Leaves of Absence or Loss of Eligibility

Family Medical Leave Act (FMLA)

FMLA requirements do not apply to certain small employer groups (generally those who regularly employ less than 50 employees). If your employer is subject to FMLA requirements:

• Your employer, not the Trust, determines if you are eligible for FMLA leave.
• There are limits on how long you can be absent from work on FMLA leave.
• For your benefits to continue, your employer must continue to make contributions to the Trust on your behalf.

Military Leave

If you must leave work with a participating employer to perform military service, federal law (the Uniformed Services Employment and Reemployment Rights Act or USERRA) gives you certain rights regarding your benefit coverage.

You may elect to continue your benefits coverage for up to the lesser of:

• The 24-month period beginning on the date on which your absence begins, or
• The day after the date on which:
  » you fail to return from protected military service, or
  » you fail to apply for or return to work.

• Refer to the Active Employee SPD for more information regarding other circumstances in which your continuation coverage under USERRA may end early.

If you are on leave for less than 31 days, your benefit coverage will continue as long as your employer continues to make contributions to the Trust on your behalf.

If you are on leave for 31 days or more, you may continue self-pay coverage pursuant to USERRA and COBRA (your participating employer is NOT required to make contributions to the Trust).

Short-Term Disability

If you are on leave due to a short-term disability, your health benefits will continue as long as your employer makes contributions to the Trust on your behalf during your absence.

If you do not return to work, your benefits will end; however, you may continue self-pay coverage through COBRA.

Return-to-Work Coverage

The Plan will provide Trust-paid return-to-work coverage for the month following the month in which you return to work from a layoff, short hours, leave of absence, disability or labor dispute, provided both of the following requirements are met:

• You work (or are paid for) at least 100 hours during the month you return to work.
• You have coverage for the month in which you return to work, provided either by hours previously worked or self-pay coverage through COBRA.
  

Self-Pay Coverage through COBRA 

You, your spouse and your dependents may qualify to continue self-pay coverage through COBRA (the Consolidated Omnibus Budget Reconciliation Act) when your eligibility for coverage ends.

Active Employees

Self-pay coverage through COBRA allows you to continue coverage for a temporary period, in situations such as a job loss or a reduction in hours.

To be eligible for COBRA, you must lose eligibility for one of these reasons:

• You quit, are discharged or laid off (any voluntary or involuntary termination of employment for reasons other than gross misconduct)
• Your hours are reduced below continuing eligibility requirements
• Your plant closes 
• You are disabled
• You do not work during a labor dispute
• You take a non-FMLA leave of absence 
• You retire

Dependents

Enrolled dependents have the right to enroll in self-pay coverage through COBRA in the following events:

• Loss of dependent status (e.g., a child turns 26 and is no longer eligible for coverage as a dependent child)
• The employee does not continue Active Plan coverage after it has been lost; for example, during a temporary reduction in hours
• Divorce
• Death of the employee

Please refer to the Active Employee Plan Benefit Summary Plan Description or Retiree Plans Summary Plan Description, or contact the Administrative Office for more information about self-pay coverage through COBRA.

To be eligible for COBRA you must provide written notice to the Administrative Office within  60 days from the date of the occurrence of the death, divorce or loss of dependent coverage status (as applicable); or the date coverage would be lost. 

Please refer to the Active Employee SPD or your COBRA Election Packet for information regarding types of COBRA coverage available, costs, and deadlines.

What You Pay

You pay the full cost of coverage plus a 2% administrative fee.

Your first self-payment must be made within 45 days after the day you enroll and include payment for all past months since your Trust Plan coverage ended.

You may continue to self-pay for up to 18 or 36 months (depending on the qualifying event).

Contact the Administrative Office for monthly dollar amounts, additional details, and to enroll.

Tip: You may be eligible for lower-cost alternatives.

• A health plan through the Health Insurance Marketplace may save you money; learn more at HealthCare.gov. 
• If you are eligible to enroll in another group plan (such as a spouse’s plan), your loss of coverage may qualify for a special enrollment.