Health & Welfare SPD

B. RETIREE MEMBER ELIGIBILITY RULES

1. Retiree Defined.

A member in good standing of the IBEW who retires from the electrical industry and who can meet the requirements set forth below will qualify for enrollment as a Retiree member.

2. Regular Retirees.

If you have attained at least age 62, you will qualify for enrollment as a Regular Retiree if you have satisfied one of the following requirements:

120-Month Option. You have been covered as an Active member for 120 out of the last 180 months and two (2) periods of 12 consecutive months within the 60 months immediately preceding age 62 or subsequent retirement age.

300-Month Option/Retired.
1. you have been covered as an Active member for at least 300 months of which at least two (2) periods of 12 consecutive months of coverage were within the 60 months immediately preceding age 62 or subsequent retirement age; and
2. you qualify for retirement and have retired under the Northern California Electrical Workers Pension Plan (“NCEW Pension Plan”).

150 Month Option/Retired.
1. you have been covered as an Active member for at least 150 months out of the last 240 months of which at least two (2) periods of 12 consecutive months of coverage were within 60 months immediately preceding age 62 or subsequent retirement age; and
2. you qualify for and have retired under the Northern California Electrical Workers Pension Plan.

Continuous Coverage Since Inception/Enrolled Apprentice.
1. you have been continuously covered as an Active member since the inception date of your work in the electrical industry; or
2. you are currently an enrolled apprentice in a San Francisco Electrical Industry Apprenticeship program.

NOTE: Participation as an Active member includes participation in the Electrical Workers Area Health and Welfare Plan, the predecessor to this Plan which terminated February 1, 1998. A Retiree's "Home Plan" is the successor Plan to the Area Retiree Health & Welfare Plan, sponsored by the Local Union and NECA chapter in whose jurisdiction the majority of Active member contributions were made on his or her behalf. For example, if a Retiree has ten (10) years of participation as an Active member, but only four (4) of those were through the IBEW Local 595 Trust and six (6) were through the IBEW Local 6 Trust, Retiree coverage will be provided by the Local 6 Trust, not the Local 595 Trust. This rule applies to IBEW Locals 639, 595 and 6 only.

3. Disability Retirees.

If you are a Covered Employee under age 62 and become totally and permanently disabled, as defined in subparagraph c, below, while Active coverage is in force, you will qualify for enrollment as a Disabled Retiree member provided:

you have exhausted coverage pursuant to your hour bank reserve and/or temporary disability coverage; and
you have been covered as an Active member for 120 out of the last 180 months and two (2) periods of 12 consecutive months within the 60 months immediately preceding the date of onset of disability; and
proof of total and permanent disability is submitted.

“Total and permanent disability” means that the applicant is unable to engage in any substantial gainful activity due to a medically determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of at least twelve months, or can be expected to result in death. The impairment must be so severe as to prevent the individual not only from engaging in the individual’s usual work but, considering the individual’s age, education, previous training and work experience, from engaging in any substantial gainful work which exists in significant numbers in the region in which the individual lives.

You must be under the care of a legally qualified Physician and have been awarded a permanent Social Security disability benefit under Title II of the Social Security Act. Proof that you continue to qualify for Social Security disability benefits and that a Physician deems you to still be totally and permanently disabled will be required at reasonable intervals by the Plan.

A Social Security disability award will be presumptive proof that you are permanently and totally disabled; however, that presumption may be rebutted by other pertinent evidence. If you fail to furnish proof, or if you refuse to be examined by a Physician (designated and paid for by the Plan), you will no longer be considered totally and permanently disabled for purposes of disability retirement eligibility under the Plan.

4. Early Retirees.

Subject to the following provisions, if you retire, you may maintain coverage in the Plan as an Early Retiree.

Minimum Age Requirement. You must be at least 55 years old.

Retirement Requirement. You must have retired under the Northern California Electrical Workers Pension Plan. Exception: Participants of the Plan who work under IBEW Local 6 Collective Bargaining Agreements that do not require contributions to the NCEW Pension Plan (e.g., employees working under the Storekeeper and Residential Wire Agreements) are exempt from this requirement, provided that based on their hours worked, they would have otherwise qualified under the service requirements under the NCEW Pension Plan.

Service Requirements. You must satisfy one of the four Regular Retiree service requirements as set forth in paragraph 2, above, at your retirement date to qualify as an Early Retiree between ages 55 and 62.

If you satisfy the service requirements in paragraph 2 within the period immediately preceding age 62 or subsequent age, (which, among other things, requires that your hour bank runs out after you attain age 59) you will not to be required to continue Early Retiree participation and pay the Early Retiree copayments in order to participate as a Regular Retiree. However, if at the exhaustion of your hour bank you elect not to enroll as an Early Retiree, you may not again participate until you are eligible as a Regular Retiree at age 62.

If you do not satisfy the service requirements in paragraph 2 within the requisite periods immediately preceding age 62 or subsequent age, (generally, your hour bank runs out before you attain age 59), you will be required to participate as an Early Retiree and pay the monthly co-payments in order to participate as a Regular Retiree at age 62.

The current Early Retiree and Regular Retiree Co-payment Schedules are included in Appendix 1. Generally, these amounts are adjusted annually on August 1st based on percentage increases to the Plan following contract renewals with the various Plan carriers. Since the copayment amount required between ages 62 and 65 varies depending upon whether or not you satisfy the service requirements in the period prior to age 62, you may want to review the copayment schedule, or contact the Plan Office, before making your retirement plans.

Self-Payment Periods Not Counted. Periods of Early Retiree self-payments and COBRA self-payments are not taken into account to determine Retiree status at age 62 or 65. (See Section IV describing COBRA Extension Coverage.) Early Retirees must meet the requirements for Regular Retiree member status by satisfying the requirements set forth in paragraph 2, above, solely from periods of coverage as an Active member. This includes periods of direct self-payments (during periods of unemployment) and periods of temporary disability coverage.

5. Effective Date of Retiree Coverage.

Regular or Disability Retiree Coverage. If you meet all of the requirements to qualify for Regular or Disability Retiree coverage under the Plan, you will become eligible for Retiree coverage effective on the first of the month following submission of a completed application for enrollment or upon exhaustion of any temporary disability coverage or hour bank reserve, whichever occurs later. Exception: A maximum of 12 months of retroactive coverage will be credited to a Disabled Retiree who submits his or her application within 60 days from the date of receipt of a Social Security Disability Award Notice.

Early Retiree Coverage. Early Retiree coverage must commence with the later of:
1. the first of the month following termination of coverage based on Employer contributions and exhaustion of the member's reserve hour bank (including temporary disability coverage) or
2. the first of the month following retirement under the Northern California Electrical Workers Pension Plan. An application for Early Retiree coverage received by the Plan Office more than 60 days following the later of retirement or exhaustion of hour bank reserve coverage shall be deemed “untimely” for the purposes of this subparagraph.
If you are an Early Retiree who is eligible to defer Retiree coverage pursuant to paragraph 4(c)(i)(I), above, you shall be deemed to have chosen to defer enrollment when an application for Early Retiree enrollment is not received by the Plan office within 60 days of the last qualifying date for entitlement to Early Retiree coverage.

Early Retiree self-payments are due by the 10th of the month preceding the month for which coverage is to be provided. Failure to make timely payments may result in the cancellation of Early Retiree coverage without a right of reinstatement. At your request, your Retiree health care premiums may be deducted from your monthly pension benefit from the Northern California Electrical Workers Pension Plan. A form permitting the deduction from your pension check is available from the Plan Office.

Retiree Dependent Coverage. Coverage for your Dependents as defined in subsection C, below, will become effective on the later of the following dates:
1. the date you become eligible for Retiree coverage; or
2. ) the first of the month after you acquire a Dependent, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

6. Monthly Charge for Retiree Coverage.

The Plan may charge Retirees and surviving spouses and other Dependents a monthly charge for coverage. The Board of Trustees has the discretion to change at any time the amount of the monthly charge based on the cost of coverage to the Plan. Co-payments are subject to a formula determined by the Board of Trustees and based on the Plan's benefit consultant's calculations. The rates may differ between different categories of Retirees.

7. Medicare Enrollment.

Medicare is our country's health insurance program for people age 65 or older, certain people with disabilities who are under age 65, and people of any ages who have permanent kidney failure. If you are receiving Social Security Disability Income (“SSDI”) benefits, you generally become eligible for Medicare coverage 24 months after your SSDI benefits begin.

There are two parts to Medicare that relate to hospital and medical insurance. They are hospital insurance (Medicare Part A) and medical insurance such as for the cost of Physicians (Medicare Part B). Medicare Part A is financed by payroll taxes; and, if you are eligible to receive it based on your own--or your spouse’s--employment, you do not pay a premium. Medicare Part B is partly financed by monthly premiums paid by those who choose to enroll. For enrollment and eligibility information, call Social Security at 1-800-772-1213. You can also find Medicare information on the Internet at www.medicare.gov.

The Plan offsets expenses for services or supplies to the extent they are or may be payable under Medicare. For this purpose, if you are a Medicare-eligible Retiree, the Plan Office will assume that you have full Medicare coverage (Parts A and B) whether or not you have enrolled for the full coverage. Therefore, if you are a Retiree who has selected coverage under the Indemnity Plan, once you or your Dependent becomes eligible to enroll in Medicare, the Plan will process any claim for Covered Expense incurred on or after that date as though it is secondary to Medicare coverage, even if you or your Dependent fails to enroll. If you or your Dependent is eligible to enroll in Medicare and has selected one of the Plan’s HMOs, you or your Dependent must enroll in the HMO’s Medicare Program (“Medicare Part C”). The difference between the premiums charged to the Plan and the premium for the Medicare Program will be billed back to you as the Retiree member if you and/or your Dependent fail to enroll in the Medicare Risk Program. If you or your Dependent does not reside in the HMO’s Medicare service area, you must enroll in one of the other available plans.

Medicare Part D is addressed in VII.A, beginning here .

8. Suspension/Cancellation of Retiree Benefits.

General Rule. If you are eligible for benefits as a Retiree member, you shall have such eligibility suspended during any period you have returned to work in “prohibited employment” as either defined below or which would result in a suspension of benefits under the NCEW Pension Plan:
1. Prior to Age 65. Before the attainment of Normal Retirement Age (65), “prohibited employment” means the performance of services in any capacity in the electrical industry in the United States.
2. After Attainment of Age 65. After attainment of Normal Retirement Age “prohibited employment” means the performance of services of 40 hours or more during the month:
  1. in the ten counties comprising the San Francisco Bay Area: San Francisco, Alameda, San Mateo, Contra Costa, Marin, Solano, Napa, Santa Clara, Sonoma and San Benito;
  2. of the type performed by Employees covered by the NCEW Pension Plan on your Pension Effective Date; and
  3. which requires directly or indirectly the use of the same skills employed by Employees on the Pensioner’s Pension Effective Date, including any supervision of employees in the same trade or craft or directly or indirectly using the same skills as Employees covered by the NCEW Pension Plan on the date the Pensioner retired.
“Prohibited employment” and “work” includes employment for which a salary is paid, work as an independent contractor, work for which the NCEW Pension Plan Participant receives a deferred benefit and work for which the NCEW Pension Plan Participant receives anything of value in exchange for services rendered.

Exceptions to the Suspension of Benefits Rule. The NCEW Pension Plan provides a limited number of exceptions that allow a Retiree to engage in otherwise prohibited employment. Those exceptions are:
1. as a private or public building or electrical inspector;
2. as an instructor in a Taft-Hartley Trust apprenticeship and training program;
3. in sales of electrical equipment or products; or
4. in the manufacturing or marketing of electrical or electronic products and systems which does not substitute for on-site fabrication that is protected or which is sought to be protected under IBEW Inside Wire Agreements.
Retiree Coverage Continued for Limited Time. If you are receiving Retiree benefits under this Plan and return to Active employment pursuant to a Collective Bargaining Agreement requiring contributions on your behalf to establish eligibility for coverage under the Plan, your Retiree benefits shall be suspended commencing upon the date your eligibility as an Active member is reestablished or upon the first of the third month following the date of your return to Covered Employment, whichever occurs first.

Reinstatement Rule. Upon notification that your pension benefits are no longer suspended, Retiree benefits shall be reinstated no later than the first of the third month following the last month for which benefits were suspended.

Forfeiture Rule. If you are an Early Retiree (including an Early Retiree who elects to defer Retiree coverage under the Plan), you must refrain from engaging in work in the electrical industry unless you return to work for a Contributing Employer. If you return to work for a non-Contributing Employer, your coverage or eligibility for deferred coverage under this Plan will be canceled without right to reinstatement and you will be obligated to reimburse the Plan for any benefits paid on your or your family's behalf during any period of such employment.

If you are an Early Retiree who returns to employment covered under the Plan and who subsequently becomes eligible for coverage as an Active member based on your work hours, you will not be required to continue making Early Retiree self-payments. Upon subsequent retirement prior to age 62, you will be required to make continuous early retirement self-payments until you qualify for full Retiree status.

9. Annual Verification of Retiree and/or Dependent Eligibility.

In order for you or your Dependent to maintain eligibility for Retiree benefits under this Plan, you must submit a completed Verification of Eligibility form must be returned to the Plan Office at least once a year. This form will be sent to Retirees at a time designated by the Board of Trustees.