PLASTERERS AND CABINET MAKERS HEALTH FUND

Eligibility:

• Q. How do I initially become eligible for benefits through the Plan if I am a Plasterer?

  A. For Plasterers, eligibility is determined on a quarterly basis, as follows:
  
  

  Hours worked in the following months:		Provides coverage in these months:
  January, February, March		May, June, July
  April, May, June		August, September, October
  July, August, September		November, December, January
  October, November, December		February, March, April

  
  If you are a Plasterer, you are eligible in the first quarter (according to the above table) following either the three or six month period (whichever is shorter) in which you work at least 350 hours (and the Plan receives Contributions). Once you meet this initial eligibility requirement, you will be covered for at least one quarter.

• Q. Once I become initially eligible, how do I continue my eligibility for benefits through the Plan if I am a Plasterer?

  A. If you are a Plasterer, once Covered Under The Plan, you will remain covered for an additional quarter if you are credited with at least 350 hours of Employer Contributions per working quarter (under the table above).

• Q. How do I initially become eligible for benefits through the Plan if I am a Cabinet Maker?

  A. For Cabinet Makers, eligibility is determined on a monthly basis, as discussed further below in this section. If you are a Cabinet Maker, You are eligible on the first day of the month following the first month in which -

  • • You work in a position for which your employer is required to contribute to the Plan on your behalf; and
  • • Your employer timely makes this required contribution to the Plan on your behalf, as required by the applicable bargaining agreement.
• Q. Once I become initially eligible, how do I continue my eligibility for benefits through the Plan if I am a Cabinet Maker?

  A. If you are a Cabinet Maker, once Covered Under The Plan, you will be eligible for continued coverage in any month following a month in which your employer timely makes a contribution to the Plan on your behalf. For example, your employer’s timely contribution in September 2015 will provide you with coverage in October 2015.

• Q. How do I initially become eligible for benefits through the Plan if I am an Industrial Carpenter?

  A. If you are an Industrial Carpenter transferring to the Plan from Non-Minnesota Industrial Carpenter Health Plans on or after July 1, 2011,
  You are initially eligible for coverage under this Plan on the first day of the month following the first month in which –

  • • You work in a position for which your employer is required by a Collective Bargaining Agreement to contribute to the Plan on your behalf; and
  • • You first exhaust any dollar bank, hours bank or other banked coverage you have available under the health fund you were covered under as of June 30, 2011; and
  • • Following exhausting any dollar, hours or other banked coverage from your prior health plan, you have sufficient Employer Contributions to pay the premium for one month of coverage under this Plan.

  Your monthly premium for coverage is dictated by the hourly or monthly contribution amount provided for in your Collective Bargaining Agreement. The premiums for coverage under the Plan are subject to review and change by the Board of Trustees on a periodic basis.
  
  This Industrial Carpenter eligibility provision is also subject to these additional ongoing eligibility rules:

  • • Six-Months to Establish Eligibility: You will have six-months, once Contributions start being made to the Plan, to establish initial eligibility for coverage under the Plan. If you are unable to establish initial eligibility, the Contributions on your behalf will be forfeited.
  • • Dependent Child Coverage: As of January 1, 2015, if you work for an employer who is considered a large employer under the Affordable Care Act (50 or more full-time employees), and only have single coverage, you will have the option of electing for (1) single coverage or (2) coverage for you and your Dependent Children (children under age 26). If you elect to add Dependent Child Coverage, the additional cost of that coverage will be your responsibility.
  • • Dollar Bank: You will be allowed to build a Dollar Bank for coverage of up to $2,000 dollars. The Dollar Bank can be used in months in which your employer contributions are insufficient to pay the monthly premium for coverage.
  • • Self-Paying for Coverage: If, once you’ve established eligibility for coverage under the Plan, the amount of contributions received, as well as any available banked dollars, are insufficient to pay the premium for one month’s coverage, you can continue your coverage by:
    • o Making self-payments for the difference between your available contributions and bank dollars and the required monthly premium for coverage for up to eighteen consecutive (18) months; or
    • o Electing for COBRA Continuation Coverage.
  • • Disability Coverage: Participants are eligible for disability coverage (including for disability for a work related injury) and will be covered for up to 26 weeks as long as they remain Disabled and otherwise meet the following requirements:
    • • A Participant’s dollar bank will be credited daily or weekly based upon whether the Participant has family or single coverage and dependent upon the amount and method their individual contributions are made to the Plan per their participation agreement. Crediting will work as follows:
      • • For example, if your monthly premium is $858 for family coverage, you will be credited with $214.50 per week or $30.64 per day to continue your coverage due to your disability; or
      • • For example, if your monthly premium is $367.50 for single coverage, you will be credited with $91.88 per week or $13.13 per day to continue your coverage due to your disability.
      • • Note: The above noted dollar amounts are subject to change from year to year and merely serve as examples of how the dollar bank will be credited.
      • • Participants will need to be credited with sufficient dollars in their dollar bank to maintain their coverage if Disabled.
      • • Participants will need to follow the same procedures as required for Plasterers and Cabinet Makers as detailed on Page 14.
    • Retiree Coverage: Participants who become eligible under this Industrial Carpenter eligibility provision are not eligible for Retiree Coverage under the Plan.
• Q. Once I become initially eligible, how do I continue my eligibility for benefits through the Plan if I am an Industrial Carpenter?

  A. If you are an Industrial Carpenter, once Covered Under the Plan, you will remain covered as long as the amount of Contributions received, as well as any available banked dollars, are sufficient to pay the premium for one month’s coverage. Your monthly premium for coverage is dictated by the hourly contribution amount provided for in your Collective Bargaining Agreement. The premiums for coverage under the Plan are subject to review and change by the Board of Trustees on a periodic basis.

• Q. When are my hours paid into the Fund Office?

  A. Hours for a particular month are due into the Fund Office on the 15th of the following month. For example, if you are looking for hours worked in January, they are not due into the Fund Office until February 15th.

• Q. Do I have an Hours Bank or Dollars Bank?

  A. Yes, as stated below:
  
  Hours Bank (Plasterers) Any hours worked in excess of 350 in a calendar quarter are recorded as bank hours. The maximum number of bank hours you can accumulate is 750. If you work less than 350 hours in a calendar quarter, you will be allowed to use your bank hours to continue coverage under the Plan for the next coverage quarter. To continue coverage under this provision, the Plan will subtract the number of hours you worked in the quarter from 375, and the result will be taken from your bank and applied to continue coverage under the Plan for the next coverage quarter.
  
  Monthly Eligibility Bank (Cabinet Makers) Each Cabinet Maker Employee employed in that capacity after April 2003 is eligible to gain up to two (2) months of bank coverage in the Plan. Bank coverage is used to extend eligibility in the Plan in the event the Employee terminates employment in a covered position or if the employer fails to timely make Contributions to the Plan.
  
  One month of bank coverage will be granted for each six-consecutive-month period in which the Employee is Covered Under The Plan after April 2003 due solely to timely Employer Contributions (that is, coverage is not attributable to the use of bank coverage or COBRA payments). After one month of bank coverage has been earned, a new six-month eligibility period will begin and the Employee may earn a second month of bank coverage. An Employee may maintain a maximum of two months of bank coverage at any time.
  
  Dollars Bank (Industrial Carpenters) If, once you’ve established eligibility for coverage under the Plan, the amount of Employer Contributions received exceeds the amount needed to pay the premium for the current month’s coverage, you will be allowed to build a Dollar Bank for coverage with the excess Contributions of up to $2,000 dollars. The Dollar Bank can be used in months in which your Employer Contributions are insufficient to pay the monthly premium for coverage.

• Q. If I lose my eligibility through the Plan, am I able to make self-payments?

  A. Yes, although accordance with below:
  
  Self-Pay (Applies only to Plasterers) If you (a Plasterer) do not work 350 hours in a quarter and you do not have enough hours in your hour bank to continue coverage, you can still continue coverage in the Plan for the next coverage quarter by self-paying. The amount you will need to self-pay is determined by subtracting the number of hours worked during a quarter and any hours in your hour bank from 375. The remainder is the number of hours you will need to self-pay to continue coverage for the next quarter. The amount of the self-payment is the number of hours you need to self-pay multiplied by the current hourly contribution rate in the Collective Bargaining Agreement.
  
  For example, a Plasterer has worked 200 hours in a quarter and has 100 hours in his hours bank. In order to continue coverage for the next coverage quarter, the Plasterer would need to make a self-payment equal to 75 hours times the current Plasterer hourly contribution rate. (375 - 200 - 100 = 75 hours needed.)
  
  The maximum time you can self-pay is SIX QUARTERS (18 months).
  
  Self-Pay (Applies only to Industrial Carpenters)
  If, once you’ve established eligibility for coverage under the Plan, the amount of Contributions received, as well as any available banked dollars, are insufficient to pay the premium for one month’s coverage, you can:

  • • Continue your coverage by making self-payments for the difference between your available Contributions and bank dollars and the required monthly premium for coverage for up to eighteen (18) months; or
  • • You may continue your coverage via the COBRA Continuation Coverage provisions of the Plan.

  Self-Pay – When Is Payment Due? (Applies only to Plasterers and Industrial Carpenters)
  If you choose to make self-payments, you must make your first self-payment to the Plan Administrator’s office within 30 days of receiving written notice from the Plan Administrator. Failure to make payment within 30 days will cause your self-payment coverage to end.
  
  If you do not elect to make self-payments, you can still elect for COBRA coverage. As further described in the COBRA section starting on Page 23, you have 60 days from the date of a qualifying event, to elect for COBRA coverage. The qualifying event date will also be the date reflected on the self-payment notice. Your 30-day period to make your first self-payment also constitutes the first 30 days of your COBRA election period. If you fail to make self-payment within 30-days, you still have an additional 30 days to elect for COBRA.
  
  For example, if you receive written notice on April 1st that you have 30 days to elect and make self-payments, your first self-payment is due by April 30th. If you fail to make your self-payment by April 30th and therefore lose the self-payment coverage option, you still have until May 30th (an additional 30 days) to elect for COBRA coverage. As mentioned previously, see the COBRA coverage section beginning on Page 23 for more details regarding electing and paying for COBRA coverage.

• Q. What if I stop working in a job classification for which contributions must be made to the Plan?

  If you stop working in a job classification for which contributions must be made to the Plan, you will immediately become ineligible for Plan benefits, your Hours Bank (Plasterers) and Dollars Bank (Industrial Carpenters) or Monthly Eligibility Bank (Cabinet Makers) hereafter referred to collectively as Bank (or your Bank), will be cancelled (reduced to zero), and you will have no right to continue to be covered under the Plan (other than any right you may have under COBRA), if all of the following are true:

  • • You work for an employer or as an employer that is not obligated to contribute to the Plan;
  • • Your work is of a type for which Employers contribute to the Plan; and
  • • Employer contributions for your work would be due to the Plan if you were working under a Collective Bargaining Agreement.

  If your eligibility is terminated and your Bank is cancelled, any period of time you were covered by your Bank after you last worked in employment for which your Employer contributed to the Plan will count as part of any Continuation Coverage under COBRA period to which you may be entitled.
  
  If you are maintaining coverage via your Bank and if the Plan requests, you must provide to the Plan access to reasonable information for the purpose of verifying your employment. The information which the Plan may require for this purpose may include, but is not limited to: paycheck stubs, Internal Revenue Forms 1040 (with attachments), and release forms permitting the Plan to obtain information from your employer.
  
  The Plan is entitled to request that you periodically:

  • • Certify to the Plan in writing on a form acceptable to the Plan that you are unemployed or, in the alternative,
  • • Provide information satisfactory to the Plan to enable the Plan to conclude that any employment in not of a type that would cause you to lose your eligibility and Bank.

  If you fail to respond to the Plan’s request for information or certification or provide an incomplete or inadequate response, the Plan may do one (1) or more of the following:

  • • Terminate your eligibility;
  • • Cancel your Bank;or,
  • • Withhold payment of benefits until you respond or provide a complete and adequate response.

  The Plan will notify you in writing if it terminates your eligibility and terminates your Bank.