Health and Welfare Summary Plan Description

 
  • Health and Welfare SPD / Article VI / Enrollment and Termination of Coverage >>

6.6 Termination of Coverage.

  1. General Rules. Coverage under the Plan will terminate for Covered Individuals as follows:
    1. upon exhaustion of the Participant's Hour Bank balance (or charging of hours below 120) as provided in Section 3.2 (for the Participant and Dependents);
    2. upon nonpayment, or untimely payment, of a required Monthly Coverage Payment (for the Participant and all Dependents, effective immediately before the first day of the month for which the payment would have applied);
    3. upon the adoption of any Plan amendment that terminates the Covered Individual's coverage (as the amendment provides);
    4. upon the first date on which the Participant works in the electrical industry that is not Covered Employment (for the Participant and Dependents);
    5. if and when the Participant fails to maintain membership in good standing in IBEW Local 6 (for the Participant and Dependents);
    6. when a Dependent ceases to qualify as a Dependent (for the Dependent only, effective at the end of the month);
    7. upon the Participant's death (as provided in Section 5.2);
    8. upon the Participant's Retirement (for the Participant and Dependents, except as coverage may be available under Article IV);
    9. the date any family member enrolls in a Medicare Part D program outside this Plan (as provided in Section 4.5(d)); and
    10. upon the failure of any Covered Individual to abide by the Plan's provisions (such as the commission of fraud or material misrepresentation) that results in a forfeiture of coverage (for the Covered Individual and his or her covered Dependents, effective immediately); and
    11. upon affirmative disenrollment by the Participant.
  2. Certificate of Coverage. HIPAA provides that group health plans must limit the time for which coverage is not provided for pre-existing conditions. Your coverage under the Plan will reduce the pre-existing condition limitation period of another plan for which you may become eligible. For example, if another plan imposes a 12-month pre-existing condition limitation and you have been eligible under this Plan for 12-consecutive months before becoming eligible under the other plan, the pre-existing condition limitation of the other plan will not apply to you. When you experience a COBRA Qualifying Event under the Plan, the Plan Office will provide you, along with your initial COBRA notice, a certification of the number of months for which you and your Dependents have been eligible for benefits under the Plan. This certificate provides evidence of your health coverage under this Plan that you may need to buy, for yourself or your family, health insurance that does not exclude coverage for medical conditions that are present before you enroll. If you are eligible for coverage due to new employment, you may want to furnish a copy of this certificate to your new employer so that you can become eligible for the greatest number of benefits due to employment as quickly as is possible. You or your new employer should contact the Plan Office if any additional information certifying your coverage under this Plan is required. Once you become eligible under another plan that has no pre-existing condition limitation which limits the coverage available to you, your rights to continue COBRA Coverage under this Plan terminates.

    Note on Health Care Reform. Health care reform will eventually cause this subsection to become obsolete, since medical plans cannot impose pre-existing condition limitations after December 31, 2013. However, because of various transition rules, the Plan will continue to provide certificates of creditable coverage through December 31, 2014.