Health and Welfare Plan BenefitTabs™
Retiree Coverage
Eligibility
Your eligibility for retiree coverage depends on whether you take a Regular Retirement, Early Retirement or Disability Retirement and upon when your coverage as an Active Member ceases. The copayment amount you are required to make also varies based on type of retirement, age at retirement, and meeting the applicable service requirements. In addition, surviving dependents of deceased participants who were retired or eligible to retire may qualify for coverage.
Regular Age 62 or Over
You qualify for coverage in this category in one of four ways. These alternative criteria are primarily based on months of coverage as an Active Member immediately prior to retirement.
120-Month - 120 months coverage out of the last 180, and
- 2 periods of 12 consecutive months coverage out of the last 60
- 300 consecutive months of coverage, and
- 2 periods of 12 consecutive months coverage out of the last 60, and
- retired under the Pension Plan.
- 150 months coverage out of the last 240, and
- 2 periods of 12 consecutive months coverage out of the last 60, and
- retired under the Pension Plan.
- continuous coverage since first employed in the electrical industry, or
- currently enrolled in the Apprenticeship program.
Early Retiree Age 55-62
In general, you must be at least age 55 and have retired under the Pension Plan (with an exception if you were not a participant in the Pension Plan). In addition, you must have met the same service requirements as shown above for Regular Retiree status as of the date of your early retirement.
If you are required to make payments, they must be continuous. And, in no case do months of coverage obtained by COBRA coverage count towards the stated Retiree Status service requirements.
If you satisfy the regular retiree service requirements and your active coverage following retirement ends after you attain age 59, you may make the copayments stated below as an early retiree in this category. You also have the option to postpone enrollment until age 62 or later. However, if you elect to postpone, this is irrevocable, and you cannot regain retiree coverage until you reach age 62.
If you satisfy the regular retiree service requirements and your active coverage following retirement ends before you attain age 59, you may enroll and make the copayments stated below as an early retiree in Category II. You must continue to make the required payments until you reach age 62. From age 62 to 64 your copayments will be at a higher rate than early retirees in Category I as shown below. No gap in coverage is permitted if you are in this category.
Disability
If you are covered as an Active member under age 62 and become totally and permanently disabled, you will be eligible for Disability Retirement Coverage if you meet the following requirements:
- you first exhaust your reserve hour bank and/or temporary disability extension, and
- 120 months coverage out of the last 180 or 150 months coverage out of the last 180 or 300 consecutive months, and
- 2 periods of 12 consecutive months coverage out of the last 60, and
- submit proof of total and permanent disability as defined by the Plan.
Surviving Dependents
If you die while you are an Early Retiree or Regular Retiree (or if you would have been eligible for such coverage when you died), your dependents will remain eligible for Retiree member Dependent coverage in the Plan upon your death.
In all cases, surviving spouse coverage will cease upon a remarriage.
Domestic Partners and their children are not eligible for coverage under this plan provision.
Retiree Copayments
The rates shown below are charged for coverage beginning 2/1/2023. These co-payments are automatically adjusted annually in direct proportion to the changes in Plan costs.
Retriee Copayments
Retiree Benefits
In general, retirees not yet eligible for Medicare have the same coverage as active members. Retirees eligible for Medicare must enroll in Medicare Parts A + B as described below. Dental, vision, and member assistance benefit programs are covered for all eligible retirees.
When you become eligible for Medicare, then Medicare becomes your primary insurance and the Plan becomes secondary. A full description of how Medicare pays first and the Plan second is contained in Section V, Coordination of Benefits.
Retirees are not eligible for death benefits provided under the Health Plan or the long term disability benefit. Early retirees under age 62 only are eligible for the death benefit.
Medicare Enrollment
For all practical purposes, you and your eligible dependents must enroll in Part B of Medicare as soon as you are eligible. If you are a Retiree in the Self Funded PPO Plan and eligible for Medicare, the Plan will process any claim for you as though the Plan is secondary to Medicare coverage. So, if you neglect to enroll in Medicare, you will have to pay out-of-pocket whatever balance is billed by your health care provider.
If you or your dependent is eligible to enroll in Medicare and has selected Kaiser HMO, you or your dependent must enroll in their Medicare Program ("Medicare Part C"). Otherwise, you will be billed for the difference in premium.
If you or your Dependent does not reside in the Kaiser Senior Advantage service area, you must enroll in the Self Funded PPO Plan. Blue Shield does not offer a Senior Plan.
It is not necessary for you to enroll in Medicare Part D offered outside of the Plan with a non-Plan provider. If you choose to enroll in a Medicare Part D program outside of the Plan, you will lose coverage under the Plan and not be allowed to re-enroll. See the Prescription Drug section of the SPD for additional information.