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Eligibility

Your Eligible Dependents

Once you become eligible for benefits, your eligible dependents are also covered under the medical, dental, prescription drug and vision care plans.

Eligible Dependents:

• Your spouse
• Unmarried children up to their 19th birthday, or age 23 if they are full–time students at any eligible educational institution
• (If your children are no longer eligible for coverage but return to full–time student status prior to reaching the age of 23, and are unmarried, then their coverage will be reinstated on the date they resume full–time student status.)
• Unmarried children who cannot work because of a physical or mental disability and who depend on you for support, provided the disability began before age 19 (or age 23 for full–time students)

Termination of Insurance

Your employee insurance will cease on the first of the following:

1. The date the policy is canceled
2. The employer’s participation under the plan ceases
3. The date on which the plan’s grace period ends for your employer to make a required contribution
4. The date the policy is changed to cancel insurance on the class of employees you are in
5. The last day for which you made a required contribution for the insurance
6. The last day of the insurance period your combined credited and excess hours do not qualify you for the next insurance period; EXCEPT THAT you may continue your insurance, provided you pay directly to the Fund prior to the insurance period, the balance of the required hours under your Collective Bargaining Agreement
7. The date you cease to be actively at work in an eligible class of employees, EXCEPT THAT your employer may continue insurance as follows, while the policy is in force
• Disability. If you are disabled, your insurance will be continued for six months during the disability if you conform to the requirements for continued disability benefits outlined in this SPD
• Your dependent’s eligibility will end when your participation ends, or when an individual dependent no longer qualifies as an eligible dependent

Reporting Changes in Family Status

You must notify the Local 170 Fund Office immediately if you have a change in family status or a change of address. A change in family status includes the following:

• Getting married
• Adding new dependents, including birth or adoption of a child and care of a foster child, or in the event of a “Qualified Medical Child Support Order”
• Divorce or legal separation
• Death of a dependent
• When a dependent child is no longer eligible (i.e., upon turning age 19, or age 23, or upon loss of physically or mentally disabled status or full–time student status under age 23, or upon return to full–time student status)
• When a change in your spouse’s employment–related health care coverage occurs; and
• Upon obtaining eligibility of Medicare or Medicaid disability status as determined by Social Security

If You Become Disabled

If you become disabled and received Weekly Disability benefits through the Health & Welfare, you may remain eligible for medical benefits for up to 39 weeks of disability. For the first four weeks of disability, your employer is required to contribute to the Fund at the rate of 32 hours per week for a full–time employee and 19.25 hours per week for part–time employees. After the first four weeks of disability, the Fund Office will credit you the required hours for full and part–time employees.

If you are disabled on the job and receive workers’ compensation benefits, your employer is required to contribute as follows:

• Full Time Employee: 32 hours per week for 1 year
• Part Time Employee: 19.25 hours per week for 1 year
• Heavy Construction: 32 hours per week for 6 months

These hours will be credited toward your eligibility as if you were working. The plan does not cover medical expenses caused by a job–related illness or injury. These expenses are covered by workers’ compensation insurance.

However, The Fund Office may pay you weekly disability benefits for any injury or accident that is disputed by your employer as being work related if you sign a lien in which you agree to reimburse the Fund in full from any settlement or recovery.

Coordinating with a Third Party
If your injury or illness is work related, no benefits are payable by the Teamsters Health and Welfare benefit program. If a claim is made for Workers’ Compensation, the Teamsters Health and Welfare benefit program cannot process a medical claim for the same disability unless and until Workers’ Compensation determines that there is no basis for the claim. If you receive a settlement from a Worker’s Compensation claim, you cannot claim benefits for the same disability from the Teamsters Health and Welfare Program.

Continuation of Dependent Insurance After Your Death

If you are eligible for dependent coverage when you die, your dependent(s) who are insured for the benefits set forth below will remain so insured while the dependent insurance remains in force. The policy will remain in effect until the first to occur of:

1. One year after your death
2. As to the surviving spouse, the date he/she remarries
3. The date that the person would have ceased to be a dependent, if you were alive; or
4. The date that the person becomes eligible to be covered under any group policy or other arrangements for benefits (insured or not) as an employee or as a dependent of another employee; The dependent benefits which may continue are those benefits which are in effect on the date of death.