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An Outline Describing the Basic Eligibility Rules of Five Rivers Carpenters Health and Welfare Plan for Bargaining Unit Employees

Basic Rules

Dollar Bank (DB) and HRA Accounts

  • When money in the form of employer contributions is first received on your behalf, it is credited to your Dollar Bank account which is used to provide life insurance, AD&D benefits and short-term disability benefits. (Although your DB account pays for these benefits, you are only entitled to these benefits when you are also eligible for medical/Rx benefits.)
  • When your dollar bank reaches $150, the excess is credited to your HRA account. There is no maximum on how much you can accumulate in your HRA account. Your HRA account is used to cover eligibility for all the other benefits provided by the Five RiversH&W Plan, including medical and prescription drugs.

Dollar Bank (DB) = $150

HRA = No maximum

Contribution (Work) Quarters and Benefit Quarters

Eligibility for Plan benefits is determined on a quarterly basis. Contribution (work) quarters and benefit quarters are separated by an administrative lag month as shown below:

Contribution (Work) Quarter Lag Month Benefit Quarter
September, October, November December January, February, March
December, January, February March April, May, June
March, April, May June July, August, September
June, July, August September October, November, December

Initial Eligibility

  • A NEW employee will become initially eligible on the first day of the month after the Fund has received and credited a total $3,100 to his or her DB and HRA accounts. (Employers are supposed to make their payments the month following a work month.)

    Example of Initial Eligibility

    Contributions Received Running Total Employer Sends Payment Effective Date
    $700 for March work $700
    $900 for April work $1,600
    $900 for May work $2,500
    $900 for June work $3,400 July August

  • A NEW employee’s initial eligibility date may or may not be the first day of a benefit quarter. But, either way,the newly eligible employee will remain eligible through the end of the benefit quarter in which his or her initial eligibility date falls.

    In the example above, the employee became eligible August 1, which is not the first day of a benefit quarter. This mid-quarter eligibility rule only applies to NEW employees.

    Mid-Quarter Eligibility is Only for NEW Employees

    A NEW employee is someone who has never been covered by this Fund before

    • Benefit Quarter:
    • July
    • August
    • September

  • The NEW employee’s DB/HRA accounts will be charged $1,034 for each month of coverage remaining in the initial eligibility quarter. $1,034 is 1/3 of the amount required for a quarter of coverage. (Part of the $1,034 will come from your DB and some from your HRA, based on the cost of the various coverages.)

Continuing Eligibility

  • Continuing eligibility is based on whether or not you have $3,100 in your DB and HRA accounts to cover another benefit quarter.
  • You can make up the difference with a self-payment if your DB and HRA accounts are insufficient for the next quarter’s eligibility. In order to self-pay you must be available to work for a contributory employer.
  • Self-payments can be made for a maximum of four consecutive quarters. Or, you can elect COBRA coverage when your eligibility terminates. COBRA is generally more expensive than self-paying for short hours, and extends coverage on a month-to-month basis.
  • If you fail to make a self-payment when you are entitled to do so, you will lose coverage and your DB and HRA account balances will be reset at $0.

Reinstatement After Loss of Coverage

If you lose coverage, your eligibility will be reinstated at the start of the next benefit quarter after you have accumulated $3,100 in your accounts.

Example of Reinstated Eligibility

Contributions Received Running Total Employer Sends Payment Effective Date
$700 for March work $700
$900 for April work $1,600
$900 for May work $2,500
$900 for June work $3,400 July October

Reinstated eligibility will become effective only on the first day of a benefit quarter (January, April, July, October).

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This Is Just a Summary

This is just a brief summary of the basic eligibility rules for bargaining unit employees. You should consult your Summary Plan Description (SPD) for a more complete explanation. If there is any unintentional discrepancy between this explanation and the Summary Plan Description (SPD) booklet, the SPD will govern.

Trustee Authority

The Trustees of the Five Rivers Fund determine the eligibility rules, which are summarized above and explained in more detail in your Summary Plan Description (SPD) booklet. The dollar amounts required for eligibility are also determined by the Fund’s Trustees, and may be changed at any time.