Understanding eligibility
Contributions are received into the Plan for each hour that is worked. Health & Welfare contributions go into the Fund which are used to pay medical, dental, vision and prescription claims for all covered participants and covered dependents. Hours are what drives eligibility for an individual and that individual’s covered dependents. If one of the hourly requirements are met, then the coverage can be extended for a Benefit Quarter. The maximum extension would be if the Plan Year Rule of 1560 uncapped credit hours was met, coverage would be extended for six months of the same year. For example: 1560 uncapped hours worked from May 1 through April 30 would extend coverage for July-December of the same year.
How “understanding eligibility” affects understanding this response
The money paid in for each hour worked goes into a pot (the Health & Welfare Trust Fund) for all covered individuals to use. A participant who works more than the maximum hours extension (1560) offsets the cost for coverage for those who do not receive the full Journeyman contribution rate, such as Apprentices, and for dependents for which working members pay no additional money to cover. Each working member does not have his/her own “account” of money. All gets put in one pot to be invested and grow to help the overall Fund. If all participants had their own account, it would look like something like the following example:
For illustrative purposes only
Say a member, “Jack”, works 40 hours per week, which is 2080 per year. 2080 x the journeyman rate of $9.35 would put $19,448 in his/her “account” (remember, this is not an actuality but an example). If Jack and/or his covered dependents go to the doctor, dentist, eye doctor or fills a prescription, the money in Jack’s pot would be applied just for his/his family’s claims. If Jack’s claims for himself and his dependents would exceed $19,448 in one year, then that money runs out, then he’s paying out of pocket for everything beyond that. This is not reality and would result in much higher out of pocket for most individuals covered under the Plan.
The way the Plan has been established, there are out-of-pocket maximums and safeguards in place and to ensure our participants and their families get the best benefits for the lowest cost for as long as possible.
