Active Participants

You're considered an active participant if you're eligible for benefits as defined above. (See "How to Become Eligible for Benefits".)

Your Eligible Dependents
If you're eligible for benefits, you may enroll:

• Your legal spouse or same-sex domestic partner (For more information about enrolling same-sex domestic partners, see "Same-Sex Domestic Partners");
  
  
• Your unmarried children younger than age 19, including:
  
  
  • Your natural child or stepchild;
  • Your adopted child or child placed for adoption with you (coverage begins on the date the child was placed for adoption with you or the date the adoption was final, whichever is earlier); and
  • Any other child who depends on you for support and lives with you in a parent-child relationship if you provide proof of these conditions;
    
    
• Your unmarried children younger than age 23 who are full-time students in an accredited institution of higher learning and who depend on you for full support (See the Glossary for the definition of "full-time student"); and
  
  
• Unmarried children over age 19 who are incapable of self-sustaining employment because of mental retardation or physical handicap, as long as:
  
  
  • The mental retardation or physical handicap existed while the child was covered by the Fund's health plan and began before the child reached age 19, or before age 23 if the child was covered as a full-time student;
  • The child is primarily dependent on you for support; and
  • You provide evidence of incapacity to the Fund within 31 days after the child reaches age 19, or age 23 if the child was covered as a full-time student. (The Fund may ask for proof of continuing incapacity at other times during the child's coverage.)
    
    

    Important!

    Your domestic partner's children are not eligible for coverage.

Same-Sex Domestic Partners
You may enroll your same-sex domestic partner for coverage under the Fund's health plans. For purposes of the Fund's coverage, the Fund's definition of a domestic partnership is a committed same-sex relationship that:

• Has been in existence for at least six months;
  
  
• Includes financial interdependence; and
  
  
• Is intended by both partners to be permanent.

You must complete and notarize an Affidavit of Domestic Partnership and submit other documents to enroll your partner. Contact the Administrative Office for a complete information package on same-sex domestic partner coverage, including an
affidavit form.

Same-sex domestic partner coverage is different from spouse coverage. For instance:

• You're required to pay income taxes on the dollar value of the benefits provided to your domestic partner if your partner doesn't qualify as your "dependent" according to the Internal Revenue Code. You do this by paying the Fund the amount of any state and federal tax due, in advance, on a quarterly basis. The tax amount will be based on the value of the coverage the Fund provides to your partner, less the amount of your quarterly dependent premium payment.
  
  
• If you don't enroll your partner when he/she is first eligible, coverage for any pre-existing conditions will be limited. Pre-existing conditions won't be covered until the calendar quarter beginning after the earlier of:
  
  
  • 90 days after your partner was last treated for the condition; or
  • One year from the date your partner could have first received coverage.*
    
    
• Your partner's children are not eligible for coverage.
  
  
• COBRA continuation coverage is not available for your partner.
  
  
• The extension of benefits due to a disability doesn't apply to domestic partners.

* This pre-existing condition exclusion period will be reduced on a day-for-day basis if your partner provides a certificate of creditable coverage indicating that he/she didn't have a break in coverage of 63 days or more.

Enrolling Your Dependents
If you want to cover your eligible dependents, you must pay a monthly dependent coverage premium, which is payable in advance on a quarterly basis. (See "Paying for Dependent Coverage" for more information and the Summary Of Benefits for the exact premium amount.) All of your eligible dependents are covered under one monthly premium once you've enrolled them. Your dependents must be enrolled in the same plan in which you're enrolled.

To enroll your dependents, you must submit a completed dependent card, along with your premium payment, to the Fund within 30 days of the date your dependent becomes eligible. If you don't enroll your dependents within this 30-day period, you won't be able to enroll them until the next Open Enrollment period unless you submit an enrollment form in a timely manner following the change in status. Additionally, if you decline coverage for your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll your dependents, subject to plan rules then in effect, provided you request coverage within 30 days after the other coverage ends. 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 your dependents, provided you request coverage within 30 days after the marriage, birth, adoption or placement for adoption.

Open Enrollment is usually held in the fall, and coverage takes effect on January 1. To enroll your dependents, you'll need to provide the following documentation:

If you're re-enrolling for dependent coverage, have previously submitted the appropriate documentation, have not been asked to supply additional or modified information and have not been advised that you're not eligible to enroll, then all you need to do is pay the dependent coverage premium to re-enroll.

Paying For Dependent Coverage
In addition to meeting eligibility earnings requirements, you must pay a monthly premium if you wish to cover your dependents. Your dependents include:

• Your spouse or same-sex domestic partner; and
  
  
• All eligible dependent children.

(See "Your Eligible Dependents" for the definition of "eligible dependents.")

This premium covers all eligible dependents in your household who you enroll for medical, dental and vision benefits. Your own coverage, which you receive when you meet the eligibility earnings requirement, doesn't require a premium payment. The dependent premium amount is listed in the Summary Of Benefits.

You pay dependent premiums on a quarterly basis in advance, based on invoices sent to you by the Fund. Only the dependents you've enrolled will be covered, and you must submit a dependent card to the Fund to enroll them. If the Fund doesn't receive the required premiums by the due date, dependent coverage will be terminated, and you won't have another opportunity to enroll your dependents, unless you have a change in status, until the next Open Enrollment period, with coverage taking effect the following January 1. (See "Changes in Status," below, for more information).

Retroactive Or Rescinded Coverage
Sometimes employer compliance audits uncover cases in which a participant earned eligibility or lost eligibility due to earnings and was unaware of the correct status. The Fund then makes the appropriate adjustments:

• Retroactive eligibility will be granted for the period in which you would have been eligible if contributions had been received in a timely manner.
  
  
• If you're awarded retroactive eligibility and want dependent coverage, you'll have to pay monthly premiums retroactively for the number of (consecutive) quarters for which you want coverage.
  
  
• If your coverage is rescinded, the premiums you paid for the quarters involved will be refunded.

Changes In Status
If you experience one of the following changes in status, you'll be allowed to add or drop dependent coverage during the year:

• Marriage, divorce or legal separation;
  
  
• Birth or adoption of a dependent child or placement of a child for foster care or adoption;
  
  
• Death of a spouse, same-sex domestic partner or dependent;
  
  
• Any change in a spouse's, same-sex domestic partner's or dependent's employment status that results in a significant change to benefits, such as the start or end of employment, change from full-time to part-time employment, or start or end of an unpaid leave of absence;
  
  
• Unmarried dependent's gain or loss of benefits eligibility due to a change in age or student status; or
  
  
• Change in worksite or residence for the participant or his/her spouse, partner or dependent if that change affects benefits.

Other status changes, such as a change in a family member's coverage, may apply. For example, if your spouse elects family coverage during his/her open enrollment period, you may be allowed to drop dependent coverage. Another status change occurs if the plan is required to cover a dependent based on a legal judgment or court order. You may contact the Administrative Office if you have questions about these status changes.

To add dependents, you'll need to provide the following documentation:

You must notify the Fund within 30 days of the change in status. Otherwise, your request will be delayed until the following Open Enrollment period, and your dependent won't be covered under the Fund's health plans until the following January 1, unless you have another change in status.

You won't have to pay the entire quarterly premium if your change in status takes place during the quarter. Instead, your premium will be prorated to the first day of the month in which the most recent change takes place. If you don't make a premium payment at the time of a change in status, you won't be able to enroll your spouse, same-sex domestic partner or dependent children until the next Open Enrollment period and they won't be covered under the Fund's health plans until the following January 1, unless you enroll them due to a change in status.

When Coverage Begins
To accommodate administrative processes concerning earnings reports, your coverage will take effect one calendar quarter (i.e., three months) after you satisfy the eligibility earnings requirement during your earnings cycle. You'll have your full period of coverage from the first date of coverage.

You'll need to pay attention to three different time periods:

• The final calendar quarter in which you satisfy your covered earnings minimum;
  
  
• The coverage period when you can receive benefits; and
  
  
• The earnings cycle when you must meet a new covered earnings minimum in order to continue coverage.

The chart below provides some examples1:

1 Years shown for illustrative purposes only.

When Coverage Ends
If your current coverage period ends, coverage for you and your eligible dependents will continue uninterrupted another 12 months if you've met your eligibility earnings requirement in the previous earnings cycle. If you don't meet the eligibility earnings requirement that would qualify you for an additional 12 months of eligibility, you lose your eligibility, and your coverage will end on the last day of the 12-month period during which you were eligible for coverage.

Your coverage also ends if:

• The plan is modified to terminate coverage for your class of participants; or
  
  
• The plan ends.

Your dependents' coverage ends when yours does. In addition, dependent coverage ends:

• If you don't pay the dependent premium on time;
  
  
• On the last day of the month that a dependent child reaches age 19, unless he/she is a full-time student;
  
  
• At the end of the month in which a dependent child between ages 19 and 23 stops being a full-time student;
  
  
• On the earlier of the last day of the month in which a dependent child who is a full-time student reaches age 23, or 90 days after he/she no longer depends on you for full support; or
  
  
• When a dependent child enters full-time military service.

If you become legally separated or divorced, your spouse's coverage ends on the last day of the month in which:

• You were legally separated; or
  
  
• The divorce was final.

Your same-sex domestic partner's coverage ends on the last day of the month in which:

• You failed to pay the required taxes;
• You failed to pay the required dependent premiums

• The partnership ended.