Health and Welfare Benefit Summaries

Your Active Eligibility is based upon hours reported by employers with an agreement with Local #12 requiring contributions to the Health & Welfare Fund. You need 200 hours or more during a qualifying work quarter to be  eligible for the corresponding  eligibility quarter.  Qualifying quarters are based on calendar quarters, Jan-Mar, April-June, July-September, October-December. The corresponding  eligibility quarters are May-July,  August-October, November-January, February-April. A lag month occurs between the qualifying quarter and eligibility quarter to allow the Fund office to process the employer contributions.

If you work for certain employers who have special agreements, eligibility is on a monthly basis. For each month you work (Work Month), you earn one Eligibility Month. As with quarterly eligibility, the Work Month and Eligibility Month are separated by a one-month lag.  So, a Work Month of January, for example, provides coverage in the Eligibility Month of March.

• Legal spouse (The Fund does not provide eligibility for “common-law” spouses or domestic partnerships).
• Children under 26 years of age.
• Step-children under 26 years of age.
• Legally adopted children – children in the process of being legally adopted must live with the eligible participant or they cannot be covered.
• Foster children – you must provide a copy of the court order which establishes you as a foster parent. Usually foster parents are paid a subsistence for the child and the government agency will furnish medical coverage.
• Legal Guardianship – you must provide the court order which, pursuant to State Law, establishes Legal Guardianship.
• Physically or mentally handicapped dependent children over the age of 25 may be covered under certain circumstances.

The reserve account helps to keep you covered during quarters when you work less than 200 hours. If you work more than 400 hours in a Qualifying Quarter, those hours over 400 will be added to your reserve account. If you work less than 200 hours in a qualifying quarter, and you have sufficient hours in your reserve account, hours will be withdrawn from the reserve account to make up the 200 hours needed for continued eligibility. The maximum number of hours you can save up in your reserve account is 500.

For participants on the monthly system, each month of reporting provides a reserve of 15 hours, with a maximum reserve of 500 hours. 83 hours are withdrawn from the account for one month’s eligibility so the maximum extension for 500 hours is six months.

Your coverage will end when the combined sum of your worked hours and/or your reserve account is less than the 200 required for a quarter. When you lose coverage you may be able to make payments under the Plan’s Buy-Up Plan or through COBRA to continue coverage for a limited time. See the Buy-up/COBRA section for additional details about these programs and other potential extensions to your coverage.