You and your dependents must meet the Plan’s eligibility requirements to be eligible for benefit coverage. Eligibility requirements vary depending on whether you are a salaried or hourly employee (see sections below).
New and Bargaining Unit Employees
Eligibility for Bargaining Unit Employees
Bargaining Unit Employees. You are eligible for benefits based on the amount in your Dollar Bank. You become eligible for benefits after the minimum required amount has been credited to your Dollar Bank (without self-payment). On an annual basis, the Board of Trustees determines the Dollar Bank minimum balance requirement. Contact the Fund Office to find out the minimum balance applicable to you.
Reminder! Track your Dollar Bank balance and eligibility status through the Member Dashboard.
Eligibility for New Employees
If you are new to the Fund and don’t have the minimum required Dollar Bank balance, your initial eligibility is based on your classification as follows:
- For regular, active members in the Comprehensive Major Medical Plan and not in the CW/CE classification: you must have accumulated a balance in your Dollar Bank of at least $278 (40 hours X $6.95 per hour—does not include HRA) on the eligibility determination date and made a self-payment.
- For regular, active members in the Flexible Choice Plan and not in the CW/CE classification: you must have accumulated a balance in your Dollar Bank of at least $182 (40 hours X $4.55 per hour—does not include HRA) on the eligibility determination date and made a self-payment.
- For members of the CW/CE classification: you must have accumulated a balance in your Dollar Bank of at least $182 (40 hours X $4.55 per hour—does not include HRA) on the eligibility determination date and made a self-payment.
- Regardless of your classification, you may request a credit (or loan) to your Benefit Credit Bank. This is a loan that is repaid with contributions made to your Dollar Bank for work in covered employment. To request a credit, you must:
- have never been eligible for coverage under the Fund;
- be associated with a Local Union affiliated with the Fund;
- be working or be available for work under a Collective Bargaining Agreement covering participants of the Local Union you belong to; and
- complete and execute an agreement that provides repayment of the credit.
The deposit (or credit) to the Benefit Credit Bank is the amount required to purchase coverage through the Fund for three months. Benefits are effective on the first day of the benefit month. Eligibility continues on a month-to-month basis. If your Dollar Bank balance is not sufficient to continue benefits for the fourth month, you may continue coverage by making self-payments.
Contribution Carry Forward
If you do not make a required self-payment to continue coverage, the balance in your Dollar Bank will be carried forward. After an additional contribution to the Dollar Bank is received, you have the opportunity to make a self-payment for the difference, if any, between the required amount and your Dollar Bank balance. (Note: The option to make a self-payment to purchase coverage is only offered after a deposit to your Dollar Bank.) The balance in the Dollar Bank is “rolled forward” until the earlier of:
- The month you make the required self-payment to purchase coverage;
- The month your Dollar Bank balance reaches the required minimum for coverage without self-payment.
- The date your Dollar Bank has been inactive for 12 months. (Your Dollar Bank balance is forfeited after a 12-month period without a deposit.)
If you are eligible for coverage when your Dollar Bank balance falls below the required level, you have the option to:
- Pay the required difference (with no minimum balance required); or
- Roll forward your Dollar Bank balance.
If you do not make the required self-payment, you will be ineligible for coverage. However, if you make a partial self-payment to maintain your eligibility, you have the option to either elect COBRA or make a full self-payment for the next month, assuming no further deposits to your Dollar Bank.
COBRA. Under the federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may elect to continue certain benefits provided by the Plan in the event your or your eligible dependent’s coverage would otherwise end.
You may continue your medical, prescription drug, dental, vision, and life insurance benefits for 18 months, 29 months, or 36 months, if applicable. The length of the time for which the benefits elected may be continued is based upon the ‘qualifying event’ that causes the loss of benefit eligibility. Qualifying events include:
- Termination of your employment or a reduction in your hours of work;
- Your death;
- Your entitlement for health care coverage under Medicare;
- Your divorce or legal separation; and
- Your child’s loss of dependent status under the Plan.
In order to elect continued coverage under the regular self-payment program, you must reject the COBRA continuation option in writing. Click here for full details about COBRA Continuation Coverage.
When Coverage Begins
If you are a bargaining unit or new employee, benefits are effective on the first day of the benefit month if your Dollar Bank balance on the first day of the previous month is at least the minimum required. Eligibility continues on a month-to-month basis. For example:
- December 1: Charles started working.
- January: Contributions from his employer(s) are received by the Fund and credited to his Dollar Bank.
- February 1: Charles’ Dollar Bank balance is reviewed for eligibility and it has the minimum required balance to be eligible for coverage.
- March 1: Charles is eligible for benefit coverage for that month.
If your Dollar Bank balance is not sufficient to continue benefits for the next month, you may continue coverage by making self-payments.
Return From Military Leave
In general, three months of coverage will be provided at no cost for bargaining unit participants returning to covered employment after serving in the military. After this three-month period, a member may use his or her Dollar Bank account to cover the cost of coverage if the Fund receives insufficient contributions on the member’s behalf. Under the Family and Medical Leave Act of 1993 (FMLA), new provisions apply that offer extended coverage. Click here to learn more.
If you are a salaried employee, you become eligible for benefits based on the payment of required contributions to the Fund on your behalf.
When Coverage Begins. Benefits are effective on the first day of the benefit month following the payment of the required monthly amount by your employer. Eligibility continues on a month-to-month basis.
If You Lose Eligibility. If you cease working for your employer, you may make COBRA payments to purchase continuation coverage.
Return From Military Leave. In general, three months of coverage will be provided at no cost for salaried participants returning to covered employment after serving in the military. Under the Family and Medical Leave Act of 1993 (FMLA), new provisions apply that offer extended coverage. Click here to learn more.
Eligible Dependents Include:
- Your legal spouse, provided you are not legally separated or divorced. This means your current legal spouse as recognized by federal law and the state in which you reside.
- Your children (biological, legally adopted, children placed for adoption and stepchildren) until the date they reach age 26.
- Your disabled children age 26 and older, provided they are disabled under the terms of the Plan and are dependent on you for principal support and unable to earn their own living due to their disability.
Grandchildren, nieces, nephews, siblings, etc., are not eligible for coverage unless you have initiated the adoption process.
Surviving Spouse and Children. If you should die while you are eligible for coverage, benefits for your eligible dependents will continue without payment until the end of the Benefit Month during which the second anniversary of your death falls or until your spouse’s remarriage, whichever occurs first.
This survivor benefit continuance applies only to active participants, and covers dependents covered on the date of your death and any of unborn children once they meet the definition of “dependent” above. An individual dependent’s coverage under this survivor benefit continuance will terminate at the earliest of:
- the end of the Benefit Month described above;
- the date the individual no longer meets the definition of a “dependent;” or
- the date the individual becomes eligible for Medicare.
Qualified Medical Child Support Orders. In certain circumstances, a court may order a non-custodial parent to provide health care coverage on behalf of his or her child. This is accomplished through the use of a Qualified Medical Child Support Order (QMCSO). The Plan has adopted procedures to determine whether a medical child support order meets all of the elements required by law. Any participant or beneficiary may obtain a copy of the procedures, without charge, by contacting the Fund Office at 1-304-525-0331 or 1-888-466-9094.