Life Events

Your benefits are designed to adapt to your needs at different stages of your life. Since different life events can affect your benefits coverage, this section describes how your coverage is affected and what you may need to do when different events occur.

Getting Married

When you marry, your spouse is eligible for healthcare coverage as of the date of your marriage. However, the Fund will not pay any benefits on behalf of your spouse until you enroll your spouse for coverage. You must send a copy of your marriage certificate, your spouse’s birth certificate, and your spouse’s Social Security Number to the Fund Office as soon as it is available. Once your spouse is enrolled, benefits will be paid retroactively back to the date of your marriage.

Keep in mind that when you experience a life event that adds or eliminates a Dependent from coverage, you need to notify the Fund Office, and provide the required documentation about your Dependents.

Adding a Child

Your natural Child will be eligible for coverage on the date of birth. If you adopt a Child, have a Child placed with you for adoption, or acquire a stepchild through marriage, he or she will be eligible for coverage on the date of placement or date of marriage, as long as you are responsible for healthcare coverage and your Child meets the Plan’s definition of a Dependent Child (see pages 6-7).

You must enroll your Child for coverage before the Fund pays any benefits for that Child. To enroll your Child for coverage, provide the required documentation to the Fund Office as soon as it is available. See the Enrollment Procedures section on page 12 for more details.

Getting Divorced or Legally Separated

If you and your spouse get a divorce or legal separation, your spouse will no longer be eligible for coverage. Your spouse may elect to continue coverage under COBRA for up to 36 months upon divorce or legal separation. You or your spouse must notify the Fund Office within 60 days of the divorce or legal separation date for your spouse to obtain COBRA Continuation Coverage.

A Qualified Medical Child Support Order (QMCSO) that is issued in the course of a divorce, legal separation or domestic relations proceeding could have an effect on your benefit coverage or elections. Please notify the Fund Office if your situation involves a QMCSO. You or your Dependent may request a copy, free of charge, of the Fund’s procedures for handling these orders.

Child Losing Eligibility

Limiting Age Under the Plan, the limiting age for your unmarried Dependent Child is: Age 19; or Age 23, if your Child is a full-time student at an accredited school and dependent on you for support and maintenance.

In general, your Child is no longer eligible for coverage when he or she marries, enters the military on a full-time basis, reaches the limiting age, or is no longer dependent upon you for support. You should notify the Fund Office when one of these events occurs.

Your Child may elect to continue coverage under COBRA for up to 36 months after your Child loses eligibility. You or your Child must notify the Fund Office within 60 days of the date your Child no longer meets the definition of a Dependent in order to obtain COBRA Continuation Coverage.

If your Child is not capable of self-supporting employment upon reaching the limiting age because of a mental or physical disability or handicap, you may continue coverage for that Child for as long as your own coverage continues and the Child depends on you for the major portion of his or her support. To qualify, your Child’s disability must begin before his or her coverage would otherwise end. You must consult the Fund Office within 31 days before Plan benefits might otherwise terminate to apply for continued coverage for your disabled or handicapped Dependent.

Taking A Family and Medical Leave Of Absence

If your Employer is required to grant you leave under the Family and Medical Leave Act (FMLA), and you qualify for such leave, the FMLA allows you to take up to 12 weeks, or 26 weeks if applicable, of unpaid leave during any 12-month period due to:

• The birth or adoption of a Child or placement of a Child with you for foster care or adoption;
• The care of a seriously ill spouse, parent, or Child;
• Your serious illness; or
• Effective when final regulations have been adopted by the Department of Labor, you have an urgent need for leave because your spouse, son, daughter, or parent is on active duty in the armed services in support of a military operation.

If you and your spouse both work for the same Employer, you and your spouse are eligible for a combined total of 12 weeks (or 26 weeks, if applicable) of leave during a 12-month period.

In addition, under the FMLA, you may be able to take up to 26 weeks of unpaid leave during any 12-month period to care for a service member. The service member must be your spouse, son, daughter, parent, or next of kin, must be undergoing medical treatment, recuperation, or therapy, for a serious illness or Injury incurred in the line of duty while in military service, and must be an Outpatient, or on the temporary disability retired list of the armed services.

Your leave will end on the earlier of your return to work or 12 weeks, or 26 weeks if applicable. If you do not return to work within 12 weeks, or 26 weeks if applicable, you may qualify for COBRA Continuation Coverage (see pages 20-21).

The Fund will maintain your eligibility and medical coverage until the end of the leave, provided your Employer properly grants the leave under the federal law and makes the required notification to the Fund. Contact your Employer for more information relating to a leave under the FMLA.

An Employer is required to grant FMLA leave to eligible Employees if it employs 50 or more Employees within a 75-mile radius for at least 20 weeks of the current or preceding year. To be eligible for FMLA benefits, an Employee must:

• Work for an Employer required to grant FMLA leaves;
• Have worked for that Employer for a total of at least 12 months;
• Have worked at least 1,250 hours over the previous 12 months; and
• Work at a location in the United States or in any territory or possession of the United States where at least 50 Employees are employed by the Employer within 75 miles.

You or your Employer must notify the Fund Office if you are taking a FMLA leave.

Taking a Military Leave

If you enter military service (active duty or inactive duty training) for up to 31 days, your health coverage will continue as long as contributions have been received for your coverage.

If you enter military service for more than 31 days, your coverage terminates and you have a choice of either: (1) making self-payments for coverage and having your remaining eligibility frozen until your reemployment after service; or (2) using your remaining eligibility for coverage, continuing coverage through self-payments when your eligibility is exhausted, and making self-payments for coverage upon reemployment after service. You may continue your Plan coverage through either of these methods for up to 24 months, or if shorter, the end of the period during which you are eligible to apply for reemployment in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994, as amended (USERRA).

Your coverage under USERRA will continue until the earliest of the following:

• The date you or your Dependents do not make the required self-payments within 30 days of the due date;
• The date you reinstate your eligibility for coverage under the Plan;
• The date you lose your rights under USERRA (for instance, for a dishonorable discharge);
• The end of the period during which you are eligible to apply for reemployment in accordance with USERRA;
• The last day of the month after 24 consecutive months; or
• The date the Fund no longer provides any group health benefits.

Reemployment Following your discharge from service, you may be eligible to apply for reemployment with your former Employer in accordance with USERRA. Reemployment includes your right to elect reinstatement in any existing healthcare coverage provided by your Employer.

You need to notify the Fund Office in writing when you enter the military. For more information about Self-Payments under USERRA, contact the Fund Office. Continuation coverage under USERRA will be administered by the Fund Office in the same way that COBRA continuation coverage is administered, except that coverage may continue for up to 24 months under USERRA. The Trustees will set the amount of your premium payment for continuation coverage under USERRA.

If you do not continue coverage under USERRA, your coverage will end immediately within 31 days of the date you enter active military service. Your Dependents will have the opportunity to elect COBRA Continuation Coverage.

When you are discharged or released from military service, you have up to the USERRA-specified time period to report to work for a Contributing Employer. If you return to work or make yourself available for work during this period, your eligibility and your Dependents’ eligibility will be reinstated on the day you report to work. If you do not report to work in Covered Employment within this period, you will be considered a new Employee and you will need to satisfy the initial eligibility requirements (see page 6).

In the Event of Death

If you die, your spouse and Eligible Dependents may continue coverage for up to 36 months by electing COBRA Continuation Coverage and making the necessary Self-Payments or, if eligible, by electing Special Health Continuation Coverage (see pages 18-19).

When You Stop Working or Retire

Contact the Fund Office about your coverage options as you get closer to your retirement date. They can provide you with a copy of the booklet that explains Retiree coverage.

Coverage for you and your Dependents will end if contributions needed to maintain your eligibility are not made on your behalf (see page 10). You may be eligible to continue coverage by electing COBRA Continuation Coverage and making the necessary self-payments for such coverage by the due date (see page 23).

If you retire, you may be eligible for Retiree coverage. You should refer to the Summary Plan Description for the Sheet Metal Workers’ Welfare Plan for Retirees for information about Retiree eligibility. Contact the Fund Office for a copy of that booklet.