Please note that the eligibility guidelines outlined below are standard guidelines and may not apply to all Employers and their employees.
Employee Eligibility Rules
Only “employees” of a “participating Employer” are eligible for coverage under the Plan on the following date:
If you are an “employee” of a “participating employer” on the date your Employer begins participation in the Teamsters Managed Trust Funds, you will become eligible for benefits pursuant to the terms required under the “Collective Bargaining Agreement” and your Employer makes the required contribution to the Trust Fund on your behalf.
If you are hired after your Employer has begun participation in the Trust Fund, you will become eligible for benefits on the first day of the month following the third month in any six consecutive months in which you satisfy the terms required under the “Collective Bargaining Agreement” and your Employer makes the required contributions to the Trust Fund on your behalf.
If you have been eligible for benefits under another Teamsters Taft-Hartley Health and Welfare Trust Fund within the last twelve (12) months, you will become eligible for benefits on the first day of the month immediately following a month in which you work the hours required under the “Collective Bargaining Agreement” and your employer makes the required contribution to the Trust Fund on your behalf.
Continuation of Eligibility for Active Employees
Once you have established initial eligibility, you will remain eligible for benefits provided that you work the required hours and your Employer makes the required contributions to the Trust Fund on your behalf. Eligibility for benefits in any month is contingent upon receipt of the required contributions.
Termination of Eligibility
Your eligibility for benefits will automatically terminate on the earliest of the following dates:
1. The date on which you enter full-time military service; or
2. The first day of a month in which your Employer fails to make the required contribution to the Trust Fund on your behalf; or
3. The date the Plan terminates.
Reinstatement of Eligibility
If you become covered under the Plan, lose eligibility and then return to work for a “participating Employer” your eligibility date will be the first day of the month immediately following a month in which you work the hours required under the “Collective Bargaining Agreement” and your Employer makes the required contribution to the Trust Fund on your behalf.
Dependent Eligibility Rules
1. Your lawful spouse.
2. Your children (including stepchildren, legally adopted children and children for whom you or your spouse are the court appointed legal guardian) less than 26 years of age.
*Note: The Plan is no longer covering Domestic Partners, effective January 1, 2016.
1. The term dependent will not include any person who is in full-time service of the Armed Forces, who lives outside the Continental United States or who is eligible as an “employee.”
2. Foster children and children for whom you are not the legal guardian may not be eligible as dependents.
3. If both parents are eligible under the Plan as employees, a child may be included as a dependent of both.
Initial Dependent Eligibility
Individual providers have their own rules on when a dependent first becomes eligible. See the provider plan summaries for initial dependent eligibility rules.
Enrolling Newly Acquired Dependents
To enroll newly acquired dependents including a newborn, contact the Plan Administrative Office, complete a new Enrollment Application within thirty-one (31) days and supply evidence of dependent status, as may be required. You must also complete any applications or forms your providers require to enroll a new dependent.
Termination of Dependent Eligibility
Dependents cease to be eligible on:
1. The day that eligibility for the “employee” ceases, or
2. The date the dependent ceases to be eligible as a dependent as set forth under the definition of dependent. For Example: Your child ordinarily will lose eligibility at age 26.
Retiree Eligibility Rules
A person who has retired from active employment under the Teamsters Managed Health Care Trust Fund is eligible for benefits under the plan if the following conditions are met:
1. He/She is at least 55 years of age (see Note (a) below) or has qualified under Federal Social Security for monthly benefits; and
2. He/She is not eligible as an active employee under any plan of group insurance or group coverage; and
3. He/She makes timely self-payments (see Note (d) below) in an amount as determined by the Board of Trustees; and
4. There is no gap in coverage between eligibility as an active employee covered under the Trust Fund, and eligibility as a retiree (see Note (b) below); and
5. He/She was employed at the time of retirement by an employer who contributes to the Trust Fund, and the employer continues to contribute to the Trust Fund (see Note (c) below).
Note (a): The minimum age requirement will be waived for retirees younger than 55 receiving a monthly pension from the Western Conference of Teamsters (WCT) Pension Fund or any other pension plan approved by the Board of Trustees.
Note (b): A gap in coverage will be waived in cases of disability retirement so long as the application for benefits is made on a timely basis, after receipt of notice of entitlement to Social Security and the relevant Pension Fund. Copies of both the notice of Social Security eligibility and certification of pension entitlement are required to establish eligibility in this plan.
Note (c): If the former employer ceases to make contributions to this Trust Fund and makes contributions to any other health plan for the covered collective bargaining unit, he/she will cease to be eligible for benefits, except in the event of a plant closure.
Note (d): In some specific and exceptional situations, these contribution payments may be made by an employer.