When Your Dollar Bank Is Low, You Have Coverage Options
The Fund knows continuing healthcare during periods of low and no employment is important to our members. In the event that your Dollar Bank runs low, and you do not meet the Fund’s eligibility requirements for benefits, you have three different options for continuing coverage. Read on for details of how these options work. (Note: if you do not continue coverage, you may be assessed a fee, or penalty. These penalties are determined by the federal government, not the Fund.)
Recap of the Eligibility Cycle
You first become eligible for healthcare benefits once your Dollar Bank reaches the required amount for your classification. Then, on a month-to-month basis, your eligibility is maintained as long as you have the required balance in your Dollar Bank to cover the cost of coverage. If you don’t have enough in your Dollar Bank, you can make a self-payment to offset the difference and continue your coverage. The Fund Office regularly reviews Dollar Bank balances and employer contributions to determine who is eligible for coverage (Eligibility Determination Date) and the effective date of their benefits.
Coverage Options When Your Dollar Bank is Low
When your Dollar Bank is low and you don’t meet the Fund’s eligibility requirements for benefits, you may continue coverage in one of three ways:
- The Fund offers a self-payment program that enables you to continue coverage through the Flexible Choice Plan;
- You may elect COBRA; or
- Under the Affordable Care Act, you can get coverage through the Marketplace Exchange system.
If you elect the Fund’s self-pay option:
- You must be covered under the Fund for the Building Trades Benefits in Classes B1 or SP.
- You must have a Dollar Bank Balance of $0 on the Eligibility Determination Date.
- You will be covered through the Flexible Choice benefit program instead of the Building Trades Benefit Plan.
- You must pay the required full self-contribution for Flexible Choice Benefits.
- Contributions received from employer(s) will be applied to your Dollar Bank.
- Employer contributions will not be applied to reduce the monthly self-contribution amounts for Flexible Choice Benefits.
- Employer contributions will not be applied to allow election of the Building Trades Benefit through self-contribution.
- The Fund’s benefits meet the minimum essential coverage threshold set by the federal government. So, if your Dollar Bank is low, and you elect coverage through the Plan’s self-pay system, you will not be subject to the individual mandate penalty because you will be deemed to have minimum essential coverage.
You can read more about the Fund’s self-pay option in this SMM and in this Plan Document.
If you enroll in COBRA coverage:
- You can continue your benefits for up to 18 months by electing COBRA continuation coverage.
- You will be required to make monthly self-payments to continue coverage. The Fund Office will notify you of your premium.
- The Fund Office will send you a COBRA Election Notice and Election Form within 14 days of a COBRA-qualifying event; you have 60 days to respond.
- In certain circumstances, an extension beyond the initial 18-month period is possible.
More information about COBRA is available on the “Forms & Documents” page of our website.
If you elect coverage through the Marketplace Exchange System:
- The Exchanges were opened, in part, to provide coverage to individuals who do not have coverage though their employer (i.e., the Plan) or another source. Therefore, it’s important to understand how these benefits compare to the Fund’s benefits before making a final decision.
- If you are out of work and have low earnings, you may be eligible for subsidies through the Exchanges. However, if you have a balance in the Health Reimbursement Arrangement (HRA), you will not be eligible for a subsidy unless you permanently waive participation in the HRA.
- If you lose your employer contribution to the Plan due to lack of work, you have 30 days from the loss of coverage to enroll in a plan on the Exchange (this applies even if you are outside of the annual Exchange enrollment window). If you go back to work and resume eligibility in the Plan, you can drop your coverage through the Exchange.
You can read more about the Exchanges at www.healthcare.gov.