| Q. |
| A. | You are initially eligible on the first day of the calendar month following a lag month when the Plan receives at least 440 hours of contributions (425 hours for owner-operator) from a contributing employer within six months of commencement of covered work. Once the initial Eligibility Requirements are met, you will be eligible to receive benefits for the following two consecutive calendar quarters after the lag month. The initial quarter may be a partial quarter depending on when eligibility was established.
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Eligibility
Rules Beginning
July 1, 2022
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Work Quarters
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Dec / Jan / Feb +
Mar / Apr / May
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Mar / Apr / May +
Jun / July / Aug
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Jun / Jul / Aug +
Sept / Oct / Nov
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Sep / Oct / Nov +
Dec / Jan / Feb
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Lag
Month
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June
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September
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December
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March
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Eligibility Period
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July to December
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October to March
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January to June
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April to September
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| Q. |
| A. | For eligibility to continue, you must earn 440 hours of contributions for the last two working quarters (six consecutive months) in which you would work both quarters before the lag month to maintain eligibility (425 hours for owner-operator). Non-work credit hours can be granted for an approved disability.
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| Q. |
| A. | Your coverage will always be primary for you and your spouse’s coverage will always be primary for your spouse. If you have coverage for your dependent children, the primary payer will depend on when you and your spouse’s birthday fall in the year. If your birthday falls earlier in the year than your spouse, your plan will be the primary payer. If you spouse’s birthday falls earlier, then their plan becomes primary. This is considered the “birthday rule”. If you are a member of Local 321 or 577, it is mandatory that your spouse accept coverage through his/her employer if available. |
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| Q. |
| A. | The prescription drug coverage is through Express Scripts (ESI) |
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| Q. |
| A. | Yes. Mail order is an option under the Plan. |
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| Q. |
| A. | Yes, for eligible Active employees and qualified dependents in Locals 46, 321, 392, 396, 577, and 782. The vision program is administered by Vision Service Plan (VSP). Under this program, Active employees and their dependents can get a comprehensive eye exam every 12 months from an in-network VSP doctor for a $10 co-payment. Frames are covered up to $115 allowance, plus 20% off the amount over your allowance Vision expenses and lenses at covered at 100%. You should review the Summary Plan Description for out-of-network benefits. |
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| Q. |
| A. |
Yes, for eligible Active employees and qualified dependents in Locals 46, 392, 396, 577, and 782. Covered Dental expenses are subject to a $25.00 annual deductible per individual or a $75.00 annual family deductible. The annual maximum per individual is $2,000.00. The Plan also covers orthodontic appliances that are placed (bonded) for dependent children up to age 26. Effective January 1, 2021, all eligible adult participants over the age of 26 will have access to the orthodontia dental benefit. This benefit will be subject to the Plan's current cost sharing of 50% coinsurance and $2,000 lifetime maximum, per individual. Dental coverage through the Plan is administered separately by Delta Dental. The Plan covers care you and your eligible dependents receive from dentists who participate in Delta Dental’s networks, as well as from dentists who do not participate in Delta Dental’s networks. However, Delta Dental network dentists have agreed to provide dental care at negotiated rates, which can save you money. To locate a Delta Dental provider in your area, go to www.deltadentalmo.com. You should review the Summary Plan Description for a summary of benefits. |
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| Q. |
| A. | Yes. If you or your dependent should lose coverage as a result of a Qualifying Event, coverage may be continued for a limited period of time under COBRA by making a timely election and making monthly payments to the Fund. You should review the Summary Plan Description to understand the Plan requirements and your rights under COBRA. |
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| Q. |
| A. | Your eligibility will end on the last day of the last two consecutive calendar quarters for which you did not meet the requirements for continuing eligibility in both quarters and 440 hours of contributions paid. Coverage termination dates are March 31, June 30, September 30 or December 31.
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| Q. |
| A. | You must provide a copy of the divorce decree. Coverage for your spouse will be terminated as of the date of the divorce stated in the decree. |
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| Q. |
| A. | Yes. You must provide a copy of your marriage license if you are enrolling your spouse, and a copy of the birth certificate for any dependent children you are enrolling. |
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| Q. |
| A. | You will remain eligible for at least six months. Your eligibility will continue for the succeeding six month intervals as long as the required contributions are made on your behalf.
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| Q. |
| A. | Your spouse is eligible as long as you are married and not separated under a judicial decree. Your children are eligible up to age 26. |
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| Q. |
| A. | No. Owner-Operators contributing on their own behalf must have at least 425 hours in the same periods noted above. |