June 20, 2013   TABLE OF CONTENTS   1.1.7 Events Resulting In Termination Or Loss Of Coverage – Health Benefits   A. Termination of Employee Coverage Employee Coverage will terminate on the first to occur of the following: 1. At the end of the first month after any month during which an Employee fails to acquire 70 Contribution Hours; Example: an Employee who has been eligible for a number of months acquires 70 Contribution Hours for work performed in October, but then acquires less than 70 Contribution Hours for November; his eligibility terminates at the end of December, which is the end of the first month after the month in which he failed to acquire 70 Contribution Hours (Note: Only Contribution Hours for which employer contributions are received by the Fund are counted); See Limited Partial Self Pay Rule in Section 1.1.11 on page 44. 2. The actual date the Employee becomes covered for any health benefits as an Employee under another employer group program; 3. Death of the Employee; 4. Termination of any applicable group insurance policy with respect to coverage under that policy; 5. As of the first day of the month following the month that a Covered Employee remains actively employed by an employee whose obligation to make contributions to this Fund for hours worked has terminated. Example 1: Assume Employer ABC terminates its obligation to contribute to the Welfare Fund on August 31, 2006; is required to contribute for hours worked in August 2006; and is required to pay the contributions for hours worked in August 2006 by September 20, 2006. Eligibility of a Covered Employee who is actively employed by Employer ABC on or after September 1, 2006, will terminate immediately after September 30, 2006. Example 2: Same facts as Example 1 except that Employee Smith is laid off by Employer ABC in August 2006 after earning 70 hours and is not recalled from lay off through October 2006. Pursuant to Section 1.1.7(A)(1), Employee Smith’s eligibility will terminate immediately after October 31, 2006. 6. As of the last date for which an Employee makes any timely Self Payment as required under Section 1.4. B. Special Provision for Participants in Active Military Service If a Participant is engaged in full-time active duty in one of the uniformed services of the United States, coverage for that employee and any covered dependents will be continued for a period of 31 days, subject to payment of the Fund’s required contribution rate for Dependent coverage. If the period of military service exceeds 31 days, Participants may continue their health coverage and/or that of any covered dependents by electing and paying for continuation coverage for up to 24 months from the first day of active military service. The rules for coverage are the same as the Fund’s COBRA Continuation Coverage election and payment rules. When a Participant, whose eligibility for coverage terminated on account of entry into active duty in one of the uniformed services of the United States, returns from such service and is reemployed with a participating employer prior to the expiration of his period of re-employment rights under any applicable Federal or State law, will return to the same eligibility status prior to military leave and will be immediately reinstated. Any Participant entering active duty in one of the uniformed services of the United States should notify the Fund Office before leaving for such duty, unless advance notice is impossible, unreasonable or precluded by military necessity. The Fund Office should also be notified upon return to work with a contributing employer. Continuation of coverage under this provision is provided pursuant to the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), as amended, and applicable regulations. Any conflict between this provision and USERRA or any other applicable provision of the law shall be reconciled in favor of compliance with USERRA or other applicable law. C. Termination of Dependent Coverage Dependent Coverage will terminate on the first to occur of the following: 1. Cessation of status as an eligible Dependent; 2. Termination of coverage of the Employee through whom the Dependent is covered; provided, however, that in the event of the death of an Employee, the surviving spouse and/or Dependent children shall continue to be covered until the end of the calendar month during which the Employee’s death occurred and the two additional calendar months thereafter; 3. Failure to pay the required contribution amount for Dependent coverage when due, in which case coverage will terminate at the end of the period for which a timely contribution was made. Disabled Dependent. If an unmarried child, on the date such child’s coverage would otherwise terminate due to age, is incapable of self sustaining employment by reason of mental or physical disability and such incapacity commenced prior to the date on which such child’s coverage would otherwise terminate and such child is chiefly dependent upon the Employee for support and maintenance and such child is a dependent of the Employee for IRS purposes then, the coverage for such child shall be continued for so long as such Employee’s coverage remains in force under the Plan, provided proof of such incapacity is submitted to the Fund within 31 days after the date such child’s coverage would otherwise terminate and periodically as requested thereafter. Coverage is also provided for Dependent Children who otherwise meet the requirements of this Section 1.1.7 but are already over the maximum age for Dependent eligibility when the Employee becomes covered under the Plan. D. Your Duty To Inform The Plan Of Termination Of Dependent Eligibility If any of the following occur, it is the Employees’ responsibility to notify the Fund Office: Divorce or legal separation; Dependent Child reaching the Plan’s limiting age (19; or 23 if a full-time student); Marriage of a Dependent Child; Dependent child’s cessation of full-time student enrollment (for children age 19 or over); Dependents failure to qualify as a “Dependent” under the Working Families Tax Relief Act; or Recovery of an incapacitated child. If you fail to inform the Fund Office when one of these events occurs, your dependent may lose his or her right to COBRA continuation coverage. Further, if because you have failed to inform the Fund Office, the Fund pays out benefits for an ineligible Dependent, the Fund will have the right to recover such benefits from you, your dependent, or any provider to whom such benefits were paid. The Fund may at its option withhold future benefits due to or on behalf of you and your other Covered Dependents in order to recoup amounts it paid on behalf of an ineligible dependent. If the Plan brings a legal action to collect such benefits, the Plan, upon prevailing, will be entitled to receive and you may be required to pay not only the overpayments, but also interest and the attorney’s fees and costs the Plan incurs in such action. E. HIPAA Certificates Pursuant to the Health Insurance Portability and Accountability Act (HIPAA), the Fund will provide Covered Employees and Dependents with a HIPAA certificate of creditable coverage when coverage under the Plan terminates. This certificate will show the length of time the Covered Employee, Covered Dependents, or both were covered under this Plan. If you or a Dependent become covered under another group health plan, you may need to furnish the certificate to that plan in order to receive credit for your coverage under this Plan to aid in applying a limit to any pre-existing condition you or a dependent may have. This Plan will furnish such a certificate when regular coverage under this Plan ends, when COBRA Coverage ends, and upon the request of (or on behalf of) a Covered Person while covered under the plan or within the two years following the termination of coverage. A detailed copy of the Plan’s procedures for requesting a certificate of creditable coverage is available from the Fund Office.   TABLE OF CONTENTS   St. Louis Graphic Arts Joint Health & Welfare Fund 14323 South Outer Forty Rd. - Suite S106 Chesterfield, Missouri 63017 Fund Office: (314) 878-1579 twesthues@slgahw.org Fax: (314) 275-2640   If you have any comments about this web site, please contact us at twesthues@slgahw.org.   Site Concept and Design ©2002 jWeb. Maintenance and Hosting provided by jWeb.