WHAT ARE MY OPTIONS IF I LOSE MY ELIGIBILITY FOR BENEFITS?
If you lose eligibility in the Active Plan ends due to a reduction in hours worked or a qualifying life event, you and your dependents have options for continuing coverage in the Health Fund:
The Fund Office will send you notice of termination of coverage as well as detailed information on your coverage options, cost, and the required election forms. Click Here to read the Fund Office health care continuation procedures.
Review the Continuation Coverage Brochure to compare the coverage options available to you.
To maintain your benefits, you must complete the election form and pay your premiums in a timely manner. You may write a check, send a money order or use the online payment option through the member portal to pay using your credit card or bank account.
Click here for current COBRA & Low Cost Plan Premium Rates.
If you become ineligible due to a reduction in hours, you may be eligible to continue coverage through self-payment of hours if you meet the criteria:
- You were eligible for benefits during the preceding coverage quarter; and
- You are a Member in Good Standing with your Local Union; and
- You have not exhausted the maximum number of coverage quarters through Self-Payment of Hours.
Additional Self-Payment of Hours Restrictions apply. Apprentices who qualify for the self-payment option may continue coverage at the same level of benefits lost.
Premiums for Self-Payment of Hours
Your premium is calculated for the next coverage quarter based on your hours history. Your premium covers an entire quarter of eligibility and is calculated as:
Number of hours required to maintain eligibility x Current contribution rate
The contribution rate is based on the MARBA agreement in effect at the time your premium is calculated. Your premium payment covers an entire coverage quarter. Payments made after the grace period will not be accepted and coverage will not be reinstated.
| Calendar Quarters |
Payment Due Date |
Last Date Payment Will Be Accepted
(Postmark Date) |
| December 1 – February 28/29 |
December 1 |
December 31 |
| March 1 – May 31 |
March 1 |
March 31 |
| June 1 – August 31 |
June 1 |
June 30 |
| September 1 – November 30 |
September 1 |
September 30 |
COBRA CONTINUATION COVERAGE
You and your dependents can elect to continue coverage under COBRA if a qualifying event occurs.
| Qualifying Event |
Qualified Beneficiaries |
Maximum Coverage Period |
Continuation Coverage Options Available |
| Termination of your employment (for causes other than gross misconduct) or reduction in your work hours |
You
Your Spouse
Your Dependent Child |
18 Months |
COBRA, Low Cost Plan, or Self-Payment of Hours
If you are receiving a pension benefit, COBRA is the only option |
| Your death* |
Your Spouse
Your Dependent Child |
36 Months |
COBRA |
| You and your spouse legally separating or divorcing |
Your Spouse
Your Dependent Stepchild |
36 Months |
COBRA |
| Your child loses Dependent status under the Plan or you become entitled to, or eligible for, and enroll in Medicare coverage (and your Dependents then lose Plan coverage) |
Your Dependent Child |
36 Months |
COBRA |
*If you are age 60 or older at the time of your death, and your spouse is eligible for a Joint & Survivor pension benefit from the Mid-America Carpenters Regional Council Pension Fund or other related plan, your spouse and eligible dependents may enroll in the Retiree Plan of benefits if certain conditions are met. The Retirement Benefits Department should be notified within 90 days of the date of death.
You have options for full or limited benefit coverage under the Active Plan:
- Core Plus Coverage: includes comprehensive medical, prescription drug, dental and vision benefits; or
- Core Limited Coverage: includes comprehensive medical and prescription drug benefits.
Apprentices eligible for continuation coverage under COBRA may choose apprentice reduced coverage, which continues medical and vision benefits. This coverage does not include prescription drug and dental benefits.
To continue coverage under COBRA, you must complete the election form and pay your premiums in a timely manner via online payments through the member portal using your credit card or bank account.
THE LOW COST MEDICAL PLAN
You can elect to continue coverage under the Low Cost Medical Plan for yourself, or you and your eligible Dependents. Dependents cannot independently elect coverage under this plan.
This option is not for everyone. While the premiums are lower, the Low Cost Medical Plan deductibles and out of pocket expenses are higher. This means, if you get sick while covered under the Low Cost Plan of benefits you will pay more money out of pocket than if you continued coverage under COBRA.
The Schedule of Benefits outlines the Low Cost Plan coverage.