Continuation of Coverage After You Die

Your Dependents have several options for continuing coverage after your death. Their options depend on whether or not you were eligible for coverage when you die.

If You Were Eligible For Coverage When You Died

If you die while you are eligible for Plan coverage as an Active Employee, eligibility for your Dependents will continue without self-payment for as long as you would have been eligible for coverage, based on your accumulated eligibility.

After your death, your surviving spouse and Dependent Children may choose to continue coverage by either:

• Exhausting your Active coverage and then electing COBRA continuation coverage, or
• Electing Special Health Continuation Coverage, which is coverage under the Retiree Plan, if eligible. In this case, coverage under the Retiree Plan would begin on the date your surviving spouse begins receiving a pension from the Sheet Metal Workers’ Local 73 Pension Fund and begins payment for Retiree coverage.

If you die without meeting the requirements for Special Health Continuation Coverage, your Dependents will be entitled to COBRA continuation coverage only.

Health Continuation Coverage

Special Health Continuation Coverage is available to your survivors if you met certain requirements while you were covered by the Plan.

Your Dependents may continue coverage under the Retiree Plan through Special Health Continuation Coverage if:

• You die as an Active Employee,
• You had at least nine pension credits awarded by the Sheet Metal Workers’ Local 73 Pension Fund at the time of your death,
• You were eligible for a pension (including a Reciprocal Pension) from the Sheet Metal Workers’ Local 73 Pension Fund at the time of your death and your surviving spouse is receiving a survivor’s pension, and
• You worked at least fifteen full years with Employers that were signatories to collective bargaining agreements with the Sheet Metal orkers’ International Union or one of the Sheet Metal Workers’ Local Unions.

Your surviving spouse and Eligible Dependents must make the required self-payments to the Retiree Plan for this Special Health Continuation Coverage at a rate set by the Trustees. You may contact the Fund Office for information about the rates for this coverage. Self-payments must begin in the month following the month of your death. If self-payments are not being deducted from the pension check, they are due on the first of the month for which coverage is being provided. There is a 30-day grace period to make such direct self-payments. The premium for coverage is based upon the surviving spouse’s age and the Participant’s years of service. The rate will change on March 1 st following the years the surviving spouse reaches age 60, age 62 and age 65.

This special coverage is only available if your surviving spouse was married to you throughout the 12-month period immediately before your death. Coverage for your spouse under the Special Health Continuation Coverage provision will terminate on the first day of the month in which your spouse remarries following your death. However, your surviving spouse and any covered Dependent Children will be entitled to elect COBRA continuation coverage under the Active Plan for the remainder of the 36-month period that started on the date of your death by making timely self-payments at the COBRA rate. If the surviving spouse does not remarry, coverage will terminate for a Dependent Child who continues coverage under the Special Health Coverage Continuation provisions when the Dependent Child no longer meets the definition of Eligible Dependent under the Plan. The Dependent Child will have the option of electing COBRA continuation coverage under the Retiree Plan when a qualifying event occurs.

To be eligible to continue coverage under the Special Health Continuation Coverage provision, your Dependents must waive COBRA Continuation Coverage. However, if your Dependents lose this coverage because your urviving spouse remarries within 36 months of your death, they will be eligible to elect COBRA Continuation Coverage under the Active Plan for the balance of the 36-month period that began on the date of your death. The cost of coverage will be the COBRA rate.

If you were retired at the time of your death, your Dependents will be entitled to continue coverage under the provisions of the Sheet Metal Workers’ Local 73 Welfare Plan for Retired Employees.

Your surviving Dependent Child may elect COBRA continuation coverage for up to 36 months from the date the Child no longer meets the Plan’s definition of a Dependent.

Retiree benefits are described in more detail in the Summary Plan Description for Retired Employees. If your surviving spouse is receiving a pension from the Sheet Metal Workers’ Local 73 Pension Fund, there is no continuation of eligibility under the Active Plan and self-payments for Retiree Plan benefits must begin immediately.

If You Were Not Eligible For Coverage When You Died

If you were not eligible for Plan coverage at the time of your death, your Dependents may make self-payments for coverage under the Special Health Continuation Coverage provision if:

• You had earned 25 pension credits under the Sheet Metal Workers’ Local 73 Pension Fund; and
• You were credited with a minimum of three pension credits in the period consisting of the Pension Plan Year in which you died and the six consecutive Pension Plan Years immediately preceding the year in which you died.

Pension credits mean only those directly awarded by the Sheet Metal Workers’ Local 73 Pension Fund, not those awarded by another pension fund. If you served as a full-time Officer or Business Agent of the Union, you will be given credit for the years of service to the Union. See the Fund Office for more details.

 Continuation of Coverage During Family and Medical Leave

See pages 15-16 for information about continuing coverage during a leave under the Family and Medical Leave Act (FMLA).

Continuation of Coverage During Military Leave

See pages 16-17 for information about continuing coverage while you serve in the Uniformed Services of the United States under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

COBRA Continuation Coverage

When coverage under the Plan would otherwise end, you and/or your Dependents may be able to continue coverage by electing COBRA Continuation Coverage.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides for continuation of health coverage for you, your spouse and Dependent Children, if you lose coverage under the Plan due to a qualifying event. You and your Dependents may continue health coverage for a limited period of time by making self-payments to the Plan.

If you lose eligibility due to insufficient hours or termination of your employment, your coverage will continue without self-payment, depending upon how long you worked in Covered Employment. You may then elect COBRA Continuation Coverage for up to a maximum of 18 months. Your COBRA Continuation Coverage will be subsidized for the first six months and then you will pay the full rate for any remaining coverage thereafter. This provision applies when you elect COBRA for yourself or you elect family coverage.

If you or your Dependent loses eligibility for any other reason, the full COBRA Continuation Coverage rate will be charged for the entire period of coverage.

You and your Dependents may choose individual coverage or family coverage.

Eligibility for COBRA Continuation Coverage

If you or your Dependents are eligible for COBRA Continuation Coverage, you are considered qualified beneficiaries, meaning you were covered by the Plan on the day before the qualifying event.

COBRA Continuation Coverage allows you to pay to continue your coverage when it would otherwise end. You and/or your Dependents may be eligible to elect COBRA Continuation Coverage if you experience a qualifying event.

If you marry, have a newborn Child, or have a Child placed with you for adoption while you are enrolled in COBRA Continuation Coverage, you may enroll that spouse or Child for the balance of the period of your coverage. You must complete the enrollment within 30 days after the birth, marriage, or placement for adoption. Children born to, adopted, or placed for adoption with you will have the rights of a qualified beneficiary if they are properly enrolled in the Plan. However, other Dependents who are added to the coverage will not have the rights of a qualified beneficiary.

Scope of COBRA Continuation of Coverage

If you choose COBRA Continuation Coverage, you are entitled to the same type of coverage that you had before the event that triggered COBRA. However, COBRA Continuation Coverage does not include the Death, Accidental Death and Dismemberment, or Weekly Accident and Sickness Disability Benefits currently provided to Active Employees by the Fund. If there is a change in the health coverage, including Prescription Drug coverage that is provided by the Plan to Active Participants, that same change will be made to your COBRA Continuation Coverage.

Qualifying Events That Trigger COBRA Continuation Coverage

If you experience a qualifying event that causes you to lose coverage, you will be considered a qualified beneficiary, and the Fund will send you a COBRA Election Notice and a form for you to elect coverage. The qualifying events under which you and/or your Dependents may lose coverage under the Plan and the period of time for which you may make self-payments to continue benefits are described below.

You become a qualified beneficiary if you lose coverage because one of the following qualifying events:

• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.

Your spouse becomes a qualified beneficiary if he or she loses coverage because any of the following qualifying events:

• Your death,
• Your hours of employment are reduced,
• Your employment ends for any reason other than your gross misconduct,
• You and your spouse become divorced or legally separated, or
• You become entitled to Medicare benefits under Part A, Part B or both. Your becoming entitled to Medicare means that you: 1) were eligible for Medicare benefits, and 2) enrolled in Medicare (under Part A, Part B, or both). The entitlement date is the date of enrollment in Medicare.

Your Eligible Dependent Children become qualified beneficiaries if they lose coverage because any of the following qualifying events:

• Your death,
• Your hours of employment are reduced,
• Your employment ends for any reason other than your gross misconduct,
• The parents become divorced or legally separated,
• The Child stops being eligible for coverage under the Plan as an Eligible Dependent Child, or
• You become entitled to Medicare benefits under Part A, Part B or both. Your becoming entitled to Medicare means that you: 1) were eligible for Medicare benefits, and 2) enrolled in Medicare (under Part A, Part B, or both). The entitlement date is the date of enrollment in Medicare.

Length of COBRA Continuation Coverage

If you lose eligibility for coverage because your hours are reduced or your employment is terminated, you and your Dependents may continue COBRA Continuation Coverage for a maximum period of 18 months from the date of loss of coverage. Once coverage is lost, the monthly contribution rate for individual or for family coverage for the first six months will be subsidized. The contribution rate for the seventh through the eighteenth month is not subsidized and, therefore, is higher.

If your Dependents lose coverage under the Plan because of divorce, legal separation, your death, or loss of Dependent status, your Dependents may maintain COBRA Continuation Coverage for a maximum period of 36 months from the date coverage was lost.

Medicare Entitlement and COBRA Continuation Coverage. When the qualifying event is the end of employment or reduction of your hours of employment, and you became qualified for and enrolled in Medicare benefits less than 18 months before the qualifying event, COBRA Continuation Coverage for qualified beneficiaries other than you lasts until 36 months after the date of Medicare entitlement. However, your maximum period of COBRA Continuation Coverage will be 18 months.

In no case are you entitled to COBRA Continuation Coverage for more than a total of 18 months, unless you qualify for an additional period of up to 11 months because of disability as described below. Other family members may be entitled to COBRA Continuation Coverage for a total of 36 months.

Second Qualifying Event During Initial COBRA Continuation Coverage Period. If, during an 18-month period of COBRA Continuation Coverage following your termination of employment or reduction in hours, you die, divorce, legally separate, or your Child loses Dependent status under the Plan, the maximum period is extended to 36 months from the date you initially lost eligibility. This extension only applies to:

• Qualified beneficiaries who are members of your family and were covered by the Plan before the loss of your eligibility, and
• Your Dependent Children who were born, adopted, or placed for adoption with you while you were covered under COBRA Continuation Coverage.

Extended Coverage in Certain Cases of Disability. If, during or before the first 60 days of an 18-month period of COBRA Continuation Coverage, you or one of your Dependents are determined by the Social Security Administration (SSA) to be totally and permanently disabled so as to be entitled to Social Security Disability benefits, the 18-month maximum period can be extended for up to 11 more months (for a total of 29 months) for all qualified beneficiaries who have elected COBRA Continuation Coverage. This extension is available only if:

• The disability starts at some time before the 60th day of COBRA Continuation Coverage, and
• The qualified beneficiary or another family member notifies the Fund Office of the Social Security Administration’s determination within 60 days after the determination is received by the qualified beneficiary, and
• That notice is received by the Fund Office before the end of the 18-month COBRA Continuation Coverage period.

If a disability extension is granted, the monthly self-payment rate for COBRA Continuation Coverage for the additional 11 months of coverage under the disability extension will be higher than the monthly self-payment rate paid for the first 18 months, as explained in the next section.

Cost of and Payment for COBRA Continuation Coverage

Any qualified beneficiary who elects COBRA Continuation Coverage will pay the full cost of the coverage (with the exception explained on page 22). The Fund can charge the full cost of coverage for similarly situated Employees and their families (including both the Fund’s share and Employee’s share, if any) plus an additional 2%.

If the 18-month period of COBRA Continuation Coverage is extended because of disability, the Fund can charge the cost plus an additional 50%.

The monthly cost depends on how many people are covered. Rates are provided for one person or for family coverage. If a qualified beneficiary adds Dependents that are acquired during the COBRA Continuation Coverage period and the qualified beneficiary was previously paying for individual coverage, the qualified beneficiary will be required to pay the higher rate.

The Trustees will establish the COBRA Continuation Coverage rates in accordance with ERISA and the Internal Revenue Code, the laws that governs the Plan. Generally, the Trustees will set new rates each Plan Year beginning July 1.

When you elect COBRA Continuation Coverage, you are required to make the first payment no later than 45 days after the date of your election, which is the date your COBRA Election Notice is post-marked, if mailed. If you do not make the first payment for continuation coverage in full within the 45-day deadline after your election, you will lose all rights to COBRA Continuation Coverage. You are responsible for contacting the Fund Office to make sure that the amount of your first payment is correct.

Your subsequent payments for COBRA Continuation Coverage are due on the first day of the month for which coverage is being provided. However, you have a 30-day grace period to make the payment. If the payment is not made when due, you will lose all continuation coverage rights under the Plan. COBRA Continuation Coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. However, if you pay a periodic payment later than the first day of the month for which it applies, but before the end of the grace period (the end of the month) for the coverage, coverage under the Plan will be suspended as of the first day of the month and then retroactively reinstated, going back to the first day of the month when your payment is received.

If you lose eligibility due to insufficient hours and you elect COBRA Continuation Coverage, you will be required to pay at the subsidized rate for the first six months and at the full rate thereafter. This provision applies both to you and to any of your Eligible Dependents covered by the COBRA Continuation Coverage. You and your Dependents may separately choose individual coverage or jointly choose family coverage. If your Dependent loses eligibility for any other reason, he or she will be required to pay the full rate for the entire period of coverage.

COBRA Continuation Coverage Notice and Election

You or your covered family member must inform the Fund Office of a divorce, legal separation, or of a Child losing Dependent status. You or your Dependent must provide written notice within 60 days of the event or the person affected forfeits the right to COBRA Continuation Coverage.

Your Employer has the responsibility to notify the Fund Office of your death, termination of employment or reduction in hours within 30 days of the date that you would lose coverage due to the event. However, you or your covered Dependents are encouraged to notify the Fund Office of any event that may qualify you or your Dependents for continuation of coverage.

If your Dependent’s coverage ends due to divorce, legal separation, or loss of Dependent status, you or your Dependent must notify the Fund Office within 60 days of the event to qualify for COBRA Continuation Coverage.

When the Fund Office is notified that one of these events has occurred, it will in turn notify you or your Dependents of the right to choose continuation coverage and the time frame within which you must make the election. If you are not entitled to COBRA Continuation Coverage, the Fund will notify you of your ineligibility in writing.

You or your Dependents have an election period of at least 60 days from the date the notice is provided to inform the Fund Office of your election of COBRA Continuation Coverage.

You may elect individual coverage or family coverage. Once you make your election for COBRA Continuation Coverage, you cannot change it unless it is within the 60-day election period. This means that after the 60-day election period ends, if you elect individual coverage, you cannot change to family coverage and if you elect family coverage, you cannot change to individual coverage. However, if you elect family coverage for only two family members and one of the family members dies so that individual coverage would be less expensive, the surviving individual may change to individual coverage. The Plan will charge for the individual premium starting on the first day of the month following the day the covered family member dies.

COBRA Benefit Coverage

Keep in mind that COBRA Continuation Coverage does not include Weekly Accident and Sickness Disability Benefits, so that if you become disabled while you are on COBRA Continuation Coverage, you will not receive those benefits. However, you may receive a disability extension of COBRA Continuation Coverage if you meet the requirements in the Disability Extension section on page 22.

Under COBRA Continuation Coverage, you are entitled to the same type of coverage that you had before the event that triggered coverage. If you or your Dependents choose COBRA Continuation Coverage and make the required self-payments, the Welfare Fund will provide coverage for all medical, dental, prescription drug, wellness, Substance Abuse, employee assistance plan, hearing, and vision benefits under the Plan. Death, Accidental Death and Dismemberment, and Weekly Accident and Sickness Disability Benefits are excluded from COBRA Continuation Coverage.

In addition, if there is a change in the healthcare coverage that is provided by the Plan to Active Participants, that same change will be made to the COBRA Continuation Coverage of qualified beneficiaries.

Termination of COBRA Continuation Coverage

If you or your Dependent elects COBRA Continuation Coverage, coverage will terminate as of the date the first of any of the following events occur:

• You or your Dependents do not pay the self-payment for COBRA continuation coverage within 30 days of its due date.
• You or your Dependents become covered under another group health plan. Special rules exist concerning pre-existing conditions. Contact the Fund Office for details.
• You or your Dependents become eligible for Medicare. Contact the Fund Office for details.
• The Welfare Fund no longer provides any healthcare benefits.
• The Social Security Administration determines that you are no longer disabled during the COBRA disability extension period. You or your Dependent must give the Fund Office notice that you are no longer disabled within 30 days of the date that the Social Security Administration has determined that you are no longer disabled.

Once you lose COBRA Continuation Coverage, you must meet the Plan’s initial eligibility requirements to once again be eligible for coverage under the Plan.

When your COBRA Continuation Coverage ends, the Fund will automatically provide a certification of the length of coverage under this Plan. This is called a Certificate of Creditable Coverage and it may help reduce or eliminate any pre-existing condition limitations under a new group medical plan..

If You Have Questions

If you have questions about your COBRA Continuation Coverage, you should contact the Fund Office, or you may contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website at www.dol.gov/ebsa /.

Keep the Fund Informed of Address Changes

In order to protect your family’s rights, you should keep the Fund informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Fund.