Welfare Fund Eligibility Rules.
Active Employees - Active Employees working at the trade under the jurisdiction of the
Union who have been credited with the minimum contribution requirement in a given Work
Period, shall be eligible (on the first day) of the Benefit Period that immediately follows the Work
Period. Coverage for the Active Employee's dependents, if any, will also become effective on
the same first day of the Benefit Period.
An Active Employee who in his first Work Period has sufficient contributions credited
to meet the Minimum Contribution Requirement for:
- PLAN ONE will automatically be eligible for PLAN ONE Benefits, and may not select
PLAN TWO coverage.
- PLAN TWO will be eligible for PLAN TWO Benefits.
Special Agreement Employee - For Special Agreement Employees working under the
jurisdiction of the Union must refer to the Summary Plan Description.
Special Categories - Special categories are employees who are no longer working
or dependents of former working employees, spouses and dependent children of deceased
employees, early retirees, retirees, disabled, totally disabled employees and their
dependents. Initial eligibility for them was established when the employee last worked.
Provided the Voluntary Contribution required is received, coverage will become effective
on the first day of the next Benefit Period.
Dependent Child Working as an Operating Engineer - An eligible dependent child who
works sufficient hours at the trade may become eligible and be covered in their
own right, as a member in either PLAN ONE or PLAN TWO. If the working dependent
child is also eligible as a dependent child under the parents' eligibility, the
dependent child's coverage will be in the plan which provides the better benefits.
If the dependent child is covered in the parents' plan there will be no accumulation
of the child's employer contributions nor will there be any Reserve of Contributions
created.
Husband and Wife Working as Operating Engineers - Plan eligibility will be
determined as if the husband and wife were one individual, but both husband and
wife's employer contributions and Reserve of Contribution balance, if any, will be
used. The plan of benefits will be based on applicable minimum contribution requirements
(PLAN ONE or PLAN TWO). The husband, wife and dependent children will always be
covered under the same plan. The definition of dependents shall be the same as those
listed in the Rules of Eligibility. The husband and wife must both be working as
Operating Engineers and give written notification to the Fund Office of their desire
to follow these rules. Either individual may during any subsequent eligibility period
cancel their selection. If there is a divorce, the individual will retain their own
Reserve of Contributions, if any.
At Welfare Fund Statement time, the following method
will be used in determining HUSBAND AND WIFE WORKING AS OPERATING ENGINEERS eligibility -
The actual cost for the benefit period will be applied on a 50/50 basis against the
contributions and reserves of each individual. If the balance in either of the
accounts is not sufficient to establish eligibility, then an amount may be transferred
from the other spouse's account (if any is available) to establish eligibility.
If there is still an amount due, a Voluntary Contribution will be required. Any excess
of contributions not necessary to meet the cost of plan benefits will be added to the
individual's own reserve at 90% of the excess.
Medicare - If an employee or dependent qualifies for Medicare benefits, they must
enroll when the Health Care Finance Administration's rules permit in both Medicare
Part A and Part B. All employees, retirees and/or their dependents should apply
for Medicare Part A and Part B coverage about three months prior to becoming age 65.
Benefit payments from this Welfare Fund, Blue Cross and/or Blue Shield will take
into account payments from Medicare.
Medicare Rules (Retirees) - Federal Medicare Rules have been changed recently to
affect all retirees who return to work in the industry. Medicare benefits are secondary
to Operating Engineers Local 66 group health plan benefits if an individual is employed
and covered, by reason of employment, under a Welfare Fund.
The Operating Engineers Welfare Fund (PLAN ONE or PLAN TWO) automatically becomes
the primary provider of health coverage when a retiree, covered by Medicare, returns
to work unless the retiree refuses coverage (by electing to waive PLAN ONE or PLAN
TWO coverage). The Operating Engineers Welfare Fund cannot induce a retiree returning
to work to waive PLAN ONE or PLAN TWO coverage - for example, by offering a MEDICARE
SUPPLEMENTAL PLAN or a cash payment. The same benefit and eligibility rules must
apply to retirees returning to work as to other active employees. To coordinate
the Fund with Medicare, the following Welfare Fund rules will apply:
- A Medicare eligible retiree who returns to work and does not refuse coverage
under the Operating Engineers Welfare Fund, will be eligible only for PLAN ONE
or PLAN TWO coverage in the corresponding Benefit Period.
- This means the rehired retiree will NOT be eligible for either the Operating
Engineers MEDICARE SUPPLEMENTAL PLAN, or the credit from the Retirees
Contribution Account.
- A Medicare eligible retiree who returns to work and refuses coverage under
the Operating Engineers Welfare Fund will not be eligible for any benefits
under our plan for the corresponding Benefit Period. However, the retiree
may remain covered by the Medicare HMO, either Security Blue or Senior
Advantage. This means the rehired retiree will NOT be eligible for the
Operating Engineers MEDICARE SUPPLEMENTAL PLAN, or the credit from the
Retirees Contribution Account, or the credit for Employer Contributions
that have been paid in during the work period.
- A Reserve of Contributions will be treated as contributions by reason
of employment. Therefore, an employee who retires with a Reserve of
Contributions and/or Employer Contributions paid during the work period will,
continue in PLAN ONE or PLAN TWO, at retiree rates, until the Reserve and/or
contributions run out, even if the person is eligible for Medicare.
- A retiree who returns to work at any age will be charged the Active
Employees/Minimum Contribution Rates for coverage under PLAN ONE or PLAN TWO.
- A retiree between ages 62 and 65 who returns to work will not be eligible
for the credit from the Retirees Contribution Account.
- The dependent of a retiree who returns to work will only be covered under
the same Benefit Plan as the retiree (PLAN ONE or PLAN TWO).
Medicare Eligible Retirees - If an employee initially retires at age 65 or older, or is
disabled and eligible for Medicare, with a Reserve of Contributions or Employer
Contributions in a work period, they will remain in Plan One or Plan Two and charged
retiree rates until their Reserve of Contributions and/or Employer Contributions
run out. An employee will be eligible for the Welfare Fund's Medicare Supplemental Plan
or Security Blue or Senior Advantage and credit from the Retiree's Contribution
Account, in the eligibility period following the period in which the Reserve of
Contributions and/or Employer Contributions run out.
Retirees Not Eligible for Medicare - If an employee initially retires prior to age 65
as an early retiree with a Reserve of Contributions and/or Employer Contributions
in the Work Period, they will remain in PLAN ONE or PLAN TWO and charged retiree
rates until their Reserve of Contributions and/or Employer Contributions run out,
even if this period extends beyond age 65 when an employee would otherwise be eligible for
Medicare. If the employee is age 62 or older, they will become eligible for the credit from
the Retirees' Contribution Account in the eligibility period following the period
their Reserve of Contributions and/or Employer Contributions run out.
All Retirees - Employees should apply for Medicare Part A and Part B three months before
they reach age 65 even though they may be covered under PLAN ONE or PLAN TWO.
Timely enrollment in Medicare Part A and Part B will avoid any surcharge or delay
once an employee becomes eligible for Medicare as their primary plan.
Maintenance of Eligibility of Active Employees - Active Employees shall continue
to be eligible for benefits in subsequent Benefit Periods, provided they have
been credited with the Minimum Contribution Requirement in the preceding Work Period.
- PLAN ONE - An Active Employee who in the previous Benefit Period was
covered for PLAN ONE and who in the current Benefit Period has Employer
Contributions plus a Reserve of Contributions balance which in total is
in excess of twice the Minimum Contribution Requirement for PLAN ONE,
will automatically be eligible for PLAN ONE.
An Active Employee who who in the previous Benefit Period was
covered for PLAN ONE and meets the Minimum Contribution Requirement for
PLAN ONE, will be given the choice of selecting PLAN ONE or PLAN TWO.
The selection will be made by indicating the choice on the Welfare Fund
Eligibility Statement Stub and returning it to the Fund Office by the
stated due date. Failure to do so will automatically result in a PLAN ONE
selection.
An Active Employee who who in the previous Benefit Period was
covered for PLAN ONE and does not meet the Minimum Contribution
Requirement for PLAN ONE will be given the choice of making a Voluntary
Contribution for the balance due to be eligible for PLAN ONE or PLAN TWO.
- PLAN TWO - An Active Employee who in the previous Benefit Period was
covered for PLAN TWO and who in the current Benefit Period has Employer
Contributions plus a Reserve of Contributions balance which in total is
in excess of twice the Minimum Contribution Requirement for PLAN ONE,
will automatically be eligible for PLAN ONE.
An Active Employee who in the previous Benefit Period was covered for
PLAN TWO and who has Employer Contributions plus a Reserve of Contributions
balance which equals the Minimum Contribution Requirement for Plan One,
will be given the choice of selecting either Plan One or Plan Two.
An Active Employee who in the previous Benefit Period was covered for
PLAN TWO and who does not meet the Minimum Contribution Requirement for
PLAN TWO, will have to make a Voluntary Contribution for the balance due,
in order to be eligible for PLAN TWO only.
- Special Agreement Employees - For Special Agreement Employees working
under the jurisdiction of the Union, see the Summary Plan Secription.
- Special Categories - Special Categories shall continue to be eligible
for benefits provided the proper Voluntary Contributions are made.
RESERVE OF CONTRIBUTIONS - Employer Contributions received in a Work Period
which are in excess of the minimum contribution requirement for a Benefit Plan
may be accumulated as Contribution Credits in a Reserve of Contributions Account.
Employer Contributions not used for eligibility will be accumulated in the Reserve
of Contributions as Contribution Credits at the rate of 100% of the amount of the
excess of the minimum contribution requirement for Benefit Plans.
Contribution Credits held in the Reserve of Contributions Account will automatically
be withdrawn, to the extent necessary, in order to maintain the eligibility of an
employee who fails to meet the Minimum Contribution Requirement in a subsequent Work
Period. Should the Employer Contributions and/or the Contribution Credits held in the
employee's Reserve of Contributions Account be insufficient to meet the Minimum
Contribution Requirement, the employee may then be required to make up the shortage
in contributions through a Voluntary Contribution. If an employee fails to make the
Voluntary Contribution, coverage will be terminated and any balance in the Reserve of
Contributions Account and any Employer Contributions Credits will be canceled.
Application of the Reserve of Contributions is automatic, when needed to maintain
eligibility and cannot be waived for any reason. The credits in the account are
for maintaining eligibility in the Welfare Fund only and cannot be applied for any
other purpose nor withdrawn.
Presently there is a $30,000 maximum that can be accumulated in a Reserve
of Contributions Account.
VOLUNTARY CONTRIBUTIONS - Active employees, who were eligible for PLAN ONE
in the preceding Benefit Period and who fail to earn sufficient contributions to
maintain their eligibility in a subsequent Benefit Period, may make a Voluntary
Contribution for the difference between the total contributions credited on their
behalf and the Minimum Contribution Requirement for either PLAN ONE or PLAN TWO.
An Active Employee who in the previous Benefit Period was covered for PLAN TWO and
who does not meet the current Minimum Contribution Requirement for PLAN TWO will have
to meet the Minimum Contribution Requirement for PLAN TWO. This employee cannot make
a Voluntary Contribution for PLAN ONE. An Active Employee who in the previous Benefit
Period was covered for PLAN TWO and who has Employer Contributions plus a Reserve of
Contributions balance which equals the Minimum Contribution Requirement for Plan One,
will be given the choice of selecting either Plan One or Plan Two. If an employee is eligible
in the immediately preceding Benefit Period, Voluntary Contributions will be permitted
to be made for a maximum of 18 months (six quarterly eligibility periods). After which
time, if the Active Employee has not been re-employed in the industry, no further
Voluntary Contributions will be accepted. The Active Employee and any eligible
dependents will then be eligible for COBRA and/or conversion rights. Voluntary
Contributions will not be accepted from any Employee who was not eligible in the
immediately preceding Benefit Period. If an Active Employee has not been eligible
in the previous Benefit Period and has employer contributions made in the current
Work Period which are less than the minimum contributions requirement for PLAN TWO,
the employee will not be able to make a Voluntary Contribution for eligibility in the
current Benefit Period. These contributions will be accumulated for up to 12 months,
on a quarterly basis. If sufficient contributions to meet the minimum eligibility
requirement for at least PLAN TWO are accumulated during the 12 month period, the
employee will be eligible for the next Benefit Period. See the Summary Plan Description
for further information regarding Voluntary Contributions.