Continuing Eligibility

Once you become eligible, you and your dependents will continue to be covered during each benefit month if you meet the Continuing Eligibility rules during the corresponding eligibility month. The minimum credited hour requirement for continuing eligibility is 125 hours per eligibility month.

The following table shows how eligibility months correspond to benefit months.

Eligibility Months and Corresponding Benefit Months
125 Credited Hours
in This Eligibility Month
Make You Eligible
in This Benefit Month
November
January
December
February
January
March
February
April
March
May
April
June
May
July
June
August
July
September
August
October
September
November
October
December

Continuing Eligibility Through Working

You will meet the Continuing Eligibility rules for coverage during a benefit month if:

125-Hour Rule - You have at least 125 credited hours from working during the corresponding eligibility month.

OR

The Rollback Rule - You have an average of 125 credited hours going back for a period of up to 12 months.

For Example - Suppose you start work in August and work 160 hours in August, which provides coverage in October. Then you only work 100 hours in September. Even though you didn't work at least 125 hours in September, you have a total of 260 hours during August and September, giving you an average of more than 125 hours for the two months. Therefore, you will be covered in November.

The Rollback Rule is not an hour bank. Hours do not accumulate for use at any time in the future. Instead, your hours for the current eligibility month are added to the prior month's hours, and then to the prior 2 months' hours, and then to the prior 3 months' hours and so on, rolling back up to 12 months, to see if you have an average of 125 hours per month during any period under review. Hours more than a year prior to the current eligibility month are not taken into account. The following chart also shows how the Rollback Rule works.

Eligibility Chart

To use the chart below, first find the benefit month you are interested in, then follow the row across the chart. You will be eligible in that benefit month, if you meet ANY of the requirements shown in that row.

BENEFIT MONTH 125 Hours in 250 Hours in 375 Hours in 500 Hours in 625 Hours in 750 Hours in 875 Hours in 1,000 Hours in 1,125 Hours in 1,250 Hours in 1,375 Hours in 1,500 Hours in
MAR
JAN
 DEC-
JAN		 NOV-
JAN		 OCT-
JAN		 SEP-
JAN		 AUG-
JAN		 JUL-
JAN		 JUN-
JAN		 MAY-
JAN		 APR-
JAN		 MAR-
JAN		 FEB-
JAN
APR
FEB
 JAN-
FEB		 DEC-
FEB		 NOV-
FEB		 OCT-
FEB		 SEP-
FEB 		AUG-
FEB		 JUL-
FEB		 JUN-
FEB		 MAY-
FEB		 APR-
FEB		 MAR-
FEB
MAY
MAR
 FEB-
MAR		 JAN-
MAR		 DEC-
MAR		 NOV-
MAR		 OCT-
MAR		 SEP-
MAR		 AUG-
MAR		 JUL-
MAR		 JUN-
MAR		 MAY-
MAR		 APR-
MAR
JUN
APR
 MAR-
APR		 FEB-
APR		 JAN-
APR		 DEC-
APR		 NOV-
APR 		OCT-
APR		 SEP-
APR		 AUG-
APR		 JUL-
APR		 JUN-
APR		 MAY-
APR
JUL
MAY
 APR-
MAY		 MAR-
MAY		 FEB-
MAY		 JAN-
MAY		 DEC-
MAY		 NOV-
MAY		 OCT-
MAY		 SEP-
MAY		 AUG-
MAY		 JUL-
MAY		 JUN-
MAY
AUG
JUN
 MAY-
JUN		 APR-
JUN		 MAR-
JUN		 FEB-
JUN		 JAN-
JUN		 DEC-
JUN		 NOV-
JUN		 OCT-
JUN		 SEP-
JUN		 AUG-
JUN		 JUL-
JUN
SEP
JUL
 JUN-
JUL		 MAY-
JUL		 APR-
JUL		 MAR-
JUL		 FEB-
JUL		 JAN-
JUL		 DEC-
JUL		 NOV-
JUL		 OCT-
JUL		 SEP-
JUL		 AUG-
JUL
AUG
AUG
 JUL-
AUG		 JUN-
AUG		 MAY-
AUG		 APR-
AUG		 MAR-
AUG 		FEB-
AUG		 JAN-
AUG		 DEC-
AUG		 NOV-
AUG		 OCT-
AUG		 SEP-
AUG
NOV
SEP
 AUG-
SEP		 JUL-
SEP		 JUN-
SEP		 MAY-
SEP		 APR-
SEP		 MAR-
SEP		 FEB-
SEP		 JAN-
SEP		 DEC-
SEP		 NOV-
SEP		 OCT-
SEP
DEC
OCT
 SEP-
OCT		 AUG-
OCT		 JUL-
OCT		 JUN-
OCT		 MAY-
OCT		 APR-
OCT		 MAR-
OCT		 FEB-
OCT		 JAN-
OCT		 DEC-
OCT		 NOV-
OCT
JAN
NOV
 OCT-
NOV		 SEP-
NOV		 AUG-
NOV		 JUL-
NOV		 JUN-
NOV		 MAY-
NOV		 APR-
NOV		 MAR-
NOV		 FEB-
NOV 		JAN-
NOV		 DEC-
NOV
FEB
DEC
 NOV-
DEC		 OCT-
DEC		 SEP-
DEC		 AUG-
DEC 		JUL-
DEC 		JUN-
DEC 		MAY-
DEC		 APR-
DEC		 MAR-
DEC		 FEB-
DEC 		JAN-
DEC

Continuing Eligibility by Making Short-Hours Self-Payments

If you do not have sufficient hours in an eligibility month to satisfy the 125-Hour Rule, and if your previous hours are not sufficient to satisfy the Rollback Rule, you can make a short hours self-payment to continue your eligibility in the corresponding benefit month. The amount of your payment will be determined by deducting your credited hours in the eligibility month from 160 hours, and multiplying the difference times the current employer contribution rate. The Rollback Rule will not be taken into account when determining the amount needed.

Example - If you have 100 credited hours in November 2006, your self-payment would be 60hours x $4.75 = $285. This will provide coverage in January 2007. If you subsequently have no hours in December 2006, your self-payment would be 160 x $4.75 = $760 for coverage in February 2007.

Additional Rules Governing Short-Hours Self-Payments

  1. You are only entitled to a self-pay period if you are an active employee who is already covered under the Plan when your hours shortage occurs. You cannot make a self-payment to establish or re-establish initial eligibility, nor can you pay for any period on or after the date you leave the Plan (for example, if you begin work for a non-contributing employer).
  2. You can make up to 6 consecutive monthly self-payments. An additional 6-month self-pay period will be allowed only if you return to covered employment and re-establish your eligibility based on employer contributions. There is no annual or lifetime limit on the number of non-consecutive 6-month self-pay periods you are allowed.
  3. A short-hours self-payment is generally counted and applied in the same way as employer contributions, but no more than 125 hours will be credited to you for any one month (even if you paid for more than 125 hours). Eligibility based on these payments provides the same benefits as eligibility based on employer contributions.
  4. The Fund Office will send a self-payment notice to you at your last known address, telling you how much your self-payment will be and when it is due. While the Fund Office will attempt to notify you when a self-payment is due, it is your responsibility to keep track of your credited hours and make any required self-payments on time whether or not you receive a notice from the Fund Office.
  5. Payments must be postmarked by the 15th day of the benefit month. For example, a payment for the eligibility month of October is due by December 15 (December is the applicable benefit month). No exceptions will be allowed.
  6. Self-payments will not be refunded unless the Fund receives late creditable hours from your employer.
  7. You must maintain continuous eligibility after making your first self-payment. If you fail to make a self-payment on time, you cannot make up the payment and this will result in your coverage being terminated. In such case, you can make COBRA self-payments (see the following section).
  8. You can also elect COBRA if you make 6 consecutive short-hours self-payments and are still unable to re-establish eligibility through working.

Continuing Eligibility Through COBRA Self-Payments

You and your dependents have the right to be offered an opportunity to make self-payments for continued health care coverage if coverage is lost for certain reasons. This continued coverage is called Continuation Coverage or COBRA Coverage. The rules governing COBRA coverage start on page 26.