You will become Eligible for benefits on the first day of the eligibility quarter after you accumulate 350 contribution hours within a nine-month period. Eligibility quarters are June through August, September through November, December through February and March through May. Contribution hours are the hours you work for which an Employer contributes to the Fund on your behalf. Hours from all contributing employers count toward Eligibility.
You continue eligibility based on the number of hours your work for which an Employer contributes to the Fund on your behalf. You need to have 350 hours in a benefit quarter, 700 in the last 2 benefit quarters, 1,050 in the last 3 benefit quarters or 1,400 hours in the last 4 benefit quarters to continue coverage in the corresponding eligibility quarter.
|Benefit Quarter||Eligibility Quarter|
|January through March||June through August|
|April through June||September through November|
|July through September||December through February|
|October through December||March through May|
Your dependents become eligible when you become eligible and they meet the Fund’s definition of a dependent.
An “Eligible Child” under the Plan is any one of the following individuals:
See the Summary Plan Description (SPD) more information about active eligibility.
When you retire, you may continue coverage under the Pre-Medicare Retiree Self-Pay Program if:
If you are covered under the Tri-State Welfare Fund benefits (either by your employment or by self-payment), you and your eligible spouse may self-pay for the Medical coverage available under the Iron Workers Tri-State Pre-Medicare Retiree Welfare Plan. You must self-pay monthly for this coverage.
If you are covered under the Tri-State Welfare Fund benefits (either by your employment or by self-payment), you and your eligible spouse may self-pay for the Medicare options available under the Iron Workers Tri-State Medicare Retiree Welfare Plan. You must be entitled to Medicare and self-pay monthly for this coverage.
If you are active on, and earned at least one Quarter of Service, after your effective date and retire, you may be eligible to continue Eligibility with the Retiree Pre-Funded Allowance. You must waive COBRA Continuation Coverage in order to receive the Allowance, which is used as a discount toward the quarterly self-pay rate for the Pre-Medicare Retiree Plan of Benefits, or the Medicare Advantage Plan. The allowance is applied toward the quarterly self-pay rate for your and your dependents’ coverage.
|Pre-Funded Allowance||Effective Dates|
|Local 444||January 1, 2004|
|Local 465||January 1, 2005|
|All others||January 1, 1999|
To be eligible for the Retiree Pre-Funded Allowance, you must be:
See the brochure Ironworkers Tri-State Welfare Fund Pre-Funded Allowance Plan for more information.
See your eligibility status and current number of contribution hours by logging into the My Benefits Portal. There, you can also see your work history and past contribution hours.
For more information about the required contribution hours for continued eligibility, see your Summary Plan Description.
You can continue eligibility for yourself and your Dependents by using any reserve contribution hours you have accumulated. If you run out of reserve hours, you can self-pay in order to continue coverage. Your self-pay options include:
For more information on continuing coverage, see your Summary Plan Description.
To become eligible for the Active Plan, you currently need 350 contribution hours within a nine-month period.
Management or supervisory Employees require at least 160 contribution hours at the hourly contribution rate required in that worker’s local union.
You are required to accumulate enough hours in a three-month period, or a Benefit Quarter, in order to continue eligibility in the Active Plan.
Each Benefit Quarter is “linked” to the eligibility quarter that starts three months later. So if you accumulate enough contribution hours in one Benefit Quarter to continue eligibility, the eligibility status applies to the future Benefit Quarter.
[For example, the Benefit Quarter that runs from January to March is “linked” to the eligibility quarter that runs through June to August.]
When you accumulate the required amount of hours (currently 350 for one Benefit Quarter), you become eligible for the entire length of the linked or corresponding eligibility quarter.
If you fail to accumulate enough contribution hours in one Benefit Quarter (currently 350), the Fund will look back at previous Benefit Quarters to see if you have accumulated enough hours. The Fund will consider the current and previous three Benefit Quarters when determining eligibility.
However, when looking back at previous Benefit Quarters, the required number of contribution hours must still add up to a multiple of 350.
[For example, you only accumulated 300 hours from October through December (one Benefit Quarter). However, you accumulated 400 hours from July through September (the previous Benefit Quarter). Your total accumulated contribution hours equals 700, which is as if you had accumulated the required 350 hours for each of the two Benefit Quarters. You will be eligible for the Active Plan from March through May of the following year.]
You may also use reserve hours or you may self-pay to continue eligibility.
If you and/or your spouse are covered under the Fund and another group health plan (such as a spouse’s employer’s plan, a different Fund’s plan or Medicare), the Fund will coordinate benefits between the two plans.
The order of which plan pays benefits first depends on different factors, such as who is claiming benefits and who is considered an active employee under the Fund.
To learn more about coordination of benefits, see your Summary Plan Description
If you become disabled after the initial eligibility period, you have different options of remaining covered under the Active Plan. Depending on the circumstances, you may be eligible for:
For more information on disability benefits, see your Summary Plan Description.
If you meet the initial eligibility requirements and if you are unable to work because of an accident or illness when benefits should become effective, the Weekly Accident and Sickness Benefit coverage will be delayed until you return to active employment. You and your Dependents will be eligible for all other Plan benefits on the effective date.
If you’re unable to work due to a non-work-related disability:
For more information about what to do if you become disabled, see the Summary Plan Description.
© Iron Workers Tri-State Welfare Fund. The information on this Web site presents selected highlights of the Iron Workers Tri-State Welfare Fund. The actual Plan provisions of the Plan are in the Plan’s legal document. In the event of a conflict between the wording on the site and the legal documents, the legal documents will govern. The Trustees reserve the right to amend, modify, or discontinue all or part of the Plan at any time.