When you have reached the appropriate number of hours required for coverage, the Fund office will send you an enrollment packet. You can also contact the Fund office for a packet of information and/or if you have any questions about the information. A participant will not be eligible to enroll in our plan until they are eligible for coverage. For example, a part-time employee must work 400 hours and a full-time employee must work 500 hours before they are eligible to enroll.
You must complete a census card and insurance application and return to the Fund office with the required documents, (i.e. certified marriage certificate, birth certificates). After you have worked the required hours, you will become eligible and the fund office will issue your insurance, effective the first day of the month following the completion of the required hours.
Your coverage includes medical benefits, dental benefits, prescription drug benefits, vision care benefits, weekly disability benefits, life insurance benefits, accidental death and dismemberment insurance benefits, spousal and dependent burial benefits and certain wellness benefits. You are automatically enrolled in the Life and AD&D Benefit (Attachment #10&11) Short Term Disability Income Benefit, Vision Benefit (unless you opt out), the Spousal/ Dependent Burial Benefits, Dental Benefits (unless you opt out) and certain wellness benefits upon becoming eligible and completing your census and application.
You may elect to join one of the various medical plans offered by completing the appropriate insurance application as provided by the Fund office. The Plan provides numerous medical plan choices from which active employees, COBRA participants, retired Employees and eligible spouses can choose. There are two tiers of coverage, Tier 1 and Tier 2. Your Collective Bargaining Agreement (CBA) determines your tier of coverage. Within those coverage tiers you may choose from various plans offered by Blue Cross Blue Shield of MA and Fallon Health Plan.
You and your eligible dependents will also be automatically enrolled in the dental benefit once your census card and application are received and processed.
Special Enrollment Rights
If you do not enroll yourself and your Eligible Dependents in the Plan after you become eligible or during annual open enrollment, you may be able to enroll under the special enrollment rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) that apply when an individual initially declines coverage and later wishes to elect it. Generally, special enrollment is available if (i) you initially declined coverage because you had other health care coverage that you have now lost through no fault of your own, or (ii) since declining coverage initially, you have acquired a new dependent (through marriage or the birth or adoption of a child) and wish to cover that person. When you have previously declined coverage, you must have given (in writing) the alternative coverage as your reason for waiving coverage when you declined to participate. In either case, as long as you meet the necessary requirements, you can enroll both yourself and all Eligible Dependents within 30 days after you lose your alternative coverage or the date of your marriage or the birth, adoption, or placement for adoption of your child.
You may also enroll yourself and your Eligible Dependent(s) if you or your Eligible Dependent(s) coverage under Medicaid or the state Children’s Health Insurance Program (CHIP) is terminated as a result of loss of eligibility, or if you or one of your Eligible Dependents become eligible for premium assistance under a Medicaid or CHIP plan. Under these two circumstances, the special enrollment period must be requested within 60 days of the loss of Medicaid/CHIP coverage or of the determination of eligibility for premium assistance under Medicaid/CHIP.
Contact the Plan Administrator for details about special enrollment.
Qualified Medical Child Support Orders
A Qualified Medical Child Support Order (“QMCSO”) is an order by a court for a parent to provide a child or children with health insurance under a group health plan. The Plan Administrator will comply with the terms of any QMCSO it receives, and will:
- Establish reasonable procedures to determine whether medical child support orders are qualified medical child support orders as defined under ERISA Section 609;
- Promptly notify you and any alternate recipient (as defined in ERISA Section 609(a)(2)(C)) of the receipt of any medical child support order, and the Plan’s procedures for determining whether medical child support orders are qualified medical child support orders; and
- Within a reasonable period of time after receipt of such order, the Plan Administrator will determine whether such order is a qualified medical child support order and will notify you and each alternate recipient of such determination;
- A copy of the Plan’s Qualified Medical Child Support Order procedures will be provided to you free of charge upon request by calling the Fund office
Please contact the Fund Office once you have made your decision to file for Retirement benefits.
The Fund Office will notify you when you are eligible to continue your coverage under the Early Retiree benefit. An insurance packet with the necessary enrollment forms will be sent to you at the appropriate time. You must complete the enrollment forms and return them to the Fund Office with your first month’s payment as soon as possible after you receive the packet of information. Failure to enroll in the Early Retiree benefit at this time will waive your right to coverage in the future. The benefits available to you as an early retiree and to your dependents include: medical, pharmacy, vision, dental coverage, and may include certain wellness benefits. You are not eligible to continue enrollment in the Life Insurance/AD&D benefit once you retire.