?
If
your hours are reduced below the number needed for continued eligibility — from
lack of work or if you are collecting disability payments — your coverage under
the Health Fund will stop. Under COBRA, you may continue to be covered. In this
case, you must pay for your coverage yourself. You can find out how much you
must pay by calling the Health Fund Office.
You
or any of your dependents may continue coverage under COBRA for 18 months if
you lose eligibility because your hours are reduced. Your dependents can extend
COBRA coverage for a total of 36 months if:
·
you
die,
·
you
get divorced,
·
you
become covered under Medicare, or
·
if
the dependent is your child and reaches the maximum age.
Spouses
who become legally separated or divorced or dependent children who reach age 19
or lose their student status have 60 days to notify the Health Fund Office if
they want COBRA coverage. If they don’t provide notice within 60 days, they cannot
have COBRA coverage. You and your dependents may choose COBRA coverage for the
Full Health plans or for Medical/Drug coverage only.
COBRA
rules are described in more detail in a separate section in this book.
Military
Service
If
you’re inducted into or enlist in the U.S. military or are called for service
in the National Guard or military reserve, the Health Fund will continue your
health coverage for your first 31 days of military service. It will credit your
hours as if you continued to work in covered employment. Call the Health Fund
Office immediately if you enter military service to ensure that your coverage
continues and to learn the rules that will apply to you when you return.
If
you’re eligible for benefits at the time you entered military service, and you
continue in service beyond 31 days, you’ll have the right to continue your
health coverage if you:
·
maintain
coverage through the Health Fund based on the annual eligibility rules, or
·
suspend
your coverage and freeze the hours worked before your military service and have
them applied when you return to work in covered employment, or
·
maintain
coverage under COBRA.
If
you were eligible for coverage immediately before you entered military service,
you’ll be eligible immediately when you return as long as you’re discharged
under honorable conditions. You must make yourself available for work in
covered employment within a specified time period — based on the length of your
military service — after your date of discharge. The Health Fund is required by
law to give a grace period for military service of up to four years. The Health
Fund is not obligated to offer a grace period for military service of five or
more years.
If
you weren’t eligible for coverage under the Health Fund when you entered
military service, different rules apply. Call the Health Fund Office for
information.
The Widows
Plan If
you die when you are at least age 55, vested under the Connecticut Carpenters
Pension Fund and covered under the Health Fund, your surviving spouse — but
no other dependents — will be covered immediately under the Widows Full or
Widows Reduced Plan. If you die while on COBRA coverage, your surviving
spouse will be eligible for the Widows Plan when COBRA coverage ends. Coverage
under the widows plans is provided at a monthly cost established by the
Trustees. The cost can be adjusted at any time. Coverage
will continue until your surviving spouse becomes covered under another group
health plan or until the Trustees terminate the Widows Plan. Once coverage is
terminated under the Widows Plan it can’t be reinstated. Termination
For Cause Coverage
will end immediately if you are terminated for cause and you will not be
eligible for COBRA. To become eligible for coverage again after being
terminated for cause, you must become an employee and work the required hours
for coverage. Termination
for Cause happens if a person is convicted of a crime against the Health Fund
or any employee benefit fund, union or contributing employer, or makes false
statements to get a benefit from the Health Fund or engages in any
non-covered employment after January 1, 1998. Proof of
Your Health Coverage When
your medical and dental coverage ends, the Health Fund Office will provide
you and your covered dependents with a certificate of creditable coverage.
The Health Fund Office will mail it after coverage ends. The certificate
indicates the period of time that coverage was in effect and other
information required by law. You
would use a certificate of creditable coverage to reduce exclusion periods
for pre-existing conditions that might apply if you get coverage from a group
health plan or health insurance policy within 62 days of ending your coverage
under the Health Fund or under COBRA. Certificates are available for up to
two years after your coverage ends under the Health Fund or under COBRA. Outside
the U.S. and Canada Your
coverage is not in effect for injuries or illnesses that occur if you’re not
in the U.S. or Canada, except for medical emergencies. Two Medical Plans There are two forms of medical coverage: Full Plan and Supplemental Plan. The Supplemental Plan is available to you if you are eligible for Medicare. Please see the separate Medical Benefits sections for details. |
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Coverage |
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The
icons shown below will help you find the benefits that apply to you. |
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This
coverage: |
Includes
these people: |
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Full
Spectrum:
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Active
Members: Carpenters Millcabinet
Shop Carpenters Office
Workers |
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Full
Health:
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COBRA Full Retiree’s
Spouse under 65 Widows
Over 65 Self-Pay Widows
Under 65 Full Self-Pay |
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Medical/Drug
Only:
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COBRA
Reduced Widow
Reduced |
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Disabled
Member:
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Disabled
Members |
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Retiree
Full:
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Retiree
Under 65 Full Self-Pay Retiree
Over 65 Full Self-Pay |
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Retiree
Reduced:
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Retirees
Over 65 Plan Widows
Over 65 |
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Dependents
are eligible under any of the categories listed above. Dependents of disabled
members must pay a monthly fee for coverage. |
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