UP PLUMBERS’ & PIPEFITTERS’ HEALTH & WELFARE FUND

COMMON QUESTIONS ASKED

 

 

How are my benefits Funded?

 

The primary source of financing for the benefits provided under the Health & Welfare Fund

and for the expenses of Fund operations is employer contributions.

 

What are the Fund’s eligibility requirements?

 

Initial eligibility requires 480 hours of contributions within six (6) consecutive months or less,

skip one month for bookkeeping, eligible the following three (3) months

                                               or-

100 hours in 1 month, eligible next two (2) months (Effective with 9/95 work month)

 

 

Continuing Eligibility requires one of the following:

 

Quarterly:                              360 hours within 3 consecutive months, skip one bookkeeping month, eligible following 3 months.

 

Single:                                    160 hours in one month, skip one bookkeeping month, eligible the following month.

 

Annual:                                  Effective with January 1996 eligibility, 1200 hours in 12 consecutive months, skip one bookkeeping month

                                                (not eligible in bookkeeping month), eligible for next month.  The maximum number of eligibility months

                                                that can be accumulated is 3 months.

 

5 Week Rule:                         If participant has 160 hours within 5 consecutive weeks, he may be eligible the first day of the following month.

 

 

What do I do if my employer does not remit my fringes?

 

First call your employer.  There may be a very good reason that the fringes have not been remitted.

If your employer cannot explain the reason to your satisfaction, you should contact the Local Union.

 

How can I add my dependents to the Plan?

 

Complete a “Membership and Record Change Form” and submit copies of marriage or birth certificates.

 

What do I do when I get divorced?

 

You must send a copy of your complete divorce decree otherwise coverage will be maintained for your ex-spouse.

If the Fund pays for benefits that should not be paid because your spouse no longer meets the definition of a dependent, you will be held responsible.

 

When does coverage stop for my dependent children?

 

Dependent children are covered through the end of the year in which they turn 19 unless they meet the requirements for maintaining coverage.

The Plan requires that the dependent be a full time student with at least 12 credit hours per semester

 

Can I continue coverage when I retire?

 

Yes provided you meet the retiree requirements for maintaining coverage.

 

 

What do I do if I am injured and cannot work?

 

The Fund provides disability credit which may continue your coverage for health care benefits.

 A Disability Form completed by you and your physician is required.

 

What are the self-payment rates?

 

Single Active Member………………..$259.00

Active Member 2-Person Coverage…..$577.00

Active Member-Family Coverage…….$685.00

 

What is COBRA?

 

COBRA is the Consolidate Omnibus Budget Reconciliation Act of 1986.  COBRA requires that the Fund provide coverage

for participants and their dependents that may not otherwise be offered.  COBRA is available for dependents who no longer

meet the definition of a dependent as defined by the Plan.  The rates are 102% of the actual cost of providing benefits. 

 

What is Coordination of Benefits?

 

Coordination of Benefits or COB coordinates benefits with other health benefits you may have such as coverage through your spouse’s employer.

 

What are the Health Care Benefits?

 

The Fund has contracted with Blue Cross Blue Shield of Michigan (BCBSM) to provide participants and the Fund with discounts

on medical services.  For further details regarding the medical benefits available, please refer to the Summary Plan Description (SPD).