This is a summary of the basic
eligibility and enrollment rules for the Teamsters Miscellaneous
Security Trust Fund (Fund) which will assist you in determining when you
are eligible or when your coverage ceases. A full description of the
eligibility provisions is contained in your plan booklet.
Contact the Administrative Office,
Southwest Administrators (SWA) for more complete details or for a
copy of your plan booklet.
THE FINAL AUTHORITY IS THE
ACTUAL PLAN DOCUMENT OR PLAN BOOKLET.
Eligibility
In order for you and your dependents
to be covered by this Fund, you must be actively at work as an
employee of an employer who is making contributions for health and
welfare coverage on your behalf pursuant to a collective bargaining
agreement with this Fund.
New Hire
The initial contribution to be paid to
the Fund by your employer is determined by the language in your
collective bargaining agreement. Some agreements
require a specific number of hours to be worked in the preceding month,
some require that the first contribution is due on the first of the
month following thirty (30) days employment and some require a
probationary period. Refer to the Health and Welfare Article in your
collective bargaining agreement.
Your coverage begins on the first day
of the month for which the third employer contribution is paid on your
behalf within six (6) consecutive months. Thereafter, eligibility is on
a month to month basis.
Previously
Qualified or Returning Employee
If you are returning within six (6)
months from a termination, lay-off, leave of absence and you were
previously eligible under this Fund, you are eligible the first day of
the month for which your employer makes a contribution to the Fund on
your behalf. If you changed jobs and are now working for another
employer covered under this Fund, you are eligible with the first
contribution made on your behalf by your new employer if you were
previously qualified with this Fund and the first contribution is paid
within six (6) months. If longer than six (6) months, you must
re-qualify and you will be eligible with the third contribution.
If you are returning from a disability
leave (medical or work related) within one (1) year from the date of
your original disability, your are eligible with the first contribution
paid by your employer. If longer than one (1) year, you must re-qualify
and you will be eligible the first of the month for which the third
contribution is paid on your behalf.
If you were covered under another Fund
or employer obligated to contribute toward health and welfare under a
collective bargaining agreement (i.e. from the Food Fund or Bakery Fund
to this Fund) and you transferred within three (3) months, you are
eligible the first of the month for which an employer remits a
contribution. After three (3) months, you must requalify and will not be
eligible until the first of the month in which the third contribution is
paid.
Never
Qualified Employees
You must have three (3) contributions
paid on your behalf within a six (6) month period with one or more
contributing employers to qualify for coverage under this Fund.
Dependent
Eligibility
Your dependents become eligible for
dependent coverage on the date you become eligible for your coverage or
the day they qualify as eligible dependents. An employee’s spouse and
unmarried children (up to 19th birthday) are eligible
dependents.
Dependent children are covered up to
their 19th birthday or up to age 26 if they are a full-time
student supported by you and living with you in a parent-child
relationship. A full-time student is a dependent child who attends a
high school, college, university or vocational, technical or trade
school on a full-time basis (a minimum of 12 units). A certification
of school enrollment must be submitted at the start of each new
session, and a transcript of grades for the prior session, showing the
units completed, must be submitted at the end of each session. To
maintain uninterrupted eligibility for a student through age 25, it is
your responsibility to have the student supply the Fund with the
required documents.
An employee’s dependent child, who
is incapable of self-sustaining employment because of a mental or
physical handicap, and is chiefly dependent upon you for support may
qualify for extended coverage provided written evidence of such
incapacity is furnished to the Fund. Children who reach age 19 prior to
the participant’s initial eligibility for the benefits of this plan
are not entitled to coverage under these terms.
Enrollment
The employee has thirty (30) days from
the effective date of coverage to enroll himself and any eligible
dependent. If a Participant Data Form is not received by the
Administrative Office, the employee and/or his dependents may not be
eligible for coverage or verification of coverage. If you are enrolling
with a Health Maintenance Organization (HMO); i.e. Health Net,
Kaiser or PacifiCare, you must also obtain the appropriate enrollment
package for the HMO coverage and complete the HMO application in
order to be covered under the HMO.
ALL ENROLLMENT MATERIALS MUST BE
RETURNED TO SWA, ATTENTION UNIT 4, OR ENROLLMENT WILL BE DELAYED.
Rules
of Enrollment
Dependent
Deletion
-
A spouse and stepchildren may be
deleted with proper divorce documentation. Deletion is a COBRA
qualifying event and the Fund Office must be advised of the COBRA
qualifying event within 60 days or continuation coverage under COBRA
will be denied.
-
Dependent children are covered
until age 19 or up to age 26 if the dependent child qualifies as a
full-time student.
Termination of
Coverage
All coverage ceases at the end of the
month for which the last contribution was paid by your employer. When
employment terminates, you are laid-off or you take a leave of absence
(non-medical leave), coverage ceases at the end of the month last worked
and paid.
Dependent coverage ceases when your
coverage is terminated. Spouse and dependent children coverage will
cease the end of the last month worked and paid upon the employee’s
death.
Dependent children lose coverage upon
obtaining age 19 unless a full-time student. A full-time student ceases
to be eligible upon their 26th birthday.
Divorce
A dependent spouse’s coverage will
terminate on the date of final judgment.
See COBRA
Continuation Coverage
WARNING
You must notify the
Fund Office immediately of any change in marital status. A divorced
spouse is not eligible for Plan benefits even though a court order is
issued requiring you to provide health benefits. You will be held
personally liable in the event you fail to notify the Fund Office of a
change in marital status if a claim by your former spouse is mistakenly
paid by the Fund for services after that date. The amount of any such
mistaken payment paid will be deducted from benefits to which you would
be otherwise entitled. See COBRA Continuation Coverage.
Total
Disability for Disease or Injury
If you become totally disabled due to
an illness, injury or disease, the Fund will extend coverage to you and
your dependents for three months at no cost to either you or your
employer. When you return to active employment from a disability leave
within 6 months of the initial date of disability, you will be eligible
with the first contribution paid by the employer. If you return after
one year, you must requalify and you will be eligible with the third
contribution. Following the three-months, you and/or your dependents may
make COBRA payments for an additional 15 months or 26 months. See COBRA
Continuation Coverage
for details.
In addition to the Trust rules
for payment to the Fund because of disability, if your employer is
covered under the Family Medical Leave Act, he may have the
responsibility to continue making payments into the Fund for your
coverage for 120 days if you are eligible for such coverage. Notify your
employer for the answer to that question. The entire area of disability
and illness has been placed in a state of confusion by competing State
and Federal laws; therefore, should you be disabled for any
period of time, please notify Southwest Administrators as to your rights
and obligations under this plan of benefits.
