UFCW Midwest - Midwest Health and Pension Funds

United Food & Commercial Workers

Unions and Employers

Midwest Health and Pension Funds

Election of Coverage and Eligibility Provisions

Becoming Covered under the Plan

You and your eligible dependents become covered:

  • after you elect coverage and authorize payroll deductions; and
  • after you satisfy the applicable eligibility provisions.

These requirements are described in the below sections.

Which Eligibility Provisions Apply to You?

The eligibility provisions that apply to you are based on whether your employer makes a Rate-Per-Hour Contribution or a Flat-Rate Contribution each month:

  • Rate-Per-Hour Employer Contributions. Your employer makes a contribution for every covered hour that you work each month. the Rate-Per-Hour Eligibility provisions apply to you.
  • Flat-Rate Employer Contributions. Your employer contributes a flat amount each month. the Flat-Rate Eligibility provisions apply to you.

Your employer’s method of making contributions is specified in your Collective Bargaining Agreement with your local union. Contact your employer, your local union or the Fund Office if you need more information on which contribution method your employer uses.

The two methods of determining eligibility are described in the below sections.

Miscellaneous Provisions

Some Plan provisions apply to everyone, regardless of whether eligibility is based on rate-per-hour or flat-rate contributions:

  • Qualified Medical Child Support Order
  • Military Service
  • Extension of Coverage during Disability
  • Family and Medical Leave Act

These provisions are described under the last section below.

 
Election of Coverage and Authorization of Payroll Deductions

The Collective Bargaining Agreement between your employer and your local union requires that you elect whether or not to participate in the Health Plan. If you elect to participate, you must make a weekly contribution via payroll deduction.

Eligible employees may elect any of the following levels of coverage:

  • No Coverage. You may elect not to participate and you will not receive any health coverage or related benefits. There is no weekly payroll deduction if no coverage is elected.
  • Single Coverage. You may elect Single Coverage to receive health coverage and related benefits for yourself only (no family members) and make a weekly payroll deduction of $5. Additionally, you must work the minimum hours necessary to maintain Single Coverage. Note that Single Coverage includes the disability Income Protection Benefit if you qualify as a full-time employee.
  • Family Coverage. You may elect Family Coverage to receive health coverage and related benefits for yourself and your eligible family members and make a weekly payroll deduction of $15. Additionally, you must work the minimum hours necessary to maintain Family Coverage. (If your spouse is employed, please review the Working Spouse Rule section on the Coordination of Benefits page of this website.)

The weekly payroll deduction of either $5 or $15 can be made under an Internal Revenue Code Section 125 Cafeteria Plan that your employer can adopt. Under the Cafeteria Plan, no federal or state tax is withheld from or due on your contribution amount.

Election Form

The Fund Office or your employer will provide you with an “Election and Payroll Deduction Authorization Form” at the time you first become eligible for health coverage. A completed, signed form must be returned to the Fund Office in a timely manner or you and your family will not have health benefits coverage.

If you do not receive an “Election and Payroll Deduction Authorization Form,” contact the Fund Office immediately by e-mail or by calling.

If you do not elect coverage and authorize payroll deductions, you and your family members will not be eligible for health benefits.

Enrollment Periods

New Employee/Initial Enrollment. The enrollment period ends 60 days following the Health Coverage Effective Date. If you do not make an election within this time, you will not have health coverage. The next opportunity to enroll will be the Open Enrollment Period or the Special Enrollment Period, both explained below.

Open Enrollment Period. In December of each year, you may enroll or change your existing enrollment. The change will become effective on January 1 of the following year. Contact the Fund Office during November or early December and the proper forms will be sent to you.

Special Enrollment Period. If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the Health Plan if you or your dependents lose or gain eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage changes.

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

The Summary of the Cafeteria Plan page of this website includes a complete list of events and situations which may allow you to enroll under the Special Enrollment Period provisions.

To request Special Enrollment, contact the Fund Office.

 
Eligibility Based on Rate-Per-Hour Employer Contributions

If your employer makes a contribution for every covered hour that you work each month, these Rate-Per-Hour Eligibility Provisions apply to you.

If your employer contributes a flat amount each month, see the Flat-Rate Eligibility section below for the eligibility provisions that apply to you.

Initial Rate-Per-Hour Eligibility

Before your health coverage becomes effective, you must satisfy certain waiting periods as specified in your Collective Bargaining Agreement and other eligibility provisions.

Eligibility for you and your dependents is based on the average number of hours you work in covered employment during a certain period. Hours of covered employment are the hours that you work for which your employer contributes to the Health Fund on your behalf.

The date your coverage becomes effective depends on the length of time you must work before your employer is required to make contributions on your behalf. Refer to your Collective Bargaining Agreement to determine when your employer is required to begin making contributions.
Definition of a Week

A week is a payroll week. For example, if you are paid from Sunday through Saturday, this is what the Plan means when it refers to a week.
Average Weekly Hours Worked per Month

Use the following formula to determine your average weekly hours worked during a calendar month:

Divide the total number of covered hours
worked during payroll weeks that end in the calendar month

 


By the number of payroll weeks that end in the
calendar month (this will be either 4 or 5 weeks)

= Average Weekly Covered Hours During the Calendar Month


You should count your hours for each payroll week that ends in the month for which you are determining your average weekly covered hours. This means that some of the days for the first payroll week may be from the prior month and some of the days at the end of the month may not be counted.

 
Initial Rate-Per-Hour Eligibility Chart

The following chart illustrates the average weekly covered hours and time periods you need to work to become eligible for the different types of benefits offered.

You become eligible for these benefits When you have worked these Average Covered Hours For each week ending during this period Initial coverage begins
Life Insurance, Accidental Death and Dismemberment

 

Comprehensive Medical

Prescription Drug

Vision

Dental

12 per week 2 full calendar months in a row The first day of the month following the 2-month period
Income Protection, Dependent Coverage 28 per week (and not less than 12 per week in any month) 2 of the 3 immediately preceding calendar months The first day of the month after you meet the 28 hours requirement

 
Continuing Rate-Per-Hour Eligibility

You will continue to be eligible each month if you meet the following requirements:

To continue to be eligible for these benefits You must work these Average Covered Hours For each week ending during this period
Life Insurance, Accidental Death and Dismemberment

 

Comprehensive Medical

Prescription Drug

Vision

Dental

12 per week 2 full calendar months in a row
Income Protection, Dependent Coverage 28 per week (and not less than 12 per week in any month) 2 of the 3 immediately preceding calendar months


Termination and Reinstatement of Rate-Per-Hour Eligibility

Your eligibility for all benefits will end when you fail to work an average of at least 12 covered hours per week during weeks that end in 2 full calendar months in a row. In other words, you must work an average of 12 covered hours per week every month to remain eligible.

All coverage ends on the last day of the first month in which you fail to work the required average of 12 covered hours per week. You will lose all coverage for at least 2 months and will not be reinstated until you again work an average of at least 12 covered hours per week during weeks that end in 2 full months in a row.

You may be eligible to make self-payments to continue coverage under COBRA. See COBRA Continuation Coverage for more information.

The following chart shows when coverage ends and when it is reinstated:

Your eligibility for these benefits Ends when you fail to work these Average Covered Hours For each week ending during this period Coverage ends Reinstatement occurs
Income Protection, Dependent Coverage 28 per week 2 of the 3 immediately preceding calendar months The last day of the 3-month period The first day of the month after you again meet the 28-hours requirement
All benefits 12 per week 1 calendar month The last day of that month. Coverage is lost for two months. The first day of the month after you again meet the Continuing Eligibility requirements


Termination of Your Dependents’ Coverage

Your dependents will lose coverage on the earliest of the following dates:

  • the last day of the month in which you become ineligible for coverage; or
  • the last day of the month in which you do not work the required hours for dependent coverage; or
  • the last day of the month in which your dependent fails to meet the definition of an eligible dependent.

In the event of your death, coverage for your eligible dependents continues until the earliest of:

  • the last day of the third month following the date of your death;
  • the last day of the month in which your dependent fails to meet the definition of an eligible dependent; or
  • the date your dependent becomes eligible for health coverage under another group plan or policy.

If you have elected Family Coverage and were working enough hours to qualify for Family Coverage, dependents’ coverage may be continued by making self-payments under COBRA. See COBRA Continuation Coverage for more information.
Reinstatement after You Return-to-Work

If you were previously covered under the Plan and are returning to work immediately after:

  • a leave of absence for a period of total disability covered under the Plan of at least one calendar month but not more than 12 calendar months; or
  • a temporary layoff of at least one calendar month but not more than six calendar months; or
  • a sanctioned strike,

you will become covered again, to the extent that you were previously covered, on the date you return to work, provided that your employer is required to begin making contributions on your behalf immediately.

 
This concludes the section on Rate-Per-Hour Eligibility Provisions. You can skip the following Flat-Rate Eligibility Provisions and go directly to the final section on Miscellaneous Eligibility Provisions.

 
Eligibility Based on Flat Rate Employer Contrbutions

If your employer contributes a flat amount each month, these Flat-Rate Eligibility Provisions apply to you.

If your employer makes a contribution for every covered hour that you work each month, see the Rate-Per-Hour Eligibility section above for the eligibility provisions that apply to you.

 
Initial Flat-Rate Eligibility

Before your health coverage becomes effective, you must satisfy certain waiting periods as specified in your Collective Bargaining Agreement and other eligibility provisions.

You first become eligible on the first day of the month after your employer makes the required monthly contribution on your behalf into the Health Fund.

Eligibility for you and your dependents is based on your employer’s monthly contribution on your behalf:

  • If your employer makes a full-time contribution, both you and your dependents are eligible for benefits, including the Income Protection Benefit for you.
  • If your employer makes a part-time contribution, your dependents are not eligible for benefits and you are not eligible for the Income Protection Benefit.
  • If a contribution is not made on your behalf, you and your dependents are not eligible.

The date your coverage becomes effective depends on the length of time you must work before your employer is required to make contributions on your behalf. Refer to your Collective Bargaining Agreement to determine when your employer is required to begin making contributions.

The following chart shows the employer contributions that must be made to become eligible for the different types of benefits offered.

You become eligible for these benefits When this employer contribution is made Initial coverage begins
Life Insurance, Accidental Death and Dismemberment

 

Comprehensive Medical

Prescription Drug

Vision

Dental

1 part-time or full-time contribution The first day of the month after the month in which the contribution is made
Income Protection, Dependent Coverage 1 full-time contribution The first day of the month after the month in which the contribution is made

 
Continuing Flat-Rate Eligibility

You will continue to be eligible each month if you meet the following requirements:

To continue to be eligible for these benefits This employer contribution must be made
Life Insurance, Accidental Death and Dismemberment

 

Comprehensive Medical

Prescription Drug

Vision

Dental

Part-time or full-time monthly contribution
Income Protection, Dependent Coverage Full-time monthly contribution

 
Termination and Reinstatement of Flat-Rate Eligibility

Your eligibility for all benefits will end when employer contributions are no longer made on your behalf.

All coverage ends on the last day of the last month for which a contribution was made. You will lose coverage for the Income Protection Benefit and for Dependent Coverage if a full-time contribution is not made on your behalf.

Coverage is reinstated on the first day of the month that your employer again makes a contribution on your behalf.

You may be eligible to make self-payments to continue coverage under COBRA. SeeCOBRA Continuation Coverage for more information.

The following chart shows when coverage ends and when it is reinstated:

Your eligibility for these benefits Ends when Coverage ends Reinstatement occurs
Income Protection, Dependent Coverage A full-time contribution is not made The last day of the last month for which a full-time contribution was made The first day of the month that your employer again makes a full-time contribution
All benefits No contribution is made The last day of the last month for which a contribution was made The first day of the month that your employer again makes a contribution

 
Termination of Your Dependents’ Coverage

Your dependents will lose coverage on the earliest of the following dates:

  • the last day of the month in which you become ineligible for coverage; or
  • the first day of the month for which a full-time employer contribution is not made on your behalf; or
  • the last day of the month in which your dependent fails to meet the definition of an eligible dependent.

In the event of your death, coverage for your eligible dependents continues until the earliest of:

  • the last day of the third month following the date of your death;
  • the last day of the month in which your dependent fails to meet the definition of an eligible dependent; or
  • the date your dependent becomes eligible for health coverage under another group plan or policy.

If you have elected Family Coverage and your employer has made full-time contributions on your behalf, dependents’ coverage may be continued by making self-payments under COBRA. See COBRA Continuation Coverage for more information.

 
Reinstatement after You Return-to-Work

If you were previously covered under the Plan and are returning to work immediately after:

  • a leave of absence for a period of total disability covered under the Plan of at least one calendar month but not more than 12 calendar months; or
  • a temporary layoff of at least one calendar month but not more than six calendar months; or
  • a sanctioned strike,

you will become covered again, to the extent that you were previously covered, on the date you return to work, provided that your employer is required to begin making contributions on your behalf immediately.

 
This concludes the section on the Flat-Rate Eligibility Provisions.

 
Miscellaneous Eligibility Provisions

Miscellaneous Eligibility Provisions

 
Qualified Medical Child Support Order

A Qualified Medical Child Support Order (QMCSO) is a court order that requires a participant to provide medical coverage for his or her children (called alternate recipients) in situations involving divorce, legal separation, or a paternity dispute. Coverage will be provided to a child identified as an alternate recipient under a QMCSO even if that child was not covered under the Plan due to custody-related issues.

The Fund Office will notify affected participants and alternate recipients if a QMCSO is received. If you, your child or the child’s custodial parent or legal guardian would like a copy at no charge of the Plan’s written procedure for QMCSOs, or have any questions, please contact the Fund Office.

 
Special Rules for Continuing Eligibility

You may remain eligible for benefits under the Plan when your eligibility would otherwise end if you qualify under one of the following conditions.

Military Service. If you are inducted into the armed forces of the United States or if you enlist in military service, your eligibility and your dependents’ eligibility will end. However, coverage for you and your dependents may be continued if you satisfy the eligibility criteria of the Uniformed Service Employment and Reemployment Rights Act of 1994 (USERRA), as amended.

If you are called into uniformed service for fewer than 31 days, your medical and dental coverage during that leave period will be continued, provided that you pay your share of the premium as established by the Trustees from time to time. Contact the Fund Office to determine the amount you must contribute to continue your coverage during a leave of fewer than 31 days.

If you are called into uniformed service for 31 or more days, you can continue your coverage for up to 24 months after your coverage under the Plan would otherwise terminate (termination provisions are described above for Rate-Per-Hour and for Flat-Rate eligibility). If you fail to provide advance notice of your uniformed service, you will not be eligible to continue coverage unless the failure to provide advance notice is excused. The Trustees will, in their sole discretion, determine if your failure to provide advance notice is excusable under the circumstances and may require that you provide documentation to support the excuse. If the Trustees determine that your failure to provide advance notice is excused, you may then elect to continue coverage and pay all amounts required to continue coverage in accordance with the COBRA Continuation Coverage election and payment procedures. Your continuation coverage will then be effective retroactive to the date you lost coverage due to your leave of absence to perform uniformed service.

If the Fund Office has been notified that you are entering the uniformed service, you shall have the option of continuing the same class of coverage under the Plan. Election, payment and termination of this USERRA continuation coverage will be governed by the election, payment and termination rules for COBRA Continuation Coverage, provided that the COBRA rules do not conflict with USERRA.

COBRA and USERRA coverage run concurrently. This means that if you are not simultaneously eligible for COBRA and USERRA, then you will be entitled to the more generous benefit provisions under each law for periods in which you remain eligible for both forms of continuation coverage. If you fail to follow the COBRA rules when electing and paying for USERRA coverage, you may lose the right to continue coverage under USERRA. Once lost, the right to USERRA continuation coverage cannot be reinstated. However, if circumstances make it otherwise impossible or unreasonable for you to timely elect and pay for USERRA continuation coverage, the Trustees may, in their sole discretion, reinstate your right to USERRA continuation coverage provided that you pay all amounts required for such continuation coverage.

If you are discharged from the uniformed service under honorable conditions and have USERRA reemployment rights, eligibility may be reinstated on the date you return to work in covered employment or make yourself available for work in covered employment, provided your return to work is within 90 days from the date of your discharge or such shorter or longer period required by law if you serve less than 180 days or are hospitalized when your military service is terminated.

Extension of Coverage During Disability. If you are unable to work because you are totally disabled, your coverage, except for the Income Protection Benefit, may be automatically continued at no cost to you. If at the time of your total disability you had elected:

  • Single Coverage and you were working enough hours to qualify for Single Coverage, then your coverage will be extended for up to two months following your date of disability. If you work enough hours to qualify as a full-time employee, your coverage will be extended for up to six months following your date of disability.
  • Family Coverage and you were working enough hours to qualify for Family Coverage, then your and your dependents’ coverage will be extended for up to six months following your date of disability.

Either a new two-month or six-month extension, whichever you are eligible for as described immediately above, will apply to a newly-occurring disabling condition unrelated to a previous condition which occurs more than four weeks after you return to work. Only one two-month or six-month extension will apply to the same or related condition, even if you have returned to work for any period of time.

Any period of extended coverage provided here at no cost will reduce the period allowed for self-payment under the COBRA Continuation Coverage provisions by a period equal to the extended coverage.

If your employer is required to make contributions under the Family and Medical Leave Act or under a provision of the Collective Bargaining Agreement during a portion of your period of total disability, the automatic extension will be available to you in addition to the period of time covered by your employer’s contributions. COBRA Continuation Coverage may become available once you exhaust your entitlement to health coverage under this provision.

Family and Medical Leave Act (FMLA). Under the Family and Medical Leave Act of 1993, you may qualify to take up to 12 weeks of unpaid leave for a serious illness, to care for your newborn child or newly adopted child, to care for your seriously ill spouse, parent or child, or for a spouse, parent or child who is notified of an impending call to active duty. You may qualify to take up to 26 weeks of unpaid leave to care for a spouse, parent, child or nearest blood relative who is recovering from an illness or injury sustained while on active duty. If the Family and Medical Leave Act applies to your employer (small employers are exempt), it requires your employer to maintain your health coverage for the length of your leave (up to 12 weeks) as if you were actively at work. The Act also states that if you take a Family and Medical Leave, you cannot lose any benefits accrued before the leave.

Your employer will let you know what payment methods are available for continuing coverage during a leave of absence under the Family and Medical Leave Act and may require that the employee portion of the contributions for health coverage during the leave be paid by you upon your return to work or while you are on leave.

The Fund will grant eligibility for a Family and Medical Leave and will maintain your current eligibility status for the duration of the leave, provided your employer properly grants the leave of absence under the Federal law and makes the required contributions to the Health Fund on your behalf.

If you do not return to work after your leave and you are no longer eligible to continue health coverage under the Plan, COBRA Continuation Coverage may become available.

See your employer if you believe you may be entitled to a leave under the Family and Medical Leave Act.

 
 
(Updated 07/05/16)