Wednesday, April 1, 2026

Frequently Asked Health Care Questions



Q. Who is eligible to become a Participant in the Plan?
A. Any person employed by an Employer and covered by a Collective Bargaining Agreement or other written agreement. You must be working or actively seeking work in Covered Employment; you must have accumulated $1,000 in your account or have paid the self-payments to the Contract Administrator on or before the 24th day of the month; and you must complete the necessary enrollment forms as provided by the Plan Administrator. 
Q. How are the contributions allocated to my account?
A. Contributions  made to the Plan on your behalf will be divided between your accounts will depend on the medical coverage level, if any, you are receiving from the Plan.  After you have accumulated Contributions in your Health Care Account of at least $1,000, Contributions (less any administrative fee) will be credited to your account as they are received by the Plan from your Employer.  The following summarizes the percentages in which your Contributions will be allocated between the Health Care and Wage Accounts:
Medical Coverage Level           Health Care Account                   Wage Account
Member Only                                  50%                                            50%
Member + Spouse                          80%                                            20%
Member + Child(ren)                      80%                                            20%
Member + Family                            90%                                            10%
No Coverage (opt-out)                   20%                                            80%
Q. What if I don’t work enough hours to gain eligibility for the month?
A. If you are eligible for medical coverage for the upcoming month, (that is you have least $1,000 in your Health Care Account), but the amount in your Health Care Account is not enough to cover the monthly charge for medical coverage without causing the amount in your Health Care Account to go below $1,000, the monthly statement will tell you the amount that you must self-pay in order to continue medical coverage. 
Q. How do I maintain my monthly Health Care coverage?
A. Your eligibility for medical coverage will be determined on a month-to-month basis.  A monthly statement will be mailed to you on approximately the 10th day of each month.  The monthly statement will tell you whether you are eligible for medical coverage for the upcoming month.  If you are eligible for medical coverage for the upcoming month, (that is you have at least $1,000 in your Health Care Account) and the amount in your Health Care Account is enough to cover the monthly charge for medical converge without causing the amount in your Health Care Account to go below $1,000, the monthly charge will be paid out of the Health Care Account and you will not need to take any action. 
Q. What is the Wage Account?
A. Your Wage Account provides you with Paid Time Off.  You are entitled to up to 75 days of Paid Time Off per calendar year.  The amount of the Paid Time Off per day is $200, but these benefits will not exceed the balance in your Wage Account.  In Order to receive Paid Time Off, you must have enough funds in your Wage Account to cover all applicable taxes in order to net the $200 per day pay. 
Q. Whom should I call if I have questions about my Health Care eligibility?
A. You should call the Fund Office at (330)779-8865 for any questions regarding your eligibility. 
Q. Who are my eligible dependents?
A. Eligible Dependent means (a) your legally married spouse; (b) your child(ren) from date of birth until twenty-six (26) years of age who is a blood descendant (child), or a legally adopted child (including a child living with your during the adoption probationary period of a child placed for adoption), or a stepchild (c) any unmarried child(ren) age twenty-six (26) or older if they are disabled and incapable of self-support because of the disability (certification of disability must be o file with the Contract Administrator). 
Q. How do I add my new baby or spouse to my insurance plan?
A. You must notify the Contract Administrator by no later than thirty (30) days after the marriage, birth, adoption or placement (as applicable). 
Q. Whom should I contact if I'm getting a divorce and what documents do I need to submit?
A. You must notify the Contract Administrator by no later than thirty (30) days after the divorce.  You will need to provide a copy of your certified divorce decree.
Q. How do I obtain a replacement Medical and Prescription Card?
A. You can contact the Fund Office and request that a replacement ID card be order with the Medical provider. 
Short Term Disability Questions 
   
Q. Eligibility, How do I become eligible for Disability Benefits. 
A. If you have Medical Coverage under the Plan and are not a Retiree, you are eligible for the Plan's weekly Accident and Sickness Benefits.   You may NOT receive Accident and Sickness Benefits at the same time that you are receiving unemployment compensation benefits or workers' compensation benefits. 
Q. Does the fund offer any extensions? 
A. No, the Fund does not offer any extensions. 
Q. How much does the Disability Benefit Pay per week? 
A. The weekly benefit is $324.85 or $46.41 per day.
Q. How long can I collect a Disability Benefit? 
A. A maximum of 13 weeks.
Death/Life AD&D Benefits 
   
Q.  Are there any Death Benefits Available?  How do I qualify for Death Benefits?
A. Yes, if you have Medical Coverage under the Plan and you are not eligible for Accidental Death and Dismemberment Benefits due to loss of life, you are eligible for the Plan's Death Benefit. 
Q. Is there a filing limit for Death Benefits?
A. Up to one year after the death of the member. 
Q. How Much Does the Benefit Pay?
A. If you are covered under the Medical Coverage under the Plan,  $15,000.00 is payable to your beneficiary.  The Plan provides a death benefit in the amount of $2,000 for the loss of a spouse and $1,000 for the loss of an eligible child wo meets the definition of Dependent Child.  Retirees who have reached age sixty-five (65) must pay a quarterly premium for the death benefit and may choose a $5,000 benefit for a $10,000 benefit.  
Q. How are benefits paid out, who receives the benefits when I pass? 
A. It is important that you have a proper beneficiary on record with the Fund Office.  If there is no valid beneficiary designation on file, the death benefit will be paid to your survivors in the following order:  Spouse, children, parents, brothers and sisters, your estate.
PCA /HRA Reimbursement 
   
Q. Is there a minimum reimbursement amount?
A. No, there is no minimum reimbursement amount.
Q. Can I use the PCA reimbursement account for Self payments? What about COBRA? 
A. Yes, but you must submit the payment for Self-Payment or COBRA prior to submitting your request for reimbursement. 
Q. Is the a filing limit? 
A. A claim for reimbursement must be submitted within twelve (12) months from the date that the related Health Care Expense was incurred. 
Q. Can I lose my balance? 
A. In the event that for any two (2) year period: a) no Contributions have been made to the Plan on your behalf; and b) you have not made any self-payments to the Plan; and c)you have not made any request for reimbursement; and d) you have not completed the necessary enrollment forms as provided by the Plan Administrator and/or insurer of medical coverage under the Plan; then any balance in your Health Care Account at the end of such two (2) year period will be forfeited and added to the Fund's reserves. 
Q. Is there a fee?
A. Yes,  the Board of Trustees will charge a monthly fee for all Health Care Accounts, including retiree accounts.  The amount of the fee may be changed from time to time at the discretion of the Board of Trustees.  As of January 1, 2019, the monthly fee charged to each Health Care Account is $25.