ESTABLISHING COVERAGE IN THE PLAN
To establish coverage in the Plan you must:
- Be a Member in good standing of District Council 38 (Local Union 138, 163, or 1527, and any future locals designated by the Trustees) and be employed by a contractor/employer signatory to an agreement with one of the aforementioned Local Unions; and
- have the required number of hours-worked (240 hours, as of July 2018) within a period of six consecutive months reported and paid for by a participating employer and/or reciprocating Local Union; and
- have completed the enrollment forms and filed them with the Administrator. If the foregoing conditions have been met, coverage will begin on the first day of the month after the month in which sufficient hours have been reported. (In the case of catastrophic loss, i.e., death of the Member, coverage will commence immediately following completion of working the required number of hours in the qualifying period, provided that enrollment forms are on file with the Administrator.)
Any hours reported and not used within the six consecutive month period to establish your eligibility for coverage (that is, hours that are seven or more months old) will go into the General Fund of the Plan.
If you are not a Member of the Union at the time you would otherwise qualify for coverage, coverage will commence on the first day of the month following the month in which you become a Member of the Union, provided you are still qualified otherwise. Your hour bank will be credited with any hours reported during the period you were not a Member. Maximum six months.
You will be notified by the Administrator as soon as possible after your entitlement to coverage is determined. Once you are covered, the prevailing hourbank charge (in hours) are deducted each month from your hour bank for coverage and additional hours reported are added to your hour bank.
You may accumulate up to twelve month’s coverage in your hour bank to carry you through periods of poor employment or vacation. Any hours in excess of the twelve months total will go into the General Fund of the Plan.
LAG MONTH
You may wonder why your coverage must always be paid in advance. A time lag is required by the Trust Fund Administration to operate the hour bank system. Hours earned in a particular month are received by the Administrator from your employer during the following month.
Premiums for the current month’s coverage must be paid to the insurer by the first of the month or payment on claims for that month will be delayed.
SELF PAYMENT – FULL COVERAGE PLAN
You will be notified by mail when your hour bank falls below the required hour minimum. You may also check your record at any time with the Administrator. This notice will advise that you are short of hours for the next month’s coverage, the amount of the self-payment required and the date by which it must be paid.
The self payment provision for the Full Plan is allowed for as long as you have a minimum of one hour in your hour bank. When you no longer have a minimum hour bank balance, you will be required to change to the Partial or Mini Package.
THE ONLY WAY TO GUARANTEE CONTINUOUS COVERAGE IS TO PAY THE SELF-PAYMENT NOTICE BY THE DATE SPECIFIED ON THE NOTICE
If you receive a self-payment notice which you think is incorrect, pay the notice by the required due date and send in an accompanying letter explaining why you feel the notice is incorrect.
Shortages can occur because your employer did not report within the required time frame, because your name was accidentally left off the report, because of an error in the number of hours reported, a name misspelled, or an invalid Social Insurance Number was used. If you make a self-payment and late hours are reported or other adjustments are found later, all hours will be credited to your hour bank for future coverage.
EXAMPLE:
| Month The Hours Were Worked | The Month The Hours Were Reported to The Union | Month That The Hours are Used Toward Health Coverage | Hour Bank Balance (Beginning of Month) | Total Hours Worked (Hours Applied to Hour Bank) | Cost of Coverage | Hour Bank Balance (End of Month) | |
|---|---|---|---|---|---|---|---|
| 1 | January | February | 0 | 0 | 0 | 0 | |
| 2 | February | March | 0 | 150 | 0 | 150 | |
| 3 | March | April | May | 150 | 125 | 120 | 155 |
| 4 | April | May | June | 155 | 115 | 120 | 150 |
| 5 | May | June | July | 150 | 160 | 120 | 190 |
| 6 | June | July | August | 190 | 95 | 120 | 165 |
| 7 | July | August | September | 165 | 0 | 120 | 45 |
| 8 | August | September | October | 45 | 0 | 120 | 0 |
| 9 | September | October | November | 0 | 0 | 120 | 0 |
- No hours are worked by the member during the month of January.
- 150 hours were worked during February. The employer remitted (submitted) those hours to the union in March. Because the balance of the hour bank was less than 240 (the minimum required to start participating in the plan), the member did not receive coverage for the following month.
- 125 hours were worked during March. The employer remitted those hours to the Union in April. The balance of the Hour Bank was greater than 240, and because the employee was a Union member at the time (the Union had received their initiation fee) they received benefits beginning May 1st. On April 30th, 120 hours were deducted from the member’s hour bank to pay for coverage.
- 115 hours were worked during April. The employer remitted those hours to the Union in May. On May 31st, the Union deducted 120 hours for June coverage.
- 160 hours were worked during May. The employer remitted those hours to the Union in June. On June 30th, the Union deducted 120 hours for July coverage.
- 95 hours were worked during June. The employer remitted those hours to the Union in July. On July 31st, the Union deducted 120 hours for August coverage.
- No hours were worked in July, so no hours were remitted by the employer in August. There was an opening hour bank balance of 165 hours, 120 hours were used to pay for September coverage, leaving 45 hours in the hour bank.
- No hours were worked in August, so no hours were remitted by the employer in September. Since the opening hour bank balance was only 45 hours, the member can either let their benefit coverage lapse, or they can choose to pay the difference. The rate for each hour that is “short” is $2. Since this member is 75 hours short for coverage (120-45 = 75), the cost would be $150 (75 x $2)
- Provided the member meets certain conditions, they can self-pay to continue their benefits, up to a maximum number of months.
TERMINATION OF COVERAGE
Coverage for you and your eligible dependents is always provided on a whole calendar month basis only and will be terminated:
- When your hour bank balance falls below the minimum required number of hours and you fail to make the self payment required by the specified date. Hour bank balances less than the minimum required number of hours will go into the General Fund of the Plan if the coverage is terminated because a self-payment is not made.
- When you take a clearance card to a non-participating Local. Coverage will be extended for a maximum of two months after the month in which you leave the province of BC on a permanent basis. All hours in your hour bank at termination of coverage for that reason will go into the General Fund of the Plan.
- When you stop being a Member in good standing of the Union. Coverage will be cancelled as of the date on which you are suspended or dropped and any hour bank balance will go into the General Fund of the Plan.
- When you become self-employed or work on a sub-contract basis or go to work outside the Trade. In those cases, coverage will terminate at the end of the month in which you cease to be a union employee. All hours in your hour bank at termination of coverage for those reasons will go into the General Fund of the Plan. (See Associate Members).
- When you become a contractor signatory to an agreement with the Union or a principal in, or an administrative staff Member of same. In that case coverage will be terminated at the end of the month in which you became a contractor, principal or administrative staff Member. All hours in your hour bank at termination of coverage for those reasons will go into the General Fund of the Plan. (See Associate Members).
- In the event of the death of a Member, coverage for the Member’s spouse and eligible dependents will continue for as long as the Member’s accumulated Full Coverage hour bank will allow.
- In the event of a decertification from the Union where the Members choose to remain employed by the decertified employer, coverage for the Members will be terminated on the last day of the month in which the decertification occurred.
RE-QUALIFICATION AFTER TERMINATION
To re-qualify for coverage after termination, the conditions outlined in “Establishing Coverage In The Plan”, must be fulfilled as they must for new Members.