Retiree Eligibility

Retiree Comprehensive Plan Eligibility

The benefits currently provided for retirees and their spouses are not “vested” benefits. This means the Trustees have the right, at any time, to change the eligibility rules or benefits, to increase self-payments for the benefits, or to reduce or completely terminate the benefits provided for any category of participants or beneficiaries.

COBRA COVERAGE FOR RETIREES

Retirement is a qualifying event under COBRA coverage. If you are entitled to Medicare when you retire, you can elect COBRA coverage for up to 18 months, but you cannot elect the Plan’s Retiree Comprehensive Plan coverage.

Medicare entitlement is a terminating event under COBRA coverage. If you elect COBRA before you are entitled to Medicare, but you become entitled to Medicare before your COBRA period ends, your COBRA coverage will terminate at that time (but your dependents may continue COBRA coverage).

If you elect COBRA coverage, you cannot get into the Retiree Comprehensive Plan later, regardless of the length of your COBRA coverage period or the reason your COBRA coverage ended.

If you are eligible for the Retiree Comprehensive Plan and elect to make self-payments for that coverage, you forfeit your right to elect COBRA coverage in the future.

ELIGIBILITY REQUIREMENTS FOR THE RETIREE COMPREHENSIVE PLAN

In order to be eligible for benefits under the Retiree Plan, you must meet ALL of the following requirements:

1. You must retire from full-time employment on or after May 1, 2001;
2. You must be at least age 55 and working in covered employment at the time of retirement;
3. You must have been eligible for benefits from the Welfare Fund due to covered employment for the five years immediately preceding your retirement date; and
4. You must be receiving disability or pension benefits from the Local 734 Pension Fund.
   If you are eligible and make the required self-payments, your spouse will also be covered for the same self-payment amount.

Dependent children are not covered under the Retiree Plan.

EFFECT OF OTHER COVERAGE AND MEDICARE
Retiree coverage CANNOT be elected for any person who is covered by another group health care plan or who is eligible for Medicare.

If your spouse has other group health care coverage when you retire (for example, if she continues to work and, therefore, remains covered under her employer’s plan), she will not be covered under this Plan. If she later retires and loses her other coverage, she will then become eligible for benefits from this Plan—provided you have maintained your own eligibility by making all required self-payments.
 
Neither you nor your spouse can be covered under this Plan if you are eligible for Medicare (whether or not you have actually enrolled in Medicare).

Benefits Payable for Eligible Retirees and Their Spouses

The medical and prescription drug benefits provided to retirees are very similar to the benefits provided to active employees. These benefits are summarized on the Schedule of Benefits.

The Active and Retiree Plans are separate from each other. Your benefits, including the deductible, will start over when your retiree coverage starts, even if it is in the middle of a year.

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Self-Payments Required

The self-payment amount required for coverage is determined by the Trustees and may be changed at any time. If you are eligible and make the required self-payments, your spouse will also be covered for the same self-payment amount. (The amount is the same for the retiree only or for both the retiree and his spouse.)

Payments are due on the first day of the month for which coverage is desired.

Continuing Coverage for Spouses

If you die while you are making retiree self-payments for yourself and your spouse, your surviving spouse can continue making the self-payments under the same terms and conditions that applied to your coverage until she remarries, becomes covered under another group health plan or Medicare, or until the occurrence of one of the other events listed in the section entitled “Termination of Benefits for Spouses of Retirees,” whichever occurs first.

COBRA COVERAGE
The spouse of an eligible retiree may be able to make self-payments for COBRA coverage in the following circumstances:

1. If you are divorced or legally separated from your spouse, your spouse is entitled to elect to make COBRA coverage self-payments for a maximum coverage period of up to 36 months after the date her coverage would otherwise terminate due to the divorce or legal separation.
2. If your surviving spouse has been continuing retiree coverage by making self-payments, and if the spouse remarries within 36 months after the date of your death, she is entitled to elect to make COBRA coverage self-payments for a maximum coverage period ending 36 months after the date of your death.
    
   COBRA coverage may not be elected by a remarried surviving spouse if the spouse’s remarriage occurs more than 36 months after the date of the retiree’s death.

Except as specified above, the rules governing COBRA coverage for spouses of retirees are the same as the rules for active participants.

Termination of Retiree Plan Eligibility

RETIREES
Your benefits will automatically terminate on the first to occur of the following dates:

1. The date you become eligible to enroll in Medicare, either due to age or disability. (If your spouse is younger, you can continue to make the self-payments to cover her until she too becomes eligible for Medicare);
2. The date you become eligible for coverage under another group health plan;
3. The date you become ineligible for Local 734 pension benefits (for example, if you return to work and your pension benefits are suspended under the Pension Plan’s “Suspension of Benefits” rules);
4. The last day of the month preceding a month for which you fail to make a self-payment within 30 days of the due date;
5. The last day of the month preceding a month for which you pay for the coverage with a check that is returned for non-sufficient funds (“NSF”);
6. The date the Trustees terminate the Retiree Plan; or
7. The date the Trustees terminate this Plan of benefits.

If your coverage under the Retiree Plan is terminated for any of the reasons stated above, you will not be able to get back into the Plan later.

SPOUSES
Benefits for your spouse will automatically terminate on the first to occur of the following dates:

1. The date your spouse becomes eligible to enroll in Medicare, either due to age or disability;
2. The date your spouse is no longer legally married to you (because of divorce or legal separation), unless she is entitled to COBRA coverage and elects to make self-payments for COBRA coverage;
3. The date your (the retiree’s) benefits terminate for any reason other than your death;
4. The date the Trustees terminate benefits for dependent spouses under the Retiree Plan;
5. In the event of your death, the earliest of the following dates:
   • The date your surviving spouse remarries (unless she is entitled to make, and makes self-payments for, COBRA coverage);
   • The last day of the month preceding a month for which she fails to make a self-payment within 30 days of the due date;
   • The last day of the month preceding a month for which she pays for the coverage with a check that is returned for non-sufficient funds (“NSF”);
   • The date she becomes eligible to enroll in Medicare, either due to age or disability; or
   • The date she becomes eligible for coverage under another health plan.