Fund Policies

Premium Payment Policy

1 Monthly member co-premium and dependent premiums are due the first of the month prior to the month of coverage.
2 Payments are deemed delinquent on the 20th of the month prior to the month of coverage.
3 A termination notice is sent if payments are not received on the 30th or 31st of the month prior to coverage.

IMPORTANT NOTE: The Fund will send you a monthly premium reminder; however, if you do not receive the reminder it is your responsibility to remit your monthly premium in a timely manner.


Late Enrollment Policy

Applications and/or member co-premium payments received during the month of January will be accepted; however the Fund shall require the remittance of an additional administrative processing fee for either (1) a late enrollment (i.e., receipt of an enrollment application form) or (2) late payment of the required co-premium. The administrative processing fee is the greater of $25 or 10% of the delinquent premium. Applications received in February will not be accepted.


Late Payment Reinstatement Policy

Administrative Fee:

  1. First time delinquency Ė the greater of $25 or 10% of the delinquent premium
  2. Second time delinquency the greater of $25 or 25% of the delinquent premium
  3. Third time delinquency the greater of $25 or 50% of the delinquent premium
  4. Fourth delinquency will result in loss of coverage

Dependent Re-Enrollment Policy

Termination of Dependent coverage due to non payment of premium or withdrawal from coverage for reasons other than a change in eligibility status will result in the Dependent having to wait a minimum of 12 months from the date of termination before re-enrolling in benefits. Enrollment may then occur only at the Fund's annual open enrollment period. Dependents may only enroll if the Participant is eligible and enrolled.


Eligibility

APPEAL TO THE TRUSTEES IF YOUR ELIGIBILITY IS DENIED OR IF YOUR ELIGIBILITY IS CANCELLED OR RESCINDED OR REVOKED

A Claimant, or their duly authorized representative, has the right to appeal the denial of eligibility for participation in the Fundís benefits and coverages (i.e. failure to attain eligibility), denial of coverage of a Dependent, or rescission of coverage (i.e. revocation of benefits, which may or may not be retroactive) to the Trustees. Claimants who wish to appeal denials or rescissions, of eligibility must submit a written appeal to the Fund Administratorís Office. The Fund Administratorís Office will provide the appeal documents to the Trustees. The Trustees shall make a benefit determination no later than the date of the meeting of the Trustees which immediately follows the Fundís receipt of an appeal. Provided, however, that if the appeal is filed within 30 days preceding the date of such meeting, a final determination on the appeal may be made by no later than the date of the second Trusteesí meeting following the Fund's receipt of the appeal.

The Fund Administratorís Office shall provide a Claimant with a written or electronic notification of the Trusteeís determination on review. The decision of the Trustees, with respect to any appeal from a denial of eligibility, revocation of enrollment and/or rescission of coverage shall be final and binding and there shall be no other or further level of appeal

Any adverse decision on an appeal shall be written in a manner which is understood by the Claimant and must (i) specify the reason(s) for the adverse determination action taken; (ii) refer to the specific plan provision on which it is based; (iii) state that the Claimant is entitled to receive, upon request, and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimantís claim for benefits; (iv) describe any voluntary appeals procedures offered by the Plan and the Claimantís right to obtain the information required to make an informed judgment about whether to submit a benefit dispute to the voluntary level of appeal and a statement of the Claimantsí right to bring an action, under Section 502(a) of ERISA.

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