Sheet Metal Workers' International Association
Local Union No.73
Pension Welfare and Annuity Funds
- Your Initial Eligibility
- Your Dependents' Eligibility
- Continuation of Eligibility
- Termination of Your Eligibility
- Termination of Dependent Eligibility
- Reinstatement of Eligibility
- Enrollment Procedures
1.1. Your Initial Eligibility
Your Plan coverage begins on the first day of the calendar month after you have worked 500 hours in Covered Employment in a six-consecutive-month period (which must include at least one hour in each of four of those six months) during which your employer contributed to the Fund on your behalf.
Covered Employment means work for which a contributing Employer is required to make contributions on your behalf to this Welfare Fund under the terms of a collective bargaining agreement with Sheet Metal Workers' Local 73.
You initially become eligible for coverage on the first day of the calendar month after you work 500 hours in Covered Employment within a 6-month period during which your Employer makes contributions on your behalf. You must work at least one hour in four of those six months.
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Example: Your Plan EligibilityJohn begins working on March 1, 2009 and works steadily through August 2009, accumulating more than 500 hours by the end of August 2009 and working at least one hour each month. John is eligible for coverage under the Plan on September 1, 2009.
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- If you are an Apprentice and you attend the 10½ week pre-apprentice
program, you are eligible to participate in the Fund immediately after
you successfully complete program.
1.2. Your Dependents' Eligibility
If you are an Apprentice and you attend the 10½-week pre-apprentice program, you are eligible to participate in the Fund immediately after you successfully complete the program.
Your Eligible Dependents become Participants in the Fund on the later of:
- The day you begin participation; or
- The date you enroll them with the Fund Office.
Your newborn Child will automatically become covered as a Dependent under the Fund on the date the Child is born.
Example: Your Dependent’s Eligibility
In the example above, John becomes eligible for coverage on September 1, 2009. John’s spouse and his unmarried Dependent Children become eligible on the same date.
Eligible Dependents are defined as follows:
- Your legal spouse; and
- Your unmarried Children who depend on you for more than one-half of their support during the calendar year, maintain a principal residence with you for more than one-half of the calendar year, and are:
- Under age 19;
- Under age 23 if they are full-time students; or
- Any age if mentally or physically disabled, as long as the mental or physical handicap began before the Child reached age 19 or age 23 if the Child was a full-time student.
Children include:
- Natural born Children as of the date of birth;
- Adopted Children (determined as of the time of placement with you for adoption); and
- Stepchildren who depend on you for more than half of their support during the calendar year, live with you in a regular parent-child relationship, and maintain a principal residence with you for more than one-half of the calendar year.
To enroll your newborn or newly acquired Child, you must provide the Fund Office with a copy of the birth certificate or adoption papers. Dependent status may continue until each Child’s 19th birthday or until each Child’s 23rd birthday if the Child is a full-time student attending an accredited educational institution. You must provide proof to the Fund Office, at the beginning of each school year (September) and again in February, that the Child is taking at least 12 credit hours per semester to maintain coverage for the Child. The Dependent’s benefits terminate when the Child reaches age 19, unless the Fund Office receives proof of student status from an accredited educational institution. If such proof is received, coverage will continue each year until graduation or age 23, whichever comes first.
| You must consult the Fund Office within 31 days before Plan benefits might otherwise terminate (at age 19 or 23, if a full-time student) to apply for continued coverage for your disabled or handicapped Dependent Child. |
If your Dependent Child is mentally or physically disabled or handicapped and is chiefly dependent on you, Plan benefits will continue as long as your Dependent is disabled or handicapped. To be eligible, your Child must be unable to engage in the normal activities of a person of like gender and age in good health due to disability or handicap. You must consult the Fund Office within 31 days before Plan benefits might otherwise terminate (at age 19 or 23, if a full-time student) to apply for continued coverage for your disabled or handicapped Dependent Child.
The Plan will provide benefits for your Dependent Child who is named as an alternate recipient in a Qualified Medical Child Support Order (QMCSO).
If your Child’s principal place of residence is not with you, eligibility depends on his or her ability to meet the other non-residence-related requirements above (support and relationship tests) and to meet either of the following conditions:
- For parents who are divorced, separated or who never married:
- The Child’s parents are: 1) divorced or legally separated under a decree of divorce or separate maintenance; 2) separated under a written separation agreement; or 3) live apart at all times during the last six months of the calendar year;
- The Child’s parents provide over one-half of the Child’s support; and
- The Child is in the custody of one or both of his or her parents for more than one-half of the calendar year; or
- You provide over half the Child's support and the Child is not a "qualifying child" of any other person.
Your Dependents’ benefits are subject to the rules outlined in the Coordination of Benefits Section which begins on page 69.
Qualified Medical Child Support Order (QMCSO)
A Qualified Medical Child Support Order (QMCSO) is a court order that requires you to provide medical coverage for your Children (called alternate recipients) in situations involving a divorce, legal separation or a paternity determination.
This Plan provides benefits according to the requirements of the QMCSO. The Fund Administrator will notify you and any alternate recipient when a QMCSO is received. If the QMCSO is a valid order, the Plan will cover the named Dependent as an alternative recipient even though the Dependent might not otherwise be eligible for coverage.
In general, your coverage continues on the basis of your hours worked. See the following charts to determine continuing eligibility requirements. Chart 1 is for Employees who have been eligible for benefits for 18 months or longer. Chart 2 is for those who have been eligible less than 18 months. 1.3 Continuation of Eligibility
The requirements for continuing coverage are different, depending on how long you have been eligible for coverage.
Eligibility for your Dependents continues while you are eligible for benefits, as long as they continue to meet the difinition of Dependent under the Plan.
If you have been eligible for benefits for 18 months or longer
January December 31 If you have been eligible for benefits for less than 18 months:
YOU HAVE AT LEAST ONE HOUR IN THE PRECEDING
3-MONTH PERIOD...January 31 February 28 or 29 March 31 April 30 May 31 June 30 July 31 August 31 September 30 October 31 November 30 January December 31 Example: How Coverage Continues
Continuing from the previous eligibility examples, John first became eligible for coverage on September 1, 2009.
For the first 18 months of John’s coverage (from September 1, 2009 through the end of February 2011), John must meet the requirements of the chart for Participants who have been eligible for benefits for less than 18 months (Chart 2 on page 9). For example, in order to continue eligibility in March 2010, John must have 500 hours from August 1, 2009 through January 31, 2010 and have at least one hour during the period from November 1, 2009 through January 31, 2010.
Starting March 2011, John must meet the requirements of the chart for Participants who have been eligible for benefits for 18 months or more (Chart 1 on page 9). For example, in order to continue eligibility in April 2011, John must have 1,000 hours from March 1, 2010 through February 28, 2011 and have at least one hour during the period from September 1, 2010 through February 28, 2011. Alternatively, John can maintain eligibility in April 2011 if he has 500 hours from September 1, 2010 through February 28, 2011 and at least one hour from December 1, 2010 through February 28, 2011.
1.4 Termination of Your Eligibility
Your eligibility for Plan benefits is affected when you stop working in Covered Employment as follows.
- Eligibility for the Weekly Accident and Sickness Disability Benefit stops on the first day of the second month following a two-consecutive-month period during which you have not worked in covered employment.
- Eligibility for all other Plan benefits stops as indicated in the charts in Section 1.3, Continuation of Eligibility.
Example: Termination of Eligibility
Continuing with the previous eligibility examples, John has been participating in the Plan from September 1, 2009 through June 30, 2011.
Because he has been eligible for benefits for 18 months or longer, he must meet the requirements in Chart 1 on page 9. However, he does not have 1,000 hours in the 12 months from July 1, 2010 through June 30, 2011 or 500 hours in the six months from January 1, 2011 through June 30, 2011. John’s eligibility terminates on July 31, 2011.
If You Are Disabled
For all Plan benefits except the Weekly Accident and Sickness Disability Benefit, any month in which you have a Certified Disability for 18 or more days will be counted as a month in which you have worked in Covered Employment. However, you may not receive credit for a Certified Disability for more than six months in a period of twelve consecutive months.
A Certified Disability is one for which you would otherwise receive Weekly Accident and Sickness Disability Benefits from the Plan, were you eligible, or benefits under any Workers’Compensation Law, Occupational Disease Law or similar legislation. However, if you are not eligible for this extension, you may continue health coverage under Continuation of Health Benefits (COBRA) as explained on pages 20-22.
If You Retire
If you retire and are eligible for retiree medical benefits under the Sheet Metal Workers’ Local 73 Retiree Welfare Fund, you may continue your coverage under the Plan for Active Employees until the end of the calendar year in which you retire if you have not yet reached age 65. Beginning January 1 of the following calendar year, coverage under the Active Plan ends, and you may continue coverage under Retiree Plan. However, you must begin making self-payments for retiree coverage on your retirement date (the date you begin receiving pension payments from the Sheet Metal Workers’ Local 73 Pension Fund).
If you retire after you have reached age 65, you may not maintain coverage under the Active Plan. You must enroll in Medicare and you will be covered under the Retiree Plan, if you are eligible for that coverage.
There are two exceptions to this rule: The Fund’s Death Benefit and the Accidental Death and Dismemberment Benefit will stop six months after your retirement date.
Termination of Dependent Eligibility
Eligibility for your Dependents ends when your eligibility ends or when they no longer meet the Plan’s definition of Dependent. If your Weekly Accident and Sickness Disability Benefits have been terminated, you will be reinstated for this coverage on the first day of the month after you work two consecutive months in Covered Employment during which you work an average of 80 hours per month or a minimum of 160 hours. You must have some work in Covered Employment during each of the two consecutive months and you must satisfy the reinstatement conditions before termination of all other Plan benefits.
If you lose your eligibility for all Plan benefits, your coverage will be reinstated on the first day of the month after you complete four consecutive months of Covered Employment within one year after termination of Plan benefits. The four months include the month during which you worked but the hours for which were not included in the last determination of your eligibility before you lost eligibility. During these four consecutive months of Covered Employment, you must work at least 320 hours (as long as you had 1,000 hours in the preceding 12-consecutive-month-period). You also must perform some work in Covered Employment in each of the four months.
If your eligibility is terminated and you do not meet these reinstatement requirements within one year after termination, you will have to meet the initial eligibility requirements again. These are explained in the Your Initial Eligibility section on page 6.
Example: Reinstatement of Eligibility
Continuing with the previous eligibility examples (in which John first became eligible on September 1, 2009), John loses eligibility on July 31, 2010. If John works at least 320 hours during any consecutive four-month period between July 1, 2010 and June 30, 2011 and he works in Covered Employment in each of those four months, his eligibility will be reinstated, assuming he had worked at least 1,000 hours in the preceding 12-month period. In determining the four-month period, John can use the month of July 2010 even though he had coverage during that month because that month constitutes a month not previously used in determining his eligibility.
For example, if John works the required hours between October 1, 2010 and January 31, 2011, and has a minimum of 1,000 hours from February 1, 2010 to January 31, 2011, his eligibility will resume on February 1, 2011.
To enroll in the Plan, complete the Benefit Enrollment Form and provide the required documentation as soon as it is available. Enrollment procedures are as follows:
- New member: Complete the Fund’s Benefit Enrollment Form, available through the Fund Office.
- New spouse: Submit a copy of your marriage certificate and your spouse’s birth certificate to the Fund Office when you get married, along with your spouse’s social security number in writing.
- Newborn Child: Submit a copy of the Child’s birth certificate to the Fund Office, along with your Child’s social security number in writing.
- Newly adopted Child: Submit a copy of the initial placement papers to the Fund Office along with a copy of the birth certificate and adoption papers (when available) , along with your Child’s social security number in writing.
- New stepchild: Submit a copy of the stepchild’s birth certificate and court decree (Qualified Medical Child Support Order) to the Fund Office, along with your Child’s social security number in writing.
This Plan complies with the Federal law regarding special enrollment procedures because all eligible Employees and their Eligible Dependents are automatically enrolled in this Plan as soon as they meet the Plan’s eligibility requirements. There is no option to decline coverage.
When your coverage under this Plan ends, the Fund will provide you with a certificate of coverage that indicates the period of time you were covered under the Plan and certain additionalinformation that is required by Federal law. The certificate will be sent by first class mail within 45 days after your coverage under this Plan ends. If you elect COBRA Continuation Coverage, another certificate will be provided within 60 days after the COBRA Continuation Coverage ends.
The Fund Office will also provide a certificate to you within 45 days if you request the certificate within two years of the date your Plan coverage ended or the date your COBRA Continuation Coverage ended, whichever is later.