Section II: Eligibility Rules

RETIREES

Persons qualified to be insured:
All retirees who are receiving a pension from the U.A. Local 447 Pension Plan and:

1. Who worked in covered employment at least 300 hours per year in seven of the ten consecutive Plan years preceding retirement. Any hours lost from covered employment because of Total Disability during this period are considered qualifying hours in the same manner as hours worked; AND
2. Who were covered under this Health and Welfare Plan immediately prior to retirement; AND
3. Who have made any necessary self-payments, in accordance with the rules set forth by the Trustees; AND
4. Who have waived COBRA coverage as an active and completed an application electing retiree coverage under this Health & Welfare Plan.

When Your Coverage Begins
Your coverage becomes effective on the first day of the month following the month in which your hour bank reserve drops below 135 hours, provided you have satisfied all of the above eligibility rules.

No Medical Examination
No medical examination is required to obtain insurance for you or your dependents.

Notice of Enrollment Rights
If you decline (or previously declined) enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to elect retiree coverage for yourself or your dependents in this Plan, provided that you request enrollment within 30 days after your other coverage ends and provided that you declared in writing to the Plan that you declined enrollment due to the existence of other coverage. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

When Retiree Coverage Terminates
Your retiree coverage will end:

1. On the last day of the month for which you made the applicable copayment, if you fail to make subsequent payments;
2. On the date the Plan ends; or
3. The first day of any month for which your pension benefits are suspended.

The term “children” includes your natural children, legally adopted children, stepchildren, and foster children who are entirely supported by you and for whom you are the legal guardian. Note: Foster children are not eligible for coverage under the Kaiser medical plan. In all cases the child must be unmarried, under the age of 19 (or 25 if a full-time student) and qualified as your dependent for income tax purposes.

The Trustees may require proof of eligibility, such as a birth certificate, court adoption order, Social Security Foster Care Agreement, proof of legal guardianship, and/or income tax return showing dependency of the child.

A child will continue to be eligible for dependent coverage if, within 31 days after he or she would otherwise lose dependent status, you give proof to the administrative office that the child is incapable of earning a living due to mental retardation or physical handicap. The child must have been a covered dependent immediately before the request for continued dependent status. Children will continue to be considered dependents under this rule as long as they remain unmarried and mentally or physically incapable of earning a living. You must submit annual proof of the continued incapacity.

When Coverage Begins for Dependents
If you have eligible dependents when your insurance becomes effective, coverage for them usually begins on the same day. If you acquire an eligible dependent after your coverage starts, your dependent’s coverage will start on the date you gain the dependent. Immediate coverage is available for each newborn child of an eligible retiree and for any minor child placed in the physical custody of an eligible retiree for adoption.

Newborn children are not eligible for routine neonatal or nursery care except in certain Preferred Hospitals. For more information, call the administrative office before the baby is due.

When Coverage Ends for Dependents
In general, coverage for your dependents ends on the date your coverage ends. However, coverage will also end:

1. on the last day of the month in which your dependent no longer meets the eligibility requirements outlined in this booklet (e.g. the end of the month in which your non-student child turns 19);
2. on the date that your dependent enters full-time military, naval or air service; or
3. on the date that this Plan ends.

Concealment or omission of material information, such as a divorce or a child’s loss of student eligibility, is considered a false statement covered by this rule.

If your eligibility is suspended under this rule, you will not be permitted to purchase COBRA continuation coverage.

The Trustees may impose a shorter suspension or no suspension if they determine that the false statement was negligent rather than intentional. If the Trustees determine that a particular family member was solely responsible for the false statement, they may extend coverage to other eligible family members during the period of disqualification. The Trustees may require full restitution of erroneous payments before granting any relief from the suspension rule.

In addition to suspending benefit eligibility, the Trustees may report any false statement to the authorities for criminal prosecution under federal and/or state laws.

EXTENDED COVERAGE

COBRA Continuation Rights
In accordance with federal law, your eligible dependents are entitled to pay for a temporary extension of health coverage at group rates under certain circumstances.

COBRA self-payment rates are higher than retiree rates or the rates for employees who are employed under the labor contract or available for work (signed on the out of work list at the local union). Retirees and/or their dependents should check with the administrative office as to the proper self-payment rate.

If your spouse and/or dependent child loses coverage under this Plan because of your death, divorce, or the child’s disqualification as a dependent (for example, by attaining the disqualifying age or ceasing to be a full-time student), he or she may pay for continued coverage for up to 36 months.

The maximum continuation period is 36 months, even if more than one event occurs giving rise to COBRA continuation rights. The 36 month period of COBRA eligibility is reduced by months of free or subsidized coverage provided in the event of disability or death. COBRA continuation coverage will end before the 36 month period expires if: (1) your dependents fail to pay the required contribution on time; (2) your dependents become covered by another group health plan (except a plan which excludes or limits benefits for a preexisting condition affecting your dependent, and such exclusion or limitation is enforceable under Health Insurance Portability and Accountability Act); (3) your dependents become entitled to Medicare; or (4) your employer ceases to maintain any health plan for active employees. Continuation coverage will no longer be available under this Plan if this Plan terminates.

You or your dependents are responsible for notifying the administrative office when divorce occurs or when a child loses dependent status. Notice must be given within six months after the later of: (1) the divorce or loss of dependent status, or (2) the actual loss of coverage. If the required notice is not provided within the time allowed, COBRA self-payment will not be permitted.

Within 60 days after the administrative office is informed in writing of an event entitling your dependents to COBRA coverage, the office will provide detailed information concerning the coverage available and its cost. Anyone electing COBRA coverage must pay for it retroactive to the date he or she lost coverage under the Plan. Payment for this retroactive coverage is due within 60 days after the date COBRA coverage is elected. No benefit claim will be honored unless the required payment has been received for the period in which the claim was incurred.

If your dependents are covered by a regional plan (like a health maintenance organization servicing a limited area) and relocate to another area where your former employer has an active workforce, your dependents may be eligible to elect COBRA coverage under the plan provided for the active employees working in that area. Under no circumstances would such a transfer prolong the 36 month continuation period.

Retirees and their eligible dependents who lose their health coverage because the retiree’s former employer is the subject of a federal bankruptcy proceeding are entitled to COBRA continuation coverage until the death of the retiree or the eligible surviving spouse. Loss of coverage includes a substantial elimination of coverage occurring within one year before or after commencement of the bankruptcy proceeding. If the retiree elects continuation coverage and subsequently dies, surviving dependents may make self-payments for an additional 36 months. COBRA coverage in these circumstances does not terminate in the event the retiree becomes eligible for Medicare.

Extension of Medical Benefits if Coverage Terminates During Total Disability
(Does not apply to HMO members). If you or your dependent is totally disabled on the date coverage terminates, medical benefits for the disabling condition will continue at no charge until: (a) the disability ends; (b) twelve months after the individual’s termination date; or (c) you or your dependent become insured under another group plan, whichever occurs first.

Death
If your surviving spouse and other dependents are enrolled in one of the HMOs provided by the Plan, they can continue coverage under the Plan as long as they continue to pay the applicable monthly copayment, waive their COBRA rights under this retiree benefit program and remain covered by one of the Fund’s HMOs. If your surviving spouse and dependents are covered under The Union Labor Life Insurance Company at the time of your death, in order to maintain coverage under this Plan, they must enroll in one of the Plan’s HMOs within 60 days of your death, waive their COBRA rights under this retiree benefit program, and continue to pay the applicable copayment.

Conversion of Medical Coverage
When group medical insurance coverage ends you and/or your dependents may be entitled to enroll in an individual conversion plan offered by the insurance carrier or by your HMO. This coverage may cost more and/or provide fewer benefits than your group health coverage.

If you elect medical coverage through the insurance company rather than through an HMO, a major medical insurance conversion policy is available without medical examination, provided the group policy is in force when you lose eligibility under the group plan. You have 31 days after termination of your group coverage to apply and pay the required premium for such individual or family policy. The conversion policy shall become effective on the day after the date your group insurance terminates. The conversion privilege is available to your dependents in the event of your death. In addition, any of your dependents who cease to be eligible for coverage under the group plan may convert to an individual policy.

For HMO members, your right to conversion is discussed in the HMO brochure available from the administrative office.