Health and Welfare - Continuing Coverage FAQs

  • What are the self-payment options available under the Plan?

    The Plan allows up to a maximum of 12 consecutive direct payments for participants who are available for immediate employment with a contributing employer (i.e., registered for employment with Local 6). The direct payment is also available to participants who are disabled but in no event may the combination of direct self-payments and temporary disability coverage exceed 24 months for any single disability.

  • How much are the direct self-payments and how are they determined?

    Effective August 1, 2008 (June 2008 hours), the direct payment of $1,278.00 is based on the minimum hours needed to qualify for coverage, (currently 120), multiplied by the health and welfare contribution hourly rate (currently $10.65).

  • I am single. Why is my self-payment the same as for a member who has dependents?

    Premiums to the providers are calculated on a composite basis, meaning that they are the same for all participants regardless of family size.

  • May I self pay for medical coverage only?

    For the Plan's regular direct payment, you may not pay for medical coverage only. However, if you elect COBRA you may choose between "core" (medical only) or "core plus non-core" (medical, dental and vision).

  • May I self pay for dental and/or vision only?

    No, this option is not available.

  • What happens if my employer becomes delinquent in reporting contributions to the Plan?

    You will be notified by the EISB office in the event your employer becomes delinquent for more than one month. If the delinquency results in loss of coverage, the Plan Office can credit your eligibility for a maximum of two months. Thereafter, you would have the option to make direct self-payments with the understanding that you will be reimbursed for these self- payments once the delinquent contributions have been collected.

  • Why is my COBRA period offset by the regular self payments, temporary disability coverage, and hourbank eligibility I had under the Plan?

    The applicable COBRA continuation period begins when the qualifying event (such as insufficient hours or termination of employment) occurs. The run-out of hour bank reserve or continuation of coverage through direct payments and/or temporary disability coverage occurs during that COBRA continuation period and, therefore, reduces the number of remaining months that are available to make any COBRA payments.

  • Why doesn't my COBRA payment apply towards my "retiree" eligibility?

    COBRA payments include only the costs for active plan benefits; the cost for retiree coverage has not been factored into the rates. The plan's direct payment rate, as a function of the employer contribution rate, includes a subsidy for retiree coverage.

  • To what extent does my coverage continue if I become disabled?

    If you became disabled while coverage was in force and you remain disabled as of the date your hour bank reserve account runs out, you may continue to participate under the Plan's Temporary Disability provision, at the expense of the Trust, for a maximum of 12 months. Your actual period of entitlement, however, will be limited to the number of months that you had eligibility based on work performed during the 12 month period preceding the date your hour bank reserve account runs out.

  • What happens when all of my self-payment options under the Plan are exhausted?

    You may convert to an individual plan if you are enrolled in either Kaiser or Blue Shield HMO.

  • If I leave and later return to service under the Plan, when do I become re-eligible?

    If you return to work within 12 months from the date your hour bank reserve runs out, your eligibility will be reestablished as soon as you accumulate 125 hours. This includes a combination of hours reported and hours in your reserve account. If, however, you do not return to work within 12 months from the date your hour bank reserve account runs out, any remaining hours credited to your reserve account will be cancelled and you will be treated as a "new" participant requiring a minimum of 300 hours to re-qualify. In both cases, coverage will resume on the first day of the second month following the date you accumulate the required hours.

  • I am a reservist in the military. How are all of my benefits affected if I get called up for service?

    You should provide the Plan Office, your employer, and IBEW Local 6 of your official order for active service as soon as you receive it. The Plan Office will then provide you with a written notice of your rights under the Uniform Services Employment and Reemployment Rights Act (USERRA) relating to both the San Francisco Electrical Workers Health Plan and the Northern California Electrical Workers Pension and Retirement Savings Plans.

    Your hour bank reserve account will be frozen effective with the month you are called for active military service. After you return to civilian life and provide a copy of Certificate of Release or Discharge from Active Duty (DD Form 214), your hour bank will be reinstated immediately. If you are absent less than 31 days you may elect to continue your coverage under the San Francisco Electrical Workers Health Plan at no cost. After 30 days, you may elect to carry COBRA-like coverage for up to 24 months total, including the initial 30 days and will be charged 102% of the cost of coverage after the first 30 days.

    Your absence for military service will trigger rights under both USERRA and COBRA statutes and you will be entitled to protection under the law that provides the most favorable benefit.

  • What happens to my coverage if I have to take care of another family member?

    If you are working for any employer who has at least 50 employees and you meet the requirements of the Family and Medical Leave Act and/or California Family Rights Act of 1993, you may be eligible for Family Medical Leave.

    FMLA only applies if:

    1. your employer has at least 50 employees and
    2. you worked at least 12 months and
    3. you worked least 1,250 hours during the most recent 12 months.

    The leave must be:

    1. for the birth or placement of a child for adoption or foster care, or
    2. to care for a child, spouse, parent, or domestic partner with a serious medical condition, or
    3. for your own serious health problem.

    If you are eligible, your employer will be responsible for maintaining your coverage and you will be required to continue to make any co-payments normally required under the Plan for maintenance of coverage.