Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

CONTINUED COVERAGE DURING CERTAIN ABSENCES

A. TEMPORARY LEAVE OF EMPLOYMENT

If you have a temporary termination of Employment and you return to Covered Employment within six (6) months and provided that you remain in Covered Employment until at least one (1) month of Contributions is received on your behalf, your coverage will be reinstated immediately. If the temporary termination is in excess of six (6) calendar months, you will be required to fulfill the waiting period as described on page 15_ “When Do Benefits Begin?”

B. FAMILY AND MEDICAL LEAVE ACT

If your employer has 50 or more employees, you may be eligible for leave under the Family and Medical Leave Act (FMLA). Under the FMLA, you may take up to 12 weeks of unpaid leave for specified family or medical purposes, such as your own serious medical condition, the birth or adoption of a child, or to provide care for a spouse, child or parent who is ill. If you take FMLA leave, your employer is obligated to continue to contribute to the Fund on your behalf and your coverage through the Fund will continue.

Your coverage under the FMLA will cease once the Fund Office is notified (or otherwise determines) that you have terminated employment, exhausted your 12 weeks of FMLA leave entitlement, or if you inform the Fund Office of your intent not to return from leave. Your coverage will also cease if your employer fails to make Contributions required to maintain coverage on your behalf during the 12 week period.

If you do not return to covered employment after the end of your FMLA leave, you may be eligible to continue coverage under the Consolidated Omnibus Budget Reconciliation Act, commonly called COBRA, described below. The qualifying event entitling you to COBRA continuation coverage will be deemed to have occurred on the last day of your FMLA leave.
If you do not return to covered employment following the FMLA leave during which coverage was provided, you will be required to provide reimbursement for the cost of coverage received during the leave, unless your failure to return was based upon the continuation, recurrence or onset of a serious health condition that affects you or a family member and which would normally qualify for leave under the FMLA.

Call your employer if you have questions regarding your eligibility for FMLA leave. Also call the Fund Office regarding coverage during such a leave.

C. DISABILITY LEAVE

The applicable Collective Bargaining Agreement governs eligibility, terms and conditions of Disability Leave – for more information on Disability Leave, please refer to the Collective Bargaining Agreement or ask your employer for more information. Since weekly disability benefits are made for a maximum of 24 weeks, to maintain your medical extension after the 24 weeks are over, you must apply for COBRA coverage.

D. MILITARY DUTY IN THE UNITED STATES ARMED FORCES

If you are on active duty for 30 days or less, you will continue to receive health care coverage under the Fund for up to 30 days in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

If you are on active duty for 31 days or more, USERRA permits you to continue hospital, medical, vision, prescription drug and dental coverage for you and your Dependents at your own expense for a period of time up to the lesser of (1) 24 months, or (2) the period of the military service (as defined in the regulations) on a self-pay basis. Coverage will not be offered for any illness or injury determined by the Secretary of Veterans Affairs to have been incurred in, or aggravated during, performance of service in the uniformed services. The uniformed services and the Department of Veterans Affairs will provide care for service-connected illnesses or injuries. In order to be eligible for USERRA continuation coverage, you are required to notify you employer (in writing or orally), as far in advance as is reasonable under the circumstances, that you are leaving for military service unless circumstances or military necessity make notification impossible or unreasonable.

The amount that you will need to pay will be 102 percent of the cost to the group health plan for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. This continuation right operates in the same way as COBRA, and the same election and payment rules apply to USERRA continuation coverage as apply under COBRA. In other words:

• You must elect USERRA continuation coverage within 60 days of your separation from service due to your active service;
• Your initial USERRA continuation coverage premium payment must be paid no later than 45 days after the date of your election. If you do not make your first premium payment within this 45-day period, you will lose all rights to USERRA continuation coverage under the Plan and your coverage will terminate (as of the date it would otherwise terminate under the Plan).
• After you make your first payment for continuation coverage, payment is due on the first day of the month for which the payment applies.
• You will be given a grace period of 30 days to make each periodic payment. If you pay a periodic payment later than its due date but during its grace period, your coverage under the Plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the periodic payment is made.
• If you fail to make a periodic payment before the end of the grace period for that payment, you will lose all rights to continuation coverage under the Plan and your coverage will terminate as of the last date for which you made a timely payment.

The Plan’s COBRA rules regarding the procedures for electing and paying for continuation coverage apply to USERRA continuation coverage. Please review the section on COBRA below for more details regarding the election of, and payment for, continuation coverage.

In addition, you and your Dependents may be eligible for health care coverage under the TRICARE health care program for active duty military and their families. The Fund will coordinate coverage with TRICARE.

Even if you do not elect to continue coverage during your military service, you may be entitled to have your coverage reinstated when you return to employment with a contributing employer following your honorable discharge from the uniformed services, provided that you return to employment within the time periods prescribed by law. If you receive an honorable discharge and return to work with a contributing employer your full eligibility will be reinstated on the day you return to work as long as you return within one of the following time frames:

• 90 days of the date of discharge, if the period of service is 180 days or more;
• 14 days from the date of discharge, if the period of service was at least 31 days but less than 180 days; or
• one day after discharge (allowing 8 hours for travel) if the period of service was less than 31 days.

If you are hospitalized or convalescing from an injury caused by active duty, these time limits may be extended up to two years.

No waiting period or exclusion will be imposed in connection with such reinstatement (unless the waiting period or exclusion would have been imposed if you remained covered during your military service) except in the case of illness or injury connected with your military service.

Separation from uniformed service that is dishonorable or based on bad conduct, on grounds less than honorable, for being AWOL, or because of a conviction under court martial would disqualify you from any rights under USERRA.

Your employer is required to notify the Plan within 30 days after you are reemployed following military service; however, you should consider also notifying the Fund Office.