• SPD Table of Contents
  1. Important Contact Information
  2. Introduction
  3. Table of Contents
  4. Plan A Schedule of Benefits
  5. Plan B Schedule of Benefits
  6. Plan C Schedule of Benefits
  7. Plan 11 Schedule of Benefits
  8. Plan 11-C Schedule of Benefits
  9. Eligibility for Active Participants
  10. Eligibility for Retiree Coverage
  11. Insurance Coverage
  12. Weekly Loss of Time Benefit
  13. Medical Benefits
  14. Prescription Drug Program
  15. Medicare Part D Prescription Drug Plan (PDP) for Retirees
  16. Members Assistance Program (MAP)
  17. Dental Benefit
  18. Vision Benefit
  19. Hearing Benefit
  20. Special Fund Program
  21. General Plan Exclusions and Limitations
  22. Other Limitations on Your Benefits
  23. Definitions
  24. Claim and Appeal Procedures
  25. General Plan Provisions
  26. Information About the Plan
  27. Board of Trustees

Eligibility for Active Participants

ABOUT ELIGIBILITY CLASSES

The following table shows the eligibility categories (classes) covered by this Plan. Your class is determined by the collective bargaining agreement between your employer and Local 701 or, if you are not part of the bargaining unit, by the participation agreement between your employer and the Plan.

Eligibility Classes and Benefit Plans for Active Employees

ELIGIBILITY RULES FOR CLASS 1 BARGAINING UNIT EMPLOYEES

Class 1 employees are bargained-for employees for whom employers make contributions for each hour worked.

Class 1 employees who are eligible for benefits because they have satisfied the eligibility rules described below normally will be covered under the Plan A Schedule of Benefits. When you are eligible for Plan A benefits, your dependents will also be eligible for Plan A benefits.

Definition of “Credited Hour”

The eligibility of a Class 1 participant is based on credited hours. A “credited hour” means work performed under the jurisdiction of IBEW Local 701 for which a contributing employer makes the required hourly contribution to the Fund on behalf of the participant performing the work.

Hours for which you make a short-hours self-payment are also considered credited hours, but only for continuing (not initial) eligibility. You do not get credited hours for COBRA self-payments.

Disability hours granted by the Fund during a period of total disability also count as credited hours.

Establishing Initial Eligibility

New Apprentices in JATC Program and Participants who Previously Lost Eligibility Under This Plan

If you are not currently eligible for benefits, you will become eligible on:

• The first day of the month following the month in which at least 300 credited hours are paid on your behalf by one or more contributing employers during any contribution quarter;

OR

• The first day of the month following the month in which one of the following requirements is met:
• 600 credited hours are paid on your behalf by one or more contributing employers during any sixconsecutive-month period; or
• 1,000 credited hours are paid on your behalf by one or more contributing employers during any nine-consecutive-month period; or
• 1,300 credited hours are paid on your behalf by one or more contributing employers during any twelve-consecutive-month period.

If your eligibility terminates, it will be reinstated on the first day of the coverage quarter for which you have at least 300 credited hours during the corresponding contribution quarter.

New Participants Not in the JATC Program and Participants Who Have Never Been Eligible Under This Plan

If you are a new participant who is not in the JATC program and have never been eligible under this Plan, you will become initially eligible on the first day of the month following the month that one of the following requirements is met:

• 800 credited hours are paid on your behalf by one or more contributing employers during any six-consecutive-month period; or
• 1,200 credited hours are paid on your behalf by one or more contributing employers during any nineconsecutive-month period; or
• 1,500 credited hours are paid on your behalf by one or more contributing employers during any twelveconsecutive-month period.

If You Are Disabled on Your Effective Date

If you are not actively at work due to disability on the date your benefits would have become effective, you will be eligible for all benefits beginning on that date except the Weekly Loss of Time Benefit. Loss of Time Benefits will become effective when you return to active work.

How Eligibility Continues

Eligibility due to Work Hours

After you meet the initial eligibility requirements, you will remain eligible for benefits until the end of the three-month coverage quarter, or the remaining part of the coverage quarter, during which you became initially eligible.

You will remain eligible for each successive coverage quarter if your employer(s) contribute sufficient credited hours on your behalf. There are two ways to maintain your eligibility during a coverage quarter due to worked hours.

Continuing Eligibility

Note that there are two administrative lag months between a contribution quarter and its related coverage quarter.

Eligibility due to Self-Payments for Short Hours

If you fall short of the continuing eligibility requirement of 300 credited hours in a contribution quarter, or 1,200 credited hours during the previous twelve-month period, you may make self-payments without losing eligibility and having to meet the initial eligibility requirement again.

• Your self-payment will be an amount equal to the difference between 300 credited hours in a contribution quarter and the actual contribution hours for the most recent contribution quarter, or the difference between 1,200 credited hours and the actual contribution hours for the most recent twelve-month period, whichever is less.
• You must make self-payments for consecutive coverage quarters so that there is no break in your eligibility and so your eligibility remains continuous. In the event that your eligibility terminates because you fail to make your self-payment on time, you will lose the right to make future short-hours selfpayments until you return to work and subsequently reinstate your eligibility by meeting the requirements outlined under the “Establishing Initial Eligibility” provisions on page 17.
• Self-payments for short hours must be received by the Fund Office prior to the first day of the month for which coverage is being paid. Payments received after this date will be returned to you and your coverage will end. You will have to meet the initial eligibility requirements to become covered again. • Under no circumstances will you be allowed to make self-payments toward the establishment of initial eligibility.
• You may not make more than four full consecutive self-payments of 300 hours. You can make an unlimited number of partial self-payments.
• Self-payments for short hours are in lieu of COBRA coverage. This means that your maximum 18month COBRA period begins with the first day of the quarter for which you make a short-hours selfpayment.

Self-Payments for Plan B

Normally when you make a self-payment for short hours, you pay the full hourly contribution rate for regular (Plan A) benefits. However, if you are eligible to self-pay, you will also be offered the option of self-paying at a lower rate for a lesser benefit schedule called Plan B. (The Plan B schedule starts on page 4.)

• Plan B is only available for active (not retired) Class 1 and Class 6 employees who are eligible to make short hours self-payments. Plan B is not available for participants whose employers make flat rate or monthly contributions, or for retirees or survivors.
• If you initially elect to make self-payments for Plan A, you are permitted to drop down to Plan B during the same self-payment period, but you cannot go up from Plan B to Plan A until you re-establish eligibility based on hours worked.
• If you are eligible during a coverage quarter because of a Plan B self-payment, you will be covered under Plan B during the entire quarter. This rule applies even if your Plan B payment was only for one hour.
• Amounts applied toward deductibles, out-of-pocket limits and maximums while you were covered under Plan A will carry forward to your Plan B benefits, and vice versa.
• All the rules governing Plan A short hours self-payments apply to Plan B self-payments, including the four-quarter limit on the number of consecutive full self-payments you can make.
• If your maximum self-pay period ends while you are covered under Plan B, you will be eligible to elect COBRA coverage for Plan B benefits. (Your maximum 18-month COBRA period begins with the first day of the quarter for which you make a short-hours self-payment.)

Eligibility During Temporary Disability

If you are unable to perform work because of a certified disability that starts while you are eligible, you will be credited with 25 disability hours for each full week of disability for the purpose of maintaining eligibility. A “certified disability” is one for which you are receiving Weekly Loss of Time Benefits from the Fund.

If you remain totally disabled for more than the 26-week period for which Loss of Time Benefits are payable, the Fund will continue granting you disability hours for up to another 26 weeks if proof of total disability is submitted.

You will not be entitled to disability hours if your disability begins during a coverage quarter for which you made a full 300-hour self-payment, unless you were available for work, not turning down calls, and eligible for SUB Fund benefits, or would be eligible for SUB Fund benefits had you not already received the maximum state unemployment benefits available.

Your eligibility for disability hours will end if:

1. You recover from your total disability and/or return to work;
2. You lose eligibility for Loss of Time benefits before receiving 26 weeks of benefits; or
3. You fail to provide evidence of disability, such as a doctor’s statement.

Eligibility During Permanent and Total Disability

If you continue to be totally disabled beyond 52 weeks, you can continue receiving disability hours for up to 30 months following the initial date of your disability, provided that you are receiving or applying for a Social Security Disability award.

You are not entitled to this extension if you elect COBRA coverage.

Your benefits will terminate on the last day of the month through which the 30 months of disability hours extended your eligibility, unless you qualify for Retiree Benefits. Your coverage will end sooner if your disability ceases or you fail to provide evidence of disability, such as a copy of your application for a Social Security Disability award.

If you recover from your total disability and/or return to work, then your eligibility will be based on the requirements for continued eligibility and not based on the initial eligibility requirements for new participants.

Reciprocity

The I.B.E.W. uses the Electronic Reciprocal Transfer System (ERTS) for reciprocity transfers. If you want this Fund to be your home fund when you travel outside its jurisdiction, you should register with ERTS. You can register online at any I.B.E.W. Local Union office. You cannot be given proper credit for your reciprocity hours until you register with ERTS.

When Eligibility Ends

Your eligibility will end:

1. At the end of the coverage quarter for which you do not have the required credited hours, unless you make a correct and timely short-hours self-payment or COBRA self-payment. Coverage quarters end on March 31, June 30, September 30 and December 31.
2. If you are eligible due to short-hours self-payments, at the end of the last coverage quarter corresponding to the contribution quarter for which you made self-payments, or were permitted to make selfpayments. (You can make full self-payments for a maximum of four successive quarters.)
3. If you are eligible under the rules governing extended eligibility due to temporary disability or permanent and total disability, the end of the coverage quarter corresponding to the contribution quarter for which you had sufficient credited hours (disability hours plus hours for which an employer made contributions) to satisfy the eligibility requirements.
4. The date you enter the armed forces, unless you are entitled to make and do make self-payments for continued coverage.
5. The date the Trustees terminate the benefits provided by this Plan.
6. If you are making COBRA self-payments, at the end of the last day of the applicable maximum coverage period to which you were entitled and for which correct and on-time self-payments have been made or, on the date of occurrence of any of the events stated in “Termination of COBRA Coverage” on page 28, whichever occurs first.

How Eligibility Can Be Reinstated

If you lose eligibility for benefits because you do not have the required credited hours or you have not made the required self-payment, you may again become eligible as a new participant as described beginning on page 17. In no event will your eligibility be reinstated prior to the beginning of the next coverage quarter following your loss of coverage.

ELIGIBILITY FOR CLASS 3 (NON-BARGAINED-FOR) PARTICIPANTS

The eligibility rules for Class 3 (non-bargained-for) participants are governed by participation agreements between the Trustees and the employers that require contributions on a month-to-month basis.

• A participant covered by such an agreement will become initially eligible on the first day of his or her first full calendar month of employment for which the employer makes a contribution to the Fund. For example, if the employee starts work on January 15th, his or her coverage will begin on February 1. The employee will remain eligible through the end of the last month in which his or her employment terminates and for which the employer has made continuous contributions.
• Eligible Class 3 participants and their dependents will be covered under the Plan A benefit schedule, the same schedule provided for Class 1 employees and dependents. And, like Class 1, Class 3 participants are subject to the Wellness Program requirements. Failure of a Class 3 employee and spouse to comply with those requirements will result in coverage under Plan C, the non-compliance schedule, for the following year.
• The provisions governing short-hours self-payments, eligibility during disability, and retiree coverage do NOT apply to Class 3 employees. Class 3 participants and dependents can, however, make COBRA self-payments if coverage terminates due a COBRA qualifying event.

ELIGIBILITY FOR CLASS 6 (OWNERS IN FACT)

The eligibility rules for Class 6 participants (owners in fact) are governed by a collective bargaining agreement between the Union and the company. Contributions are required to be made for a specified amount for each hour worked.

• Eligibility is based on hours in the same manner as bargaining unit employees (Class 1), except that 437.5 hours are needed per quarter and the lookback rule does not apply.

ELIGIBILITY FOR CLASS 6 (OWNERS IN FACT)

• Eligible Class 6 participants and their dependents will be covered under the Plan A benefit schedule, the same schedule provided for Class 1 employees and dependents. The Wellness Program requirements apply to Class 6 – failure of a Class 6 participant and spouse to comply with those requirements will result in coverage under Plan C, the non-compliance schedule, for the following year.
• Class 6 participants CAN make self-payments for short hours under the Class 1 rules except that 437.5 hours are required instead of 300 hours.
• The Class 1 eligibility during disability and COBRA provisions, and retiree coverage do apply to Class 6 participants. However, a Class 6 participant or dependent will generally not be eligible for COBRA based upon a “reduction in hours” because 437.5 hours are required to be paid for a Class 6 participant regardless of the number of hours worked.

ELIGIBILITY FOR CLASS 7 (STAFF)

Class 7 participants are non-bargained-for employees who work in the Welfare Fund Office, or in the offices of Local 701 and its affiliated entities. Coverage for Class 7 participants is governed by participation agreements with the Trustees that require contributions on a month-to-month basis.

• Initial coverage for Class 7 participants begins on the first day of the month following one full month of employment. For example, if the employee starts work on January 15th, his or her coverage will begin on March 1. Coverage will remain in effect until the last day of the month following the month in which employment terminates. For example, if employment terminates September 15^th, coverage under the Fund will terminate October 31.
• The Wellness Program requirements apply to Class 7 – failure of a Class 7 employee and spouse to comply with the requirements will result in coverage under Plan C, the non-compliance schedule, for the following year.
• The provisions governing short-hours self-payments, eligibility during disability do NOT apply to Class 7 participants, but Class 7 participants and dependents can make COBRA self-payments if coverage terminates due a COBRA qualifying event.

ELIGIBILITY FOR CLASS 11 (FACTORY SIGN) PARTICIPANTS

The eligibility rules for Class 11 (factory sign) employees are governed by a collective bargaining agreement requiring employer contributions for a specified amount on a month-to-month basis.

• An employee covered by such an agreement will become initially eligible on the first day of the month for which a monthly contribution is made, and will remain eligible through the end of the last month for which the contributions are continuously made. • Eligible Class 11 employees and their dependents will be covered under the Plan 11 benefit schedule. Failure of a Class 11 employee and spouse to comply with the Wellness Program requirements will result in coverage under Plan 11-C, the non-compliance schedule, for the following year.
• The provisions governing short-hours self-payments, eligibility during disability and retiree coverage do NOT apply to Class 11 employees. However, Class 11 employees and dependents can make COBRA self-payments if coverage terminates due a COBRA qualifying event.

ELIGIBILITY PROVISIONS APPLICABLE TO ALL PARTICIPANTS

Family and Medical Leave Act (FMLA)

The Family Medical Leave Act (FMLA) requires certain employers (but not all) to grant unpaid leave. In general, affected employers must grant you a short-term leave for specific reasons, such as the birth of a child or a serious family illness. Eligibility for this unpaid leave is determined by the employer, not by the Trustees of this Fund.

If you are granted a FMLA leave, your employer must provide the necessary documentation and make contributions to the Fund on your behalf. Failure of your employer to submit contributions on a timely basis will result in loss of coverage under this Plan.

The Fund does not determine whether or not you are entitled to a family medical leave, or whether or not your employer must make contributions during a FMLA leave.

Coverage During Military Service

Eligibility Freeze - If you are a Class 1 participant and leave employment with a contributing employer to enter active duty in the uniformed services of the United States for at least 30 days, any hours you have accumulated will be frozen during your period of active duty. If you are in one of the other eligibility classes, your coverage will be suspended during any period of active duty for which your employer is not required to continue making contributions.

After your release from active duty under circumstances entitling you to reemployment under federal law, your eligibility and accumulated hours will be reinstated on the date you return to work with a contributing employer, provided your return to work is within the time prescribed by federal law.

Self-Payments - You may also choose to make self-payments for continued coverage for up to 24 months, regardless of any coverage provided by the military or government. You will not need this coverage for yourself, but you may want to maintain coverage under this Fund for your dependents. You are only entitled to make these self-payments if you are covered under the Plan but leave covered employment for active duty in the U.S. military for at least 30 days. The payment amounts, rules and provisions for continued coverage during military leave are very similar to COBRA coverage.

Upon your return, if your frozen eligibility is insufficient to re-establish your eligibility under the regular rules, you can continue making self-payments until you re-establish eligibility under the regular rules (assuming you haven’t previously reached the 24-month limit).

For Additional Information - For more information about your self-payment rights during military service, contact the Fund Office. More information about the re-employment rights of persons returning to work from the uniformed services of the United States is available from the Veterans’ Employment and Training Administration of the United States Department of Labor.

ELIGIBILITY FOR DEPENDENTS OF ACTIVE PARTICIPANTS

If you meet the eligibility requirements, your dependents will be eligible for benefits under this Plan if they meet the definition of “dependent” found on page 74 of this booklet. Dependents are always covered under the same benefit plan as the participant.

Your dependents will be eligible for benefits as long as your eligibility is maintained in accordance with the participant eligibility rules and any applicable continuation of coverage rules explained in the Plan.

New Dependents

If you acquire a dependent while eligible for benefit coverage, that dependent will automatically and immediately be eligible for benefits. Adopted children are covered from the time they are placed in your home for adoption. Contact the Fund Office for the forms needed to add a new dependent to your coverage. You will be asked to send written documentation to demonstrate that the person meets the Plan’s definition of a dependent. For example, you are required to submit your marriage certificate, your family’s birth certificates, plus all relevant court orders.

If Both Parents Are Covered as Participants

If both you and your spouse are eligible participants under this Plan, your children are covered as dependents of both of you, and the coordination of benefits rules apply. Those rules start on page 68.

Working Spouse Rule

If your spouse works and is eligible for coverage through his or her employer (a plan in which the employer contributes some or all of the premiums), then that plan is primary and this Plan will be secondary for all your spouse’s medical claims. The Plan will be secondary under these circumstances even if your spouse does not elect the employer’s coverage. In such a case, the primary plan’s benefit level will be deemed to be 80% of this Plan’s allowable charges, and the 20% balance will be the maximum payable by this Plan.

Hardship Exemption

The 20% Plan payment rule will not apply if your spouse:

1. Has gross annual wages of less than $20,000; or
2. Has gross annual wages greater than or equal to $20,000 but less than $30,000, and must pay more than $100 per month toward the cost of the least expensive health plan offered by his or her employer.

You are responsible for demonstrating your entitlement to a hardship exemption by submitting a letter attesting to wages and cost of coverage from the employer on company letterhead. The Fund Office will determine whether a spouse with variable wages qualifies for the hardship exemption by looking at the spouse’s average wages over the past 12 months.

Additional Provisions and Exceptions to the 20% Payment Rule:

1. The 20% rule only applies to your spouse’s claims, not to claims incurred by your children.
2. It applies to retirees as well as active employees, but only if the retiree’s spouse is still actively employed.
3. It does not apply to COBRA coverage, meaning that if your spouse terminates employment and declines COBRA, this Plan will pay its normal benefits (instead of 20%).
4. The rule only applies to medical and drug expenses. Enrollment in the employer’s dental and/or vision plan is not required. (However, if your spouse does enroll in the employer’s dental and/or vision programs, this Plan will coordinate benefits and pay secondary to the employer’s plan.)
5. The rule applies without regard to whether or not your spouse’s employer requires its employees to pay for part of the premium, whether or not the employer offers an incentive to induce employees not to enroll, and whether or not the employer offers a single-only coverage option. It also applies if the employer only offers medical coverage as an option under a cafeteria plan.
6. If this Plan pays 20% of your spouse’s claims because of this rule, his or her coinsurance shares will not apply to the Plan’s out-of-pocket limits, nor will the claim be paid at 100% if the applicable out-ofpocket limit was previously met by other charges.
7. No reductions will apply to a particular claim if you can demonstrate that your spouse’s claim would have been denied under the employer’s plan.
8. The requirement to enroll in the employer’s plan will not apply if the only health plan offered by your spouse’s employer is an HMO plan, and your residence is more than 25 miles outside the HMO service area.
9. If your spouse is covered under his or her employer’s plan, then your spouse must receive his or her medical care in accordance with that plan’s rules. This Plan will not cover the amount of the other plan’s noncompliance penalties, or any charges incurred because of failure to follow the other plan’s rules, including failure to use HMO providers or follow the HMO’s referral procedures. (This also applies to claims for your children when your spouse’s plan is primary).
10. You are required to provide accurate and timely information to the Fund about your spouse’s employment status and benefit entitlement, and the Fund Office may require verification of this information from your spouse’s employer.

When Dependent Eligibility Ends

The eligibility of a dependent will end on the earliest of any of the following dates:

1. The date your eligibility under the Plan ends (unless the dependent makes a correct and timely selfpayment for COBRA coverage);
2. The end of the calendar month during which the person no longer meets the definition of a “dependent” as described on page 74; or
3. In the event of your death, after any accumulated eligibility has been run out. After that, your surviving spouse may make COBRA self-payments to continue coverage for himself or herself and any dependent children.

If, upon your death, you met the eligibility requirements for retiree coverage (as described on page 30), and your surviving spouse is eligible for preretirement survivor benefits from the Electrical Workers General Pension Fund, your spouse will be able to elect and self-pay for retiree benefits after your accumulated active employee eligibility has been exhausted. If you have no surviving spouse, your eligible children who are eligible for preretirement survivor benefits from the Pension Fund can elect to make the self-payments until they no longer meet the definition of a “dependent.”

COBRA CONTINUATION COVERAGE

You may elect continuation coverage as required under the Consolidated Omnibus Budget Reconciliation Act of 1986 (“COBRA”) as an alternative to any other self-payment provisions provided under this Plan. If you choose COBRA Continuation Coverage (COBRA coverage), you cannot elect any other self-pay option under this Plan. If you were making short-hours self-payments, you can elect COBRA coverage at the end of your self-pay period, provided however that your maximum coverage period of 18 months will begin in the month in which you first made a short-hours self-payment.

Qualifying Event/Maximum Coverage Period

You or your dependents may continue health coverage for up to 18 months after Plan coverage would otherwise terminate due to one of the following events (called a “qualifying event”):

1. A reduction in the number of your work hours; or
2. Termination of employment for any reason other than gross misconduct.

If you or any of your dependents are disabled as defined by Social Security for the purpose of Social Security Disability benefits on the date of one of the qualifying events listed above, or if you or any of your dependents becomes so disabled within 60 days after an 18-month COBRA period starts, the maximum coverage period will be 29 months for all members of your family who were covered under the Plan on the day before that qualifying event. The COBRA self-payment is higher for the extra 11 months of coverage.

Your dependent may continue health coverage for up to 36 months after Plan coverage would otherwise terminate due to one of the following “qualifying events”:

1. Divorce or legal separation from you;
2. Your death; or
3. Your child’s loss of dependent status by failing to meet the definition of a “dependent.”

Multiple Qualifying Events

If your dependents are covered under an 18-month COBRA period due to termination of your employment or a reduction in hours, their COBRA coverage period may be extended as explained below if a second qualifying event (any of the following qualifying events) occurs during that 18-month period: your death, a child’s failure to meet the definition of a “dependent,” or your divorce or legal separation from your spouse.

If any of these events occur, your spouse and children (or the child) are entitled to elect COBRA coverage for up to a maximum of 36 months minus the number of months of COBRA coverage already received under the 18-month continuation.

Only a person (spouse or child) who was your dependent on the day before the occurrence of the first qualifying event (termination of your employment or a reduction in hours) is entitled to make an election for this extended coverage when a second qualifying event occurs except as follows: if a child is born to you (the eligible participant), adopted by you or placed with you for adoption during the first 18-month continuation period, that child will have the same election rights when a second qualifying event occurs as those of a person who was your dependent on the day before the first qualifying event.

It is the affected dependent’s responsibility to notify the Fund Office within 60 days after a second qualifying event occurs. If the Fund Office is not notified within 60 days, the dependent will lose the right to extend COBRA coverage beyond the original 18-month period.

Special Medicare Entitlement Rule

A special rule for dependents provides that if a covered employee becomes entitled to Medicare benefits (either Part A or Part B) before experiencing a qualifying event that is a termination of employment or a reduction of hours, the period of coverage for the employee’s spouse and dependent children ends with the later of the 36-month period that begins on the date the covered employee became entitled to Medicare, or the 18- or 29-month period (whichever applies) that begins on the date of the employee’s termination of employment or reduction of employment hours.

Your Notification Responsibilities

If a child loses dependent status or if you get divorced from your spouse, you or your dependent must notify the Fund Office within 60 days of any of these events or within 60 days of the date coverage for the affected persons would terminate, whichever date is later. If written notification is not provided within these time limits, your spouse or child will not be entitled to COBRA coverage.

It is your employer’s responsibility to notify the Fund Office of any other qualifying events that could cause loss of coverage. However, to make sure you are sent notification of your election rights as soon as possible, you or your dependent should notify the Fund Office any time any type of qualifying event occurs.

So that the Fund Office can give proper notification when coverage terminates, please be sure they always have the current mailing address for you and all your covered dependents.

Electing COBRA Coverage

When the Fund Office is notified of a qualifying event, an election notice and election form will be sent to you and/or your dependents who would lose coverage due to the event. The election notice tells you about your right to elect COBRA coverage, the due dates, the amount of the self-payments, etc. The election form is the form you or your dependent fills in and returns to the Fund Office if you want to elect COBRA coverage.

The person electing COBRA coverage has 60 days after he is sent the election notice or 60 days after his/her coverage would terminate, whichever is later, to return the completed election form. An election of COBRA coverage is considered to be made on the date the election form is personally delivered or mailed back to the Fund. The postmark will govern the date of the mailing.

If the election form is not returned to the Fund Office within the allowable period, you and/or your dependents will be considered to have waived your right to COBRA coverage.

Benefits Provided Under COBRA Coverage

The benefits provided under COBRA coverage are the same health care benefits for that which you or your dependents were eligible on the day before the qualifying event, except that you will not be eligible for Life Insurance, Accidental Death and Dismemberment Insurance or Weekly Loss of Time Benefits. You have the option of omitting dental and vision coverage for a lesser payment amount.

You or your dependent who is losing coverage will be required to pay the full monthly cost of health coverage as established by the Trustees. You or your dependent will have the option to continue medical benefits only or to continue medical, dental and vision benefits.

Class 1 and Class 6 participants eligible for regular (Plan A) COBRA will be given the option of electing Plan B COBRA instead, but the person’s coverage option cannot be changed during his or her COBRA coverage period.

A change in the benefits provided by the Plan or the cost of coverage will apply to you or your dependent the same way it would if you were covered under the regular provisions of the Plan.

COBRA Self-Payment Rules

1. COBRA self-payments must be made monthly.
2. The amount of the monthly self-payments are determined by the Trustees based on federal regulations. The amounts are subject to change.
3. A person electing COBRA coverage has 45 days after the signed election form is returned to the Fund Office to make the initial (first) self-payment for coverage provided between the date coverage would have terminated and the date of the payment. (If a person waits 45 days to make the initial payment, one or more monthly payments may also fall due within that period and must also be paid at that time.)
4. The due date for each following monthly self-payment is the first day of the month for which payment is made. A monthly self-payment will be considered on time if it is received within 30 days of the due date.
5. If a self-payment is not made within the time allowed, COBRA coverage for all affected family members will terminate. You may not make up the payment or reinstate coverage by making future payments.

Additional COBRA Coverage Rules

1. COBRA coverage may not be elected by anyone who was not covered under the Plan on the day before the occurrence of a qualifying event.
2. Each member of your family who would lose coverage because of a qualifying event is entitled to make a separate election of COBRA coverage. However, if you elect COBRA coverage for yourself and your dependents, your election is binding on your dependents.
3. If coverage is going to terminate due to your termination of employment or reduction in hours and you don’t elect COBRA coverage for your dependents when they were entitled to the coverage, your dependent spouse has the right to elect COBRA coverage for up to 18-months for himself or herself and any children within the time period that you could have elected COBRA coverage.
4. You do not have to show proof that you and/or your dependents are insurable in order to be entitled to COBRA coverage.

Termination of COBRA Coverage

Normally COBRA coverage for a covered person will terminate at the end of the last month of the applicable maximum coverage period to which the person was entitled and for which correct and on-time selfpayments were made. However, COBRA coverage for a covered person will terminate before the end of the applicable maximum coverage period when the first of the following events occurs:

1. A correct and on-time payment is not made to the Fund;
2. The IBEW Local 701 Welfare Fund no longer provides group health care coverage to any participants;
3. If the person has been receiving extended COBRA coverage for up to an additional 11 months due to his/her or another family member’s disability, and Social Security has determined that he or the other family member is no longer disabled;
4. The person becomes covered under another group health plan as a participant or otherwise after his/her COBRA election date; or
5. The person becomes entitled to Medicare after his or her COBRA election date.

Alternatives for Coverage Other than COBRA

There may be other coverage options for you and your family. You are now able to buy coverage through the Health Insurance Marketplace. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and outof-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the Marketplace. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse’s plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days.

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