Health and Welfare Summary Plan Description

3.6 No-Cost Disability and Reduced-Cost COBRA Coverage

  1. Disability Defined. For purposes of this section, you are disabled if (i) you are unable to perform the duties of your regular occupation covered under the applicable Contribution Agreement and (ii) your disability has continued for a period of 30 days. A disability is treated as a continuation of a preceding disability unless it arises from a different or unrelated cause or it is separated by at least three months of continuous Covered Employment.

  2. No-Cost Coverage for Up to Six Months. If you become disabled while covered as an Active Employee, your coverage will, upon reduction of your Hour Bank below 120 hours, be continued at no cost to you. This no-cost coverage will cease after six months or, if earlier, either at the end of the month in which you cease to be disabled or after you have been covered for the number of months as you were covered as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage. If you have less than 7 months of coverage as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage, Reduced-Cost COBRA Coverage described in subsection (c) below will not be available. You may, however, continue coverage at the standard COBRA Monthly Coverage Payment amount described in Article VII.

  3. Reduced-Cost COBRA Coverage for Up to Another Six Months. After your no-cost disability coverage under subsection (a) has ended, you must elect COBRA Coverage under the rules of Article VII in order to continue Plan coverage. If you continue to be disabled as you begin COBRA Coverage and you have more than 6 months of coverage as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage, your COBRA Monthly Coverage Payment will be reduced (to the amount described in Appendix B) for up to the first six months of COBRA Coverage. This reduced-cost COBRA Coverage will end earlier if you cease to be disabled, or once the number of your combined months of no-cost disability coverage and reduced cost disability coverage equals the number of months you were covered as an Active Employee during the 12-month period immediately before your no-cost disability coverage began. Once reduced-cost COBRA Coverage ends, you may continue COBRA Coverage at the standard COBRA Monthly Coverage Payment amount described in Article VII.

  4. Three Month Recovery Extension. If you cease to be disabled while covered under subsections (a) or (c), and you promptly register for employment under the Collective Bargaining Agreement, you may pay, for up to three months, the same Monthly Coverage Payment that you paid for your most recent month of coverage (either zero for no-cost coverage, or the reduced-cost COBRA Monthly Coverage Payment) until your Hour Bank is sufficient to provide coverage, provided such coverage does not extend beyond the earlier of 12 months or the number of months you were covered during the 12-month period immediately before your no-cost disability coverage began.

  5. Establishing Disability Coverage. Evidence of your disability must be submitted to the Plan Office in the form of a written certification of continuing disability by your attending Physician, along with an Application for Disability Coverage. The Board may designate a Physician or other medical provider to make the disability determination, and may place additional restrictions on disability coverage. Your application must be submitted no later than 90 days from the last day of your last month of coverage provided by your Hour Bank.

    Example
    : The provisions of this section are illustrated in the following example:
    Participant P began coverage as an Active Employee in October 2012. He becomes seriously ill and ceases work on March 8, 2013, when he has 300 hours in his Hour Bank. He continues to be covered through May 2013 by using 240 hours from his Hour Bank. P then receives no-cost disability coverage from June 2013 through November 2013. P, still recovering from his illness, elects reduced-cost COBRA Coverage beginning December 2013. This reduced-cost coverage is available to P only for December 2013 and January 2014 (two months) because his combined no-cost and reduced-cost disability coverage will have then lasted 8 months, the same number of months he was covered before his no-cost disability coverage began (October 2012 through May 2013). Beginning in February 2014, P must pay the full COBRA Monthly Coverage Payment to maintain coverage. However, P recovers in early March 2014 and then returns to work with sufficient hours to provide coverage in May 2014. He continues to pay his full COBRA Monthly Coverage Payment in March and April 2014.

    Had P returned to work or registered for employment under the Collective Bargaining Agreement in October 2013, he would still qualify for reduced-cost disability coverage through January 2014 (or, if earlier, until he re-establishes eligibility from hours worked) under the 3-month rule, even though he has recovered from this disability.