"Eligible Class" means those persons whose chief source of livelihood is work at Covered Employment, and who, at any given time, are working in Covered Employment; are ready, willing, and able to work at Covered Employment; or, are seeking work in Covered Employment. 

“Covered Employment” means work under a Collective Bargaining Agreement for which contributions are required to be paid to this Fund. “Covered Employment” also means work outside the area covered by this Fund for which contributions are required to be paid to this Fund pursuant to a reciprocity agreement with another health fund.

“Covered Person” means either the Participant, the Participant’s Eligible Dependent, the Retiree, or the Retiree’s Eligible Dependent unless specifically stated otherwise.

If you are an Active Covered Participant eligible for benefits under the Plan, your eligible family members are also covered for the same benefits as you, with limitations.  Eligible family members include:

• The spouse to whom you are legally married, subject to the Working Spouse rule;
• Your children (your natural child, stepchild, legally adopted child, or child placed with you for adoption) who are not yet age 26;
• Your children (your natural child, stepchild or legally adopted child) who are at least age 26 and who are incapable of self-sustaining employment because of a physical or mental handicap; and
• A child covered by a Qualified Medical Child Support Order.

In order for the Plan to enroll your Eligible Family Member in coverage, he or she must have a social security number or taxpayer identification number.

Once you accumulate the required number of Credited Hours in a six-month Work Period (as defined above), you have a Qualifying Work Period, and you are covered under the Plan for a six-month Benefit Period, as long as you continue to be in the Eligible Class.  Your Benefit Period is determined by your Qualifying Work Period as shown on the following chart.

Note:  For continuing eligibility, there is a three-month lag period after the end of the Work Period before benefits begin.  This lag period allows the Fund Office the time needed to collect and process the Employer contributions that are used to determine your eligibility for coverage.

Benefit coverage for children will generally stop as of the first of the month following the date on which they turn age 26, except that if your child is permanently disabled and the disability occurred prior to your child attaining age 26, he/she may continue to be covered under the Plan as long as he/she remains totally and permanently disabled.  The Plan must be provided with supporting documentation of the disability from the Social Security Administration prior to the date on which your child would otherwise lose eligibility.  You must also complete a disabled child questionnaire provided by the Fund Office and any other documentation deemed necessary by the Board of Trustees.

COINSURANCE is your share of the costs of eligible medical expenses covered by the Plan. For example, with the Plan's 80/20 coinsurance plan, the Plan pays 80% of covered eligible medical expense charges and you pay 20%.

A Copay is a fixed amount you pay for a covered health care service after you've satisfied any applicable deductible.

A DEDUCTIBLE is the amount you are required to pay before the Plan begins to pay for eligible medical expenses covered by the Plan.

OUT-OF-POCKET MAXIMUM is the maximum amount you are required to pay out-of-pocket in a Benefit Year for eligible medical expenses covered by the Plan. Once you hit your out-of-pocket maximum, the Plan will pay 100% of the eligible medical expenses covered by the Plan for the remainder of the Benefit Year. In other words, your coinsurance is 0% for eligible medical expenses covered by the Plan once you satisfy the Plan's out-of-pocket maximum.