When Coverage Ends (Plan I Local 85 Hour Bank) / Back

For All Participants In the Local 85 Security Fund As of the Fund's May 1, 1999 Merger Into TBT

When Coverage Ends

Coverage for you and your dependents ends on:

  1. The first day of a month when the total of your reported hours (whether reported hourly or monthly) and your Hour Bank falls below 60, or
  2. The first day of a month for which a required self-payment is not received by the 30th day of the same month.
  3. The date when you enter full-time military service.
  4. The date when you are no longer eligible for benefits.
  5. For specific benefits, the date when the maximum benefit is reached for that covered participant or when a specific benefit is discontinued.
  6. The date when your TBT Plan ends.
Coverage for your dependents ends at the same time yours ends, or sooner:
  1. For your spouse, when you divorce (on the first day of the month after your divorce is final).
  2. For your dependent child, the first day of the month after no longer qualifying as an eligible dependent as defined by the Plan (see page 5).
Reinstatement of Eligibility

If you lose eligibility and return to work with a participating Employer within 12 months, your new eligibility date will be the first day of the second month immediately following a month in which the total of your reported hours and your Hour Bank equals 60. Any hours remaining in your Hour Bank at the time when your coverage ended will be counted. If you do not return to work with a participating Employer within 12 months, you are subject to the eligibility requirements for a new employee (see Supplement page 2).

Extension of Benefits While Totally Disabled

If you are unable to work because you become totally disabled (see the definition on page 7), coverage for you and your covered dependents will continue for up to three months.

If immediately before the onset of your disability, Employer contributions were primarily submitted on your behalf on an hourly basis, your Hour Bank will be credited as follows during a period of total disability:

One day of disability:

3 hours of credit

Maximum hours credited:

15 per week

Maximum disability period:

3 months

This means that while you are disabled, you will continue to be eligible for benefits without having hours deducted from your Hour Bank, up to a maximum of three months.

If after these three months you remain totally disabled, your collective bargaining agreement may require your Employer to make contributions on your behalf for an additional period. If you remain totally disabled after the first three months after any Employer-paid extension period, and after your Hour Bank falls below 60, you may further extend your coverage as follows:

  1. Self-pay for up to six months for full coverage (medical, prescription drug, dental, vision and life insurance) at the Employer contribution rate.
  2. Self-pay for up to 18 months (and, if you remain totally disabled, up to 29 months) for COBRA benefits at the COBRA rate then in effect (see COBRA Coverage).

    If you choose the six-month option, you may elect COBRA for the balance of the COBRA eligibility months remaining. However, if you experience a second disabling condition during your extended coverage, you will not be entitled to a further extension.

    If you are enrolled in the Indemnity Medical option (rather than an HMO option) and you or a covered dependent remain totally disabled after your Hour Bank falls below 60 (hourly), or your three months of extension coverage ends (monthly), coverage for the disabling condition only will be continued without self-payment for up to 12 months. However, benefits will end as of the earliest date below:

    1. The date when the total disability ends.
    2. The date when coverage becomes effective without limitation as to the disabling condition, under any other group medical benefit or service plan or under any group insurance policy.
    3. The end of the 12-month period following the date when the Employer contributions paid on account of the eligible person stopped.
    Proof of disability must be filed with the TBT Plan Administration Office before the end of the third month for which the disability hour credit is requested. You can request a Proof of Disability Claim Form from the TBT Plan Administration Office. You and your doctor each fill out a portion of the form. Send the completed form to the TBT Plan Administration Office.
    HEALTH INSURANCE PORTABILITY
    When coverage ends, federal law requires that the Plan provide a Certificate of Group Health Plan Coverage to you. This certificate is intended for use by any new plan in which you enroll.


    Copyright © 2000 Teamsters Benefits Trust, All rights reserved.