Learn More About Your

Health and Welfare Plan Eligibility

Eligible Employees

You may become eligible for benefits as a participant in the plan if you are covered by a collective bargaining agreement requiring contributions to the St. Louis – Kansas City Carpenters Regional Health Plan.

You are also eligible to become participants in the plan if:

  • You are an employee of:
    • The Mid-America Carpenters Regional Council;
    • Mid-America Carpenters Regional Benefit Services sponsored by the Regional Council; or
    • Any other employer obligated by written agreement to make contributions to the fund on behalf of such employees and accepted by the trustees.
  • You are a retired employee for whom the Regional Council was the recognized bargaining representative when you were actively working, or were an employee of one of the employers described above.
  • You are a participant of an eligible special participation group, including:
    • Non-bargained office employees of contributing employers, and
    • Other groups of employees for whom contributions are made on a month-to-month basis under agreements acceptable to the trustees.

The current Health & Welfare Plan Document and Summary Plan Description (SPD), as well as the Plan’s Summary of Material Modifications (SMM), which includes all amendments approved by the Board of Trustees since the Plan Document was approved, may be found on the Health Plan Resources page of this website.

Initial Enrollment Or Change In Circumstances

All new participants, regardless of their employment classification, must complete the plan’s enrollment/change form before benefits will be paid.

In addition, every participant must complete the enrollment/change form upon your marriage, legal separation, divorce, birth or adoption of a child, or if you or a dependent becomes covered under another health plan (medical, prescription, dental, or vision). Coverage of a dependent will begin when the participant’s family coverage begins or when the dependent is enrolled, whichever is later. Dependents enrolled later than 30 days after a qualifying event will receive an effective coverage date that reflects the date on which the fund office received a properly completed application for enrollment.

The plan may require documentation to establish proof of eligibility of dependents, such as birth certificates or marriage licenses. The plan may also require authentic copies of court documents, such as divorce decrees, to determine whether this plan is the primary payer for a participant or dependent.

Active Classification

You are a participant in the active classification if your eligibility results from:

  • Employer contributions for your active work
  • Minimum/difference self-payments
  • COBRA self-payments; or
  • Self-employed contribution

Eligibility Classifications

There are two eligibility classes under the active classification:

  • Hours-based eligibility is composed of participants who are credited with credit hours worked by an employee whose employer is required to make contributions to this plan as a part of their collective bargaining agreement.
  • Monthly eligibility is composed of participants who are non-bargained office employees with respect to whom monthly employer contributions are required and received, or participants who are self-employed individuals with respect to whom monthly self-employed contributions are required and received.

Initial Eligibility

Effective with hours worked May 1, 2022, new participants, and participants who have not been covered by hours-based coverage under the health plan for two years or more, will earn initial eligibility by working 300 hours in any consecutive three (3) month period. Coverage will begin the first month within a Benefit Quarter upon working 300 hours in the preceding three (3) months and will be extended for 3 months. This Initial Eligibility rule will be applied to grant coverage for the first two (2) Benefit Quarters of coverage for a participant. Learn More

Initial eligibility illustrations:

THREE-MONTH PERIOD  provides  THREE-MONTHS of COVERAGE
illustration of hours worked  coverage for  resulting eligibility
May, June, July August, September, October
June, July, August September, October, November
July, August, September October, November, December

Continuing Eligibility

Once initial eligibility is earned, coverage will be extended to the end of the second Benefit Quarter by continuing to work an average of 300 hours in a rolling 3-month period. Beyond the second Benefit Quarter, Continuing Eligibility rules apply as explained below.

If you have established hours-based eligibility, you will continue to be eligible based on Benefit Quarters that follow Contribution Quarters.

Benefit Quarters begin each January 1, April 1, July 1 and October 1, as shown on the following chart:

Your hours worked during this Contribution Quarter Provides coverage for this Benefit Quarter
May, June, July October, November, December
August, September, October January, February, March
November, December, January April, May, June
February, March, April July, August, September

The plan has three separate tests to determine if you qualify for continuing eligibility, applied in this order:

  • Quarterly Rule: A participant who receives a total of at least 360* credit hours in a Contribution Quarter, will have eligibility extended through the Benefit Quarter that next follows that Contribution Quarter. *Effective May 1, 2024, the number of credit hours required to continue eligibility using the Quarterly Rule is 330 credit hours.
  • Look-Back Rule: A participant who receives a total of at least 1,440 credit hours during the four (4) previous Contribution Quarters (12 months), will have eligibility extended through the Benefit Quarter that next follows that Contribution Quarter.
  • Plan Year Rule: A participant who receives at least 1,560 credit hours whose employer contributes the full, unsubsidized Journeyman rate for health and welfare benefits in a Plan Year (May 1 – April 30), will have eligibility extended from July 1 through December 31 of the same year, or six months of coverage.

Learn More about Continuing Eligibility

Initial & Continuing Eligibility example of attaining and continuing health coverage:

Eligibility Extension for Disability

If a participant becomes Totally Disabled and has worked at least 1440 credit hours during the previous 12-consecutive months, eligibility may continue until the end of the benefit quarter that contains the first anniversary of the participant’s Total Disability date. If a participant’s disability ends prior to the first anniversary of the Total Disability, coverage will be extended to the end of the second benefit quarter following the Disability determination or Return to Work date.

Termination Of Active Eligibility

Unless you elect an available self-payment option (see below), your coverage will end on the earliest of the following dates:

  1. The last day of eligibility earned by the participant’s credit hours or monthly contribution.
  2. The date a participant is found to have engaged in employment in the construction industry by an employer who is not obligated to contribute to the Plan.
  3. The date of the participant’s death.
  4. The date the participant falsifies any information in connection with coverage, a claim for benefits or commits any action with the intent to defraud the Plan.
  5. The date a participant is eligible for Medicare that is primary to the Plan, but is not enrolled in both Medicare Part A and B. An active classification participant’s Medicare coverage is primary to this Plan if:
    1. The participant is employed by a “small employer” within the meaning of the Medicare regulations, or
    2. The participant had 30 months of secondary Medicare coverage on account of End-Stage Renal Disease and Medicare is now primary to this Plan, except if the Participant’s eligibility is based on COBRA continuation coverage.
  6. The date a participant’s employer is no longer obligated to contribute to this Plan.
  7. The date the Plan terminates.

Your eligibility for benefits under the plan will also end on the date you become eligible for Medicare coverage due to age or disability. Your Medicare coverage is primary to this plan if you are employed by a small employer as defined by Medicare, or if you have had 30 months of Medicare coverage on account of end-stage renal disease (ESRD).

If your eligibility for coverage would otherwise terminate as a result of any of the provisions described above, your eligibility will nevertheless continue to the extent required under the terms and conditions of the Family and Medical Leave Act of 1993 (FMLA) and the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). If you are absent from employment by reason of service in the uniformed services, and would otherwise lose coverage on account of such absence, you may elect to continue coverage in the plan as provided under USERRA.

Reinstatement Provisions For Active Participants

Hours-based eligibility class: If you lost coverage in the hours-based eligibility class and are not participating as a self-pay participant in the non-active classification, you may reinstate active coverage by working the same number credit hours in a contribution quarter required for continuing eligibility, as described under Continuing Eligibility: Active Participants. Note that the credit hours worked must result in continuing eligibility commencing within one year of the participant’s termination of coverage date. The reinstated coverage becomes effective on the first day of the next benefit quarter.

If you have loss of coverage in the hours-based eligibility class and do not qualify for reinstated coverage, you must again satisfy the continuing eligibility requirements to regain active coverage, as described under Active Classification: Eligibility Classes and Continuing Eligibility as listed above.

Self-Payment Provisions - Active Participants

If you would otherwise lose coverage in the hours-based eligibility class because of insufficient credit hours, you may maintain continuous coverage for a limited time by electing either minimum/difference self-payments, as described below under Minimum/Difference Self-Payments, or COBRA continuation coverage. If you elect either option, you may still regain active coverage by working credit hours, as described under the active eligibility: Reinstatement Provisions for Active Participants.

If you lose coverage due to working in non-covered employment, you and your dependents are excluded from enrolling in self-payment provisions under the plan.

If you would otherwise lose coverage in monthly eligibility class, you may maintain continuous coverage for a limited time by electing COBRA.

Minimum/Difference Self-Payments

If you are not in the special participation eligibility class and have not earned enough credit hours in a contribution quarter to maintain active eligibility, you may elect to maintain continuous active eligibility by making self-payments directly to the fund. These are referred to as “minimum/difference payments.” If you make timely payments for a particular benefit quarter, in the required amount, your eligibility will be extended through that benefit quarter.

The required amount of your minimum/difference payment for a benefit quarter is equal to the difference between 360 and the number of credit hours you actually earned in the corresponding contribution quarter, multiplied by the full, unsubsidized Journeyman level hourly employer contribution. If you earned no credit hours during the contribution quarter, your required payment amount is equal to the entire employer contribution for the minimum 360 credit hours.

If you choose to maintain your coverage eligibility through the use of minimum/difference payments, your coverage must be continuous — that is, it must begin with the first contribution quarter in which you earned less than 360 credit hours. You may generally maintain active coverage by minimum/difference payments for no more than two (2) benefit quarters within an 18-month period.

Maintaining your coverage eligibility through the use of minimum/difference payments is an alternative to making a COBRA election. COBRA continuation coverage is not available to you if you lose coverage at the end of one or more quarters of minimum/difference payments (such as if you fail to make timely payments).

If you exhaust the maximum permissible period of coverage by making minimum/difference payments, you can regain active coverage only by satisfying the continuation requirements described under Continuing Eligibility: Active Participants, or the reinstatement requirements described under Reinstatement Provisions for Active Participants. Alternatively, you may be able to maintain coverage in the non-active classification (see Non-Active Classification and Benefits).

MDP requires a full self-payment for the entire benefit quarter, due on the first day of the month prior to the applicable benefit quarter. It must be received by the fund within 30 days of the due date to be accepted. The payment schedule for quarterly payments is shown in the following table:

Benefit Quarter for Coverage Payment Due
January, February, March December 1
April, May, June March 1
July, August, September June 1
October, November, December September 1

If a contractor/owner/partner/principal/officer affiliated with a contributing contractor that is in arrears and is considered delinquent, and the contractor/owner/partner/principal/officer has applied for or is currently making minimum/difference payments, the application/payment will be rejected. Delinquent contractors who participate in the plan as active participants will be allowed the option for COBRA coverage only for up to 18 months from the date of the original qualifying event that caused the loss of coverage.

COBRA Payments

If you are an active participant who is otherwise losing coverage (and, in the case of a participant in the hours-based eligibility class, has not elected minimum/difference payments or whose option for minimum/difference payments has expired), you may elect COBRA continuation coverage as described under COBRA Continuation Coverage.

Non-Active Classification And Benefits

The non-active classification allows qualified participants and their dependents to continue coverage under the plan after they do not qualify under the active classification, by making self-payments.

The benefits provided under the non-active classification are the same as those provided under the active classification as long as the required premium is paid, with the following exceptions:

Benefits for Medicare-eligible individuals: If you are covered in the non-active classification as a participant or dependent and become eligible for Medicare, you will lose eligibility for any benefit from the plan. If you enroll in the UHC Medicare Advantage Program immediately upon becoming eligible for Medicare (see UHC Group Medicare Advantage Program as listed below), you will remain eligible for the plan’s life and accidental death benefit (participant only eligible for accidental death benefit). You will also have the option to remain eligible for the plan’s dental benefits at an increased premium. If you are a participant and enroll in the UHC Medicare Advantage Program, you will also have the option to maintain family coverage in the non-active classification of this plan for your dependents by paying the applicable premium.

Short-term disability benefits: If you become disabled while covered in the non-active classification, you are not eligible to receive short-term disability benefits.

Dental benefits: Participants covered in the non-active classification, and participants or dependents enrolled in the UHC Medicare Advantage Program, have the option to purchase the plan’s dental benefits at an increased premium. You must enroll for optional dental benefits at the time you first enroll in the nonactive classification; otherwise, you must wait for the next open enrollment period of October 1 through December 15. If you drop the dental benefit after initially electing it, you may not elect it again later.

Dependent coverage: An election of single coverage in the Non-Active Classification is irrevocable except a Non-Active Participants has the option to elect family coverage as follows, provided the Dependent meets all other enrollment requirements of the Plan:

  • A Spouse who opted out of coverage in this Plan and thereafter maintained continuous health coverage through the Spouse’s employer and that coverage did not terminate more than 63 days before the requested date for beginning Non-Active coverage in the Plan, or
  • A newly acquired Dependent can request enrollment within 30 days of the special Qualifying Event.

Working in non-covered employment: You are not eligible to enroll in the non-active classification of coverage under the plan if you are working in non-covered employment.

Self-Payment Provisions - Non-Active Participants

In order to be eligible to continue coverage under the health & welfare plan’s non-active classification self-pay option, participants must meet the following qualifications:

  • Must have at least 10 years (120 months) of coverage in the plan based on hours worked over their career.
  • Must have three (3) years (36 months) of coverage based on hours worked within the last five (5) years immediately prior to the participant’s non-active classification effective date.
  • Coverage must be continuous prior to moving into the non-active classification.
  • Must maintain union obligations with the Mid-America Carpenters Regional Council.
  • Must be receiving a pension benefit from one of the following Carpenters’ Pension Plans: St. Louis, Kansas City, Kansas Building Trades, or Geneva.

Rule Exception: Participants who lose coverage due to moving to a non-bargained position (superintendent) with a contributing employer do not have to have continuous coverage and only have to meet the 120 month rule.

To pay for coverage, participants and dependents in the non-active classification must pay the required premium directly to the benefit office.

Visit our Health Plan Resources page for current self-pay rates.

Your premium amount is determined based on your coverage selection. Your premium for coverage under the nonactive classification and for individuals participating in the UHC Medicare Advantage Program is due on the first day of the month prior to the month of coverage. If your payment is not received on time, your coverage will terminate at the end of the last month for which timely payment was made.

All premiums under the self-pay provisions are due on the first day of the month prior to the month of coverage and must be received in the benefit office within 15 days of the due date to be accepted.

For more information on self-pay, refer to our Self-Pay Guidelines on our Resources page.

UHC Group Medicare Advantage Program

If you become eligible for Medicare while covered as a participant or dependent in the non-active classification and you take no further action, you lose eligibility for any benefit from the plan. To assist your transition to Medicare, the plan has arranged for UnitedHealthcare to offer the UHC Medicare Advantage Program, at group premium rates and with benefits that may be attractive to you. The UHC Medicare Advantage Program is a group-type insurance program providing Medicare Part C benefits, and is available only to individuals who become eligible for Medicare while covered in the plan’s active or non-active classification.

If you choose to participate in the UHC Medicare Advantage Program upon first becoming eligible to enroll, you will remain eligible for the plan’s life and accidental death benefit (participant only eligible for accidental death benefit). You will also retain the right to elect coverage under the plan’s dental benefits. In each case, a monthly premium will be charged to you.

Benefits under the UHC Medicare Advantage Program are not plan benefits — they are provided entirely independently of the plan under an insurance contract with UnitedHealthcare, in return for which a premium is charged to participants. The plan’s role is strictly to collect and remit monthly premiums to UnitedHealthcare on behalf of individuals who choose to participate, and to report to UnitedHealthcare the individuals who have paid such premiums. The plan’s monthly charge for an individual who participates in the UHC Medicare Advantage Program includes the following:

100% of the premium due from the individual to UnitedHealthcare;
An administrative fee for the plan’s services;
The plan’s own premium for life and accidental death and dismemberment benefits; and
The plan’s own premium for optional dental benefits, if elected.

The plan does not endorse the UHC Medicare Advantage Program or require its use, or pay any part of its cost. Participation in the UHC Medicare Advantage Program is strictly voluntary, at the option of an individual who becomes eligible for Medicare while covered in the plan’s non-active classification. Such an individual retains the right to pursue other options; he or she may instead choose conventional Medicare (Parts A and B), or Medicare plus private supplemental insurance, or a different Medicare Advantage plan. Note, however, that enrollment in a different Medicare Advantage plan or in Medicare Part D will disqualify you for participating in the UHC Medicare Advantage Program.

To be accepted for participation in the UHC Medicare Advantage Program, you must be enrolled in Medicare Parts A and B. You must actively enroll in the UHC Medicare Advantage Program prior to your Medicare effective date or no later than 60 days after first becoming eligible for Medicare. If you wish to maintain optional benefits under the plan, you must make that election at the same time. Your dependent may participate in the UHC Medicare Advantage Program only if, and so long as:

You have elected family coverage;
You were covered in the non-active classification before becoming eligible for Medicare; and
You enrolled in the UHC Medicare Advantage Program after becoming eligible for Medicare.

Need to contact UHC?

UnitedHealthcare Group Medicare Advantage PPO website: www.UHCRetiree.com

Mailing Address: UnitedHealthcare Medicare Solutions, PO Box 29830, Hot Springs, AR 71903-9830

Customer Service Hours: Monday – Friday 8:00 am – 8:00 pm
Customer Service Phone: 1-800-758-4885 TTY 711
NurseLine: 1-877-365-7949 TTY 711
Behavioral Health: 1-800-453-8440 TTY 711
Find out more about the programs available to the Medicare Advantage members: www.uhcvirtualretiree.com/ss

Pharmacy Claims: OptumRx, PO Box 29045, Hot Springs, AR 71903
For Pharmacists: 1-877-889-6510

Retired Participants

For purposes of eligibility for retiree coverage in the non-active classification, a participant “retires” when he or she begins to receive pension benefits from any of the following Carpenters’ pension plans: St. Louis, Kansas City, Kansas Building Trades, or Geneva and who had a previous period of coverage in the hours-based eligibility class. In addition to the requirements for participation in the non-active classification, eligibility for retiree coverage in the non-active classification of the plan occurs on one of the following dates, depending on the participant’s personal circumstances:

  • All participants must enroll in the non-active classification within 63 days of retirement, date of termination under the active classification or the date you qualify as a retired self-employed participant or non-pension participant; and
  • All participants must have earned a total of 10 years of credit hours under the plan with 3 years of those credit hours earned in the 5 years prior to retirement; or
  • A participant who leaves the bargaining unit to work in a non-bargained unit position for a contributing employer must have at least 10 years of coverage under the plan; and
  • Participants must provide proof of coverage under the plan to satisfy the 10 years of credit hours in the event the plan does not have the information available, proof of disability, proof of coverage through a contributing employer or in cases of self-employed of non-pension participants, written notice of no longer working and attaining the age of 55; and
  • Participants who do not enroll in coverage as a retiree within 63 days as outlined in the first bullet cannot enroll at a later date; and
  • A participant who leaves non-active coverage creating a gap in coverage cannot be reinstated in the non-active plan, except when a participant who loses coverage due to moving to a non-bargained position with a contributing employer (must still meet the 120 month rule).
  • Dependents may have a gap in coverage provided the participant remains in the non-active classification continuous and the dependent has proof of other coverage and re-enrolls within 63 days of losing other coverage due to a qualifying event.

If you retire while covered in the hours-based eligibility class, you may be eligible for retiree nonactive coverage. For an additional premium, you may also cover your eligible dependents (see dependent coverage). To keep coverage without interruption, you must enroll for retiree coverage by the first day after your active coverage ends. If you retire while covered by COBRA you may extend the period of active coverage until the end of the applicable COBRA period.

Retired Self-Employed Participants And Non-Pension Participants

Self-employed participants: If you are a self-employed participant and not eligible to receive a pension from the Carpenters’ pension plan, you can still qualify for retiree coverage in the plan in the non-active classification if you meet all of the following conditions:

  • You have reached age 55;
  • You have stopped working; and
  • You must have at least 120 months in any combination of:
    • Months in which you performed bargaining unit work for an employer signatory to a collective bargaining agreement with the regional council but was not required to contribute to this plan,
    • Months of coverage in the hours-based eligibility class earned by contributions to this plan by a contributing employer including months of coverage by COBRA or minimum/difference payments; and
  • At least 36 months of said 120 months were earned during the 5 years immediately preceding election of non-active coverage.

Non-pension participants: A non-pension participant is an active participant in the hours-based eligibility class, other than a self-employed participant, who is not eligible to receive a pension from the Carpenters’ pension plan. If you are a non-pension participant you can qualify for retiree coverage in this plan in the non-active classification if you meet all of the following conditions:

  • You have permanently stopped working in any employment and you have notified the plan.
  • You were covered in the hours-based eligibility class immediately before beginning retiree coverage.
  • You enroll for retiree coverage by the first day after your active coverage ends; or if earlier, immediately following the day you stopped working.
  • The non-pension participant must have at least 120 months in any combination of:
    • Months in which the participant performed bargaining unit work for an employer signatory to a collective bargaining agreement with the regional council but was not required to contribute to this plan, or
    • Months of active coverage in the hours-based eligibility class earned by contributions to this plan by a contributing employer including COBRA or minimum/difference payments; and
  • At least 36 months of said 120 months must have been earned during the 5 years immediately preceding election of non-active coverage.

Disabled Participants

If you become totally disabled while covered in the hours-based eligibility class, you qualify for coverage in the non-active classification during your disability if you meet all of the following conditions:

  • You must provide satisfactory medical evidence of total disability. For purposes of this eligibility provision, “total disability” means that the participant is prevented, due solely to sickness or injury, from engaging in any of the usual activities of his or her specific, customary occupation.
  • You must provide such evidence to the trustees as soon as reasonably possible after it becomes available to you.
  • You must enroll in non-active disability coverage by first day after your active coverage ends.
  • You must provide medical evidence of the continuation of total disability as often as requested by the plan.
  • You elect such coverage within 63 days after first becoming eligible, and
  • You must have at least 120 months in any combination of:
    • Months in which your performed bargaining unit work for an employer signatory to a collective bargaining agreement with the regional council but was not required to contribute to this plan, or
    • Months of coverage in the hours-based eligibility class earned by contributions to this plan by a contributing employer including months of coverage by COBRA or minimum/difference payments; and
  • At least 36 months of said 120 months were earned during the 5 years immediately preceding election of non-active coverage.

Your non-active disability coverage will terminate when you are no longer totally disabled under the terms of the plan.

Surviving Spouse

In the event you die as a participant in the active or non-active classification, in any class except special participation eligibility, if your spouse had dependent coverage at the time of your death, your surviving spouse may qualify for surviving spouse coverage in the non-active classification. This coverage will continue for your surviving spouse’s lifetime, except if your surviving spouse remarries; the coverage will terminate upon your surviving spouse’s remarriage. To obtain this coverage, your surviving spouse must enroll no later than 63 days after the participant’s death or if later the date on which the surviving spouse’s coverage as the participant’s dependent ends if there is an extension of Active Classification coverage on account of the participant’s credit hours or a prior election of Minimum/Difference coverage and:

  • Must have at least 10 years (120 months) of coverage in the plan based on hours worked over their career.
  • Must have three (3) years (36 months) of coverage based on hours worked within the last five (5) years immediately prior to the participant’s non-active classification effective date.

Your surviving spouse may elect single coverage or family coverage, at the respective applicable premiums. An election of family coverage provides coverage only for your surviving spouse and those persons who were your dependent children at the time of your death. Your stepchildren are not eligible for benefits under the surviving spouse coverage.

A surviving spouse covered under the plan in the non-active classification is generally considered to be a participant for purposes of the plan.

Working In The Non-Active Classification

Please note that some pension plans do not allow participants to work, or limit the number of hours worked while the participant draws a pension benefit.

Participants covered in the non-active classification (other than as disabled, retired self-employed or non-pension participants) are not prohibited from earning credit hours in this plan during non-active coverage. Note, however, that some pension plans do not allow participants to work, or limit the number of hours worked while the participant draws a pension benefit. Participants who earn credit hours during non-active coverage will receive a credit against their self-payment on account of the hours worked. Your credit for hours worked in a month is limited to the amount of the premium self-payment due for that benefit month and is paid twice a year from the benefit office.

Once you enroll in non-active coverage you may not reestablish active coverage except for a one-time opportunity to reestablish coverage in the Active classification under the following conditions:

  • You must provide advance written notice to the benefit office of the intent to have credit hours applied to reinstate active eligibility. At that time, employer contributions for you will stop being credited against your premium self-payments and will begin to be credited toward initial active eligibility;
  • You must satisfy the requirements for initial hours-based eligibility class while maintaining continuous non-active coverage through premium self-payments; and
  • Only credit hours earned during non-active coverage as outlined above will be applied to satisfy initial eligibility requirements. You may move from non-active to active coverage only once, except that if you are a participant whose non-active coverage is due to total disability, you are not bound by this limitation when you are no longer totally disabled.

Termination Of Non-Active Eligibility

As a non-active participant, your coverage will end on the earliest of the following dates:

  • In case of non-payment at the end of the month for which your last timely payment was received.
  • The date of your death.
  • The date you falsify any information in connection with a claim for benefits or commit any action with the intent to defraud the plan.
  • The end of any month you are found to be working in non-covered employment.
  • The date the plan terminates.

In addition, your eligibility as a non-active participant for all or most benefits in the plan will end on the date you are eligible for Medicare, as described under Benefits for Medicare-eligible individuals and UHC Group Medicare Advantage Program.

Dependent Child Eligibility

For purposes of eligibility in this plan, your dependent child is any of the following, provided that the child is your “child” or “dependent” as defined in Section 105(b) of the Internal Revenue Code:

  • A natural child;
  • A child adopted by judicial decree;
  • A child legally placed for adoption in your home;
  • A child for whom the plan is required to provide coverage pursuant to a Qualified Medical Child Support Order (QMCSO); or
  • Your stepchild, as long as the child’s natural parent is your spouse. If your stepchild is covered under a health plan of either natural parent, this plan’s coverage of the stepchild will be secondary to the natural parent’s plan.

Your child is eligible for dependent coverage until the last day of the calendar month in which the child’s 26th birthday occurs.

Your child may remain eligible for dependent coverage past the child’s 26th birthday if the child is totally disabled and you rightfully claim a deduction for the child on your federal income tax return.

For continued coverage of a totally and permanently disabled child age 26 and over, substantiation of the child’s disability will be required by the plan no later than 63 days after the child’s 26th birthday and periodically thereafter as requested by the plan.

Opting Out Of Dependent Coverage

Any dependent eligible for coverage may opt out of coverage by signed written notice to the trustees, specifying the date on which coverage may terminate. Any dependent who has voluntarily terminated dependent coverage may reinstate coverage by written notice to the trustees, provided that the dependent qualifies for coverage at the time of reinstatement. The parent of a child under the age of 18 may request to opt out of coverage on behalf of the minor child. A dependent child age 18 or older or a spouse must request to opt out of the plan individually.

Termination Of Dependent Eligibility

Except as provided for a dependent who has elected COBRA, eligibility of a participant’s dependent will automatically end on the last day of the month in which the earliest of the following dates occurs:

  • The date the participant’s eligibility ends, except as follows:
    • Eligibility of dependents of a participant in the non-active classification will not terminate solely because the participant becomes entitled to Medicare, so long as the participant is enrolled in the UHC Medicare Advantage Program.
    • In the event of a participant’s death while covered in the hours-based eligibility class, the participant’s dependents will remain covered until the end of the third month after the month in which the death occurred, or if later, until the end of the eligibility period earned by the participant’s credit hours as of the date of death.
  • The date the individual no longer qualifies as an eligible dependent under the terms of the plan.
  • The date the dependent falsifies any information in connection with a claim for benefits or commits any action with the intent to defraud the plan.
  • The date a dependent is eligible for Medicare that is primary to the Plan, but is not enrolled in both Medicare Part A and B. An Active Classification participant’s Medicare coverage is primary to this Plan if the dependent has had 30 months of secondary Medicare coverage on account of End-Stage Renal Disease and the Medicare is now primary to this Plan, except if the participant’s eligibility is based on COBRA continuation coverage.
  • The date the participant fails to provide supporting enrollment documentation as requested by the Plan.
  • The date the plan terminates.

When Dependent Coverage Ends

You have options for continuing coverage when your coverage under the plan is about to end. Under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), you and your dependents have the right to continue coverage under the plan in lieu of minimum/difference payments if you (or your enrolled dependents) would otherwise lose coverage due to certain qualifying events such as termination of employment, death, or certain other qualifying events. For details, see COBRA Continuation Coverage.

Spousal Coverage Program

The plan requires the working spouse of an active* eligible participant to enroll in their employer’s health plan. Each year working and non-working spouses are required to complete a spousal coverage program verification form in order to be eligible for coverage. More information and FAQ regarding the plan’s spousal coverage program may be found in our spousal coverage brochure.

Did you become employed? Are you waiting for your employer’s open enrollment period? If yes, check with your employer about their enrollment deadline.

If coverage is available, you will need to enroll in your employer’s plan. Please note: When a non-high deductible plan is available, the spouse must enroll in the lower deductible plan. If you have questions or need assistance, contact Participant Services:

By phone: 314.644.4802
Toll-free: 877.232.3863
By email: [email protected]

*Active means eligibility based on hours, including minimum/difference, COBRA, self-employed and office employees.

COBRA Continuation Coverage

Important Information About Your COBRA Continuation Coverage Rights

Under COBRA, you and your covered dependents have the right to elect to continue your coverage under the plan in lieu of minimum/difference payments if you (or your covered dependents) would otherwise lose coverage because of a qualifying event (refer to the chart below). Each qualified beneficiary has the independent right to elect COBRA coverage. A qualified beneficiary means each person (you, your spouse and your dependents) covered by the plan on the day before a qualifying event, and any child born to you or placed for adoption with you while you are covered by COBRA. You may elect (but you may not waive) COBRA continuation on behalf of your spouse, as long as your spouse is a qualified beneficiary. Parents may elect COBRA continuation coverage on behalf of their dependent children, as long as the dependent children are qualified beneficiaries.

Continuation coverage under COBRA includes medical, prescription drug, dental and vision coverage that the qualified beneficiary would have been entitled to if the qualifying event had not occurred. It does not include weekly accident and sickness benefits, life insurance, or AD&D.

An active member who maintains coverage after a qualifying event by electing COBRA in lieu of minimum/difference payments may not elect minimum/difference payments to maintain active coverage at the termination of the COBRA coverage, unless and until the member reestablishes eligibility as provided in the plan. Conversely, an active member who maintains coverage after a qualifying event by electing minimum/difference payments in lieu of COBRA may elect COBRA to maintain active coverage at the termination of the period of minimum/difference payments.

Eligibility And Duration

The following chart shows the qualifying events and the periods of eligibility for COBRA continuation coverage:

If you lose coverage for any one of these reasons These people would be eligible for COBRA Continuation coverage for up to this long
Your employment terminates for reasons other than gross misconduct You and your eligible dependents 18 months*
Your eligibility through minimum/difference payments expires You and your eligible dependents a combined total of 18 months*
You became ineligible due to reduced work hours You and your eligible dependents 18 months*
You die Your eligible dependents 36 months
You divorce or legally separate Your eligible dependents 36 months
Your dependent children no longer qualify as dependent Your eligible dependents 36 months
You become entitled to Medicare Your eligible dependents 36 months

*Subject to extension up to 29 months as described below.

Please note that entitlement to Medicare means you are eligible for and enrolled in Medicare. Also note that if you are entitled to Medicare at the time that your employment terminates or you become ineligible due to a reduction in hours and your Medicare entitlement began less than 18 months before the applicable qualifying event, your dependents will be eligible for up to 36 months of COBRA after the date of Medicare entitlement.

Extension of 18-month COBRA coverage period for disability. If you’re a qualified beneficiary who has COBRA continuation coverage because of termination of employment or reduction in hours, you and each enrolled member of your family can get an extra 11 months of COBRA coverage if you become disabled. (That is, you can get up to a total of 29 months of COBRA coverage.) To qualify for additional months of COBRA coverage, you must have a notice of award from the Social Security Administration that your disability began before the 61st day after your termination of employment or reduction in hours, and your disability must last at least until the end of the COBRA coverage period that would have been available without the extension.

To elect extended COBRA coverage, you must send a copy of the Social Security Administration’s determination to the benefit office, within 60 days of the date of the Social Security Administration’s determination notice (or the date of the qualifying event or the date coverage was or would be terminated as a result of the qualifying event, whichever is latest). In addition, your notification to the benefit office must occur within 18 months after your termination of employment or reduction in hours. If you do not notify the benefit office in writing within the 60-day (and 18-month) period, you will lose your right to elect extended COBRA continuation coverage.

Extension of 18-month COBRA coverage period for your spouse or dependent children due to a second qualifying event. If your spouse or dependent children have COBRA continuation coverage because of your termination of employment or reduction in hours, they can get up to an extra 18 months of COBRA coverage if they have a second qualifying event. (In other words, they can get up to a total of 36 months of COBRA coverage.) This extended COBRA coverage is available to your spouse and dependent children if the second qualifying event is your death, divorce, or legal separation. The extension is also available to a dependent child whose second qualifying event occurs when he or she stops being eligible under the plan as a dependent child.

To elect extended COBRA coverage in all of these cases, you must notify the benefit office of the second qualifying event within 60 days after the second qualifying event (or the date that benefits would end under the plan as a result of the first qualifying event, if later). If you do not notify the Plan in writing within the 60-day period, you will lose your right to elect additional COBRA continuation coverage.

Notification

The benefit office will notify you or your dependents if you or your dependents become eligible for COBRA continuation coverage because of your death, termination of employment, reduction in hours of employment or Medicare entitlement. The notification must be made within 30 days after the qualifying event.

Under the law, you or your enrolled dependent is responsible for notifying the benefit office in writing of your divorce, legal separation or a child’s loss of dependent status. The notification must be made within 60 days after the qualifying event (or the date on which coverage would end because of the qualifying event, if later).

A disabled qualified beneficiary must notify the benefit office in writing of a disability determination by Social Security within 60 days after such determination (or the date of the qualifying event or the date coverage was or would be terminated as a result of the qualifying event, whichever is latest) and within the initial 18 months of COBRA coverage.

You or your dependent spouse can provide notice on behalf of yourself as well as other family members affected by the qualifying event. The written notice of the qualifying event should be sent to the benefit office, at 1419 Hampton Ave, St. Louis, MO 63139, and should include the following:

  • Date written notice is submitted (month/day/year)
  • Employee’s name
  • Employee’s Social Security number/ID number
  • Reason for loss of coverage
  • Loss of coverage date (month/day/year)
  • Spouse/dependent’s name
  • Spouse’s Social Security number/ID number
  • Spouse/dependent’s address
  • Spouse/dependent’s telephone number
  • Spouse/dependent’s gender
  • Spouse/dependent’s date of birth (month/day/year)
  • Spouse/dependent’s relationship to employee

If you do not notify the benefit office in writing within the applicable period or you do not follow the procedures prescribed for notifying the benefit office, you will lose your right to elect COBRA continuation coverage.

COBRA enrollment. Within 30 days after the benefit office is notified that a qualifying event has occurred, they will send you an election form and a notice of your right to elect COBRA. To receive COBRA continuation coverage, you must elect it by returning a completed COBRA election form to the benefit office within 60 days after the date of the notice of your right to elect COBRA (or within 60 days after the date you would lose coverage, if later).

If you make this election and pay the required premium within the required deadlines, COBRA coverage will become effective on the day after coverage under the plan would otherwise end.

Instead of electing COBRA continuation coverage, there may be other coverage options for you and your family through the health insurance marketplace or Medicaid. You may also be eligible for a “special enrollment period” in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying events. You will also have the same special enrollment right at the end of your COBRA coverage if you take COBRA coverage for the maximum time available to you. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

Adding A Dependent

If a child is born to you (the employee) or placed for adoption with you while you are covered by COBRA, you can add the child to your coverage as a qualified beneficiary with independent COBRA rights. In addition, each qualified beneficiary covered by COBRA may add dependents in the same manner as an active employee, but such dependents are not qualified beneficiaries.

Cost Of Coverage

As provided by law, you and/or your enrolled dependents must pay the full cost of coverage plus 2% for administrative expenses for the full 18- or 36-month period. For a disabled person who extends coverage for more than 18 months, the cost for months 19–29 is 150% of the plan’s cost for the coverage. Since the cost to the plan may change during the period of your continuation coverage, the amount charged to you may also change annually during this period.

Time for payment. You must send the initial payment for COBRA coverage to the benefit office within 45 days of the date you first notify the benefit office that you choose COBRA coverage. (A U.S. Post Office postmark will serve as proof of the date you sent your payment.) You must submit payment to cover the number of months from the date of regular coverage termination to the time of payment (or to the time you wish to have COBRA coverage end).

After your initial payment, all payments are due on the first of the month. You have a 30-day grace period from the due date to pay your premium. If you fail to pay by the end of the grace period, your coverage will end as of the last day of the last fully paid period. Once coverage ends, it cannot be reinstated. To avoid cancellation, you must send your payment on or before the last day of the grace period. (Again, a U.S. Post Office postmark will serve as proof.) Please note that if your check is returned unpaid from the bank for any reason, that may prevent your COBRA premiums from being paid on time and may result in cancellation of coverage.

When COBRA Continuation Coverage Ends

COBRA continuation coverage ends automatically on the last day of the month in which the earliest of the following dates falls:

  • the date the maximum coverage period ends
  • the last day of the period for which the person covered under COBRA made a required premium payment on time
  • the date after the election of COBRA that the person covered under COBRA first becomes covered under another group medical plan
  • the first of the month that begins more than 30 days after the date the person whose disability caused the extension of coverage to 29 months is no longer disabled (based on a final determination from the Social Security Administration)
  • the member begins working in non-covered employment
  • the date the Plan is terminated and Carpenters provides no other medical coverage.

In addition, COBRA continuation coverage normally will end when the person covered under COBRA first becomes entitled to Medicare.

If continuation coverage ends before the end of the maximum coverage period, the benefit office will send you a written notice as soon as practicable following their determination that continuation coverage will terminate. The notice will set out why continuation coverage will be terminated early, the date of termination, and your rights, if any, to alternative individual or group coverage.

COBRA continuation coverage cannot under any circumstances extend beyond 36 months from the date of the qualifying event that originally made you or a dependent eligible to elect COBRA.

Once COBRA continuation coverage ends for any reason, it cannot be reinstated. You must notify the benefit office if:

  • you have a divorce or legal separation
  • you, your spouse or an eligible enrolled dependent has a change of address
  • you, your spouse or your dependent becomes entitled to Medicare
  • your dependent child is no longer eligible
  • you or a dependent ceases to be disabled, as determined by the Social Security Administration.

If you don’t notify the benefit office in a timely manner that any of the above events has occurred, you may lose COBRA coverage.

The COBRA Administrator for the Plan is:

Carpenters’ Health and Welfare Trust Fund of St. Louis (The Benefit Office)

1419 Hampton Avenue

St. Louis, MO 63139

877.232.3863

All notices to the benefit office must be in writing and sent to this address. Any notice that you send by mail must be postmarked by the U.S. Post Office no later than the last day of the required notice period. The notice must state the name of the plan under which you request COBRA continuation coverage, your name and address, the name and address of each qualifying beneficiary, the qualifying event and the date it happened. If the qualifying event is a divorce or legal separation, you must include a copy of the divorce decree or legal documentation of the legal separation. Other applicable documentation (such as birth certificates or adoption papers) may also be required.

Unavailability of coverage. If you or your enrolled dependent has notified the benefit office in writing of your divorce, legal separation or a child’s loss of dependent status, or a second qualifying event, but you or your enrolled dependent is not entitled to COBRA, the benefit office will send you a written notice stating the reason why you are not eligible for COBRA. This notice will be provided within the same time frame the plan follows for election notices.

If You Have Questions

If you have any questions about your COBRA continuation coverage, contact the benefit office or the nearest office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone directory. Addresses and phone numbers of EBSA offices are available at www.dol.gov/ebsa. To protect your family’s rights to COBRA coverage, keep the benefit office informed of any changes of address for you and your family members.