EMPLOYEES

Initial Eligibility

To become eligible for benefit coverage, you must work at least 375 hours within a six-month period. Your benefit coverage begins on the first of the month two months later, provided your employer has made the required contributions on your behalf.

The following chart shows you how this works.

For example:
Bob began working in October and by the end of January had completed 375 hours of service. Since he met the eligibility requirements in January, his coverage will begin March 1.

Special Eligibility Rule When Transferring From Provisional Plan

If you are currently covered under the Provisional Plan and you are transferring into this Plan for active employees, you can qualify for coverage the first of the month following the month in which you accumulate 135 hours in reserve, or 135 hours of contributions are made by your employer on your behalf at the required rate. When you become eligible for this Plan you will become covered under Kaiser and will have the option to change to the Pipe Trades PPO Plus Self-Funded Indemnity Plan at the next open enrollment if you so desire.

Waiver of 375 Hour Requirement for New Bargaining Units

The 375 hour service requirement may be waived for bargaining unit employees who are on the employer's payroll on the effective date of the employer's first collective bargaining agreement providing for contributions to this Plan, if all the following conditions are met:

1. All persons within the bargaining unit have had comparable continuous coverage (no gap for more than 60 days) for at least 18 months prior to the effective date of coverage under the Plan, evidenced by a HIPAA certificate of creditable coverage; and
2. The employer is incorporated and has a place of business that is not a private residence; and
3. The employer has been in business for at least two years prior to the effective date of coverage under the Plan.

Waiver of 375 Hour Requirement for Certain New Hires

The 375 hour service requirement may be waived if your employer is a current contributing employer and you meet all of the following conditions:

1. You have had comparable continuous coverage (no gap for more than 60 days) for at least 18 months prior to the effective date of coverage under the Plan, evidenced by a HIPAA certificate of creditable coverage; and
2. You have been employed in the plumbing and piping industry for a minimum of two years; and
3. Your employer pays a contribution on your behalf equal to the contract rate for 135 hours by the 25th of the month prior to the first month of coverage; and
4. Your employer pays a second contribution by the 15th of the first month of coverage equaling the greater of 135 hours or the actual number of hours worked in the month prior to the first month of coverage; and
5. Thereafter your employer pays contributions on your behalf equal to the actual hours you work each month beginning with the first month of coverage.

Any waiver under this rule must be approved by the Board of Trustees. If a waiver is granted pursuant to this section and you cease to be available for work for a contributing employer within twelve (12) months after your first month of coverage, any hours in your reserve bank may be forfeited.

Coverage may begin on the first day of the following month provided the waiver applications and HIPAA certificate of coverage are submitted to the Plan by the 20th of the month. If not, coverage may begin the first day of the second month. Enrollment forms and proof of dependency must be submitted to the Plan before coverage begins.

Maintaining Eligibility

After qualifying for initial eligibility, you maintain benefit coverage as long as you continue to work at least 135 hours per month and your employer pays the required contributions.

Your Reserve Hour Bank

Hours in excess of the 135 required to maintain eligibility are credited to your reserve hour bank, up to a maximum of 810 hours equivalent to a six month reserve bank. If you work less than 135 hours in any month and have a large enough reserve balance, your reserve hours will be used to maintain your benefit coverage. When hours are deducted from your bank, your balance is reduced.

You may draw upon your hour bank to maintain coverage only while you are:

1. Working or available for work for a contractor who has signed a collective bargaining agreement with a local union affiliated with the United Association of the Plumbing and Pipefitting Industry (U.A.);
2. On vacation;
3. Disabled;
4. Retired; or
5. Newly employed by a city, county or state governmental agency or by the U.A. or any affiliated local union and not yet eligible for coverage under your employer's plan.

The Plan may require evidence that you satisfy these requirements before allowing coverage based on your hour bank. If you do not satisfy these requirements, your reserve hour bank will be cancelled and your hours forfeited.

If your hour bank balance is less than 135 hours and twelve consecutive months pass without an employer contribution made on your behalf, your hour bank will be cancelled and your hours forfeited. When you retire, you must use your hour bank reserve before converting to the retiree plan. Any remaining hours (less than 135) will be forfeited. When you retire and are eligible for retiree health benefits, your retiree coverage will begin at the beginning of the month following the month in which your hour bank balance falls below 135 hours. In other words, you will no longer be eligible for subsidized self-pay coverage under the active plan.

The application for retiree health and welfare coverage must be completed and received in the Fund Office prior to the date your active coverage terminates to ensure continuous health coverage.

Your eligibility for benefits depends on the continuous and up-to-date payment of employer contributions on your behalf. If your employer does not pay a contribution when it is due, those hours of work cannot be credited to your reserve bank.

Termination of Coverage – Employees

Your coverage ends at the end of the month in which you are credited with less than 135 total hours, whether the hours reflect actual employment, your reserve hour bank, or any combination of the two. Your hour bank will be eliminated if you go for 12 months without being covered under this Plan.

If you return to work within one year after losing active coverage, you will be eligible for coverage again on the first of the month after the month in which you again have 135 hours in one calendar month. If you return to work after more than one year without active coverage, you must again meet the initial eligibility requirements, as described on page 11.

If you work for an employer in an area that is not under the jurisdiction of Local 447, your employer is not required to contribute to the Fund on your behalf. Therefore, time spent outside of the Fund's jurisdiction will be treated as a period of unemployment as far as your eligibility for benefits is concerned. If the Fund receives contributions on your behalf for hours worked outside the jurisdiction of Local 447, you will receive pro-rated credit for those contributions, based on the Journeyman contribution to this Plan. There is usually a lag of at least 30 days before this Plan receives reciprocity contributions, which may result in an interruption in coverage and possibly a COBRA notice.

Your coverage can also end:

1. On the last day of the last month in which you meet the eligibility requirements outlined in this booklet;
2. On the date that you enter full-time military service; or
3. On the date this Plan ends.