IATSE NATIONAL HEALTH AND WELFARE FUND

Plan C Participation and Eligibility Rules

EFFECTIVE 7/1/2004

How Do You Become a Participant in the IATSE National Health and Welfare Fund Plan C?

 

To become a participant, you must first meet the eligibility requirement of working in covered employment. Covered employment is work covered by a collective bargaining agreement requiring your employer to make contributions on your behalf to the IATSE National Health and Welfare Fund on your behalf.

What is the Minimum Requirement and How Are Contributions Credited?

 

Employer contributions are credited to a CAPP (Contributions Available for Premium Payments) account in your name. Your right to enroll begins when the amount of employer contributions in your CAPP account reaches at least $310.00. There is no time limit to accumulate this amount. However, unused funds are forfeited after 2 years of inactivity in the account. You may not self-pay to reach this amount. As soon as your CAPP account reaches the minimum requirement of $310.00, an enrollment form is mailed to you.

The following chart demonstrates when enrollment forms are mailed and when coverage may begin.

Contributions Received That Satisfied Eligibility Requirement	Enrollment Form Mailed by the Fund to Participant	Enrollment Form Received by the Fund on the 15th of	Enrollment Coverage Begins on the 1st Day of
January	February	March	April
February	March	April	May
March	April	May	June
April	May	June	July
May	June	July	August
June	July	August	September
July	August	September	October
August	September	October	November
September	October	November	December
October	November	December	January
November	December	January	February
December	January	February	March

 

How Do You Enroll For Coverage?

 

When you receive your enrollment form, you may make one of the following choices:

• You may choose a health insurance plan (you may be required to make a payment at this time if your CAPP account is insufficient to cover the premium cost for the program you select).
• You may choose to participate in the Medical Reimbursement Program if you provide proof that you have acceptable health insurance coverage from another source.
• You may waive coverage if your CAPP balance is less than $630.00.

What If You Initially Waive Coverage?

 

If you do not enroll when you first meet the minimum eligibility requirement of $310.00, you must wait until your CAPP account reaches at least $730.00 (the cost for one quarter of single coverage under Plan C- Option 2 plus a $100 administrative fee). When this happens, you will be sent another enrollment form. At that time, You will again be given the opportunity to enroll in a health insurance program or participate in the Medical Reimbursement Program. You may not waive coverage once your balance is $730.00 or more.

 

If you do not make a coverage selection, you will be automatically enrolled for single health insurance coverage under Plan C- Option 2.

What Happens Once You Become A Participant?

 

Once you become a participant in any one of the programs, you will begin receiving a quarterly statement. The statement provides you with your enrollment status, a listing of the employer contributions received in a three-month period and the amount in your CAPP account. If your CAPP account is insufficient to cover the quarterly premium cost for the health insurance program you have chosen, you will be required to make a payment.

What If You Do Not Make The Required Payment?

• If your CAPP account is less than $630.00, your health insurance coverage will be cancelled.
• If your CAPP account is at least $630.00, you will be downgraded to single coverage under Plan C - Option 2.

If You Have Been Canceled For Non-Payment, When Can You Enroll Again?

 

If your coverage is canceled for non-payment, you must satisfy another eligibility requirement before you can re-enroll for coverage. This time, your CAPP account must reach at least $1,360.00 before another enrollment form is sent to you. This include an additional $100 re-enrollment fee.

When Are You No Longer Eligible to Continue Coverage?

 

Your right to participate will end when both of the following happen:

• Your CAPP account is zero, and
• You have not had employer contributions of at least $630.00 over a 24-month period.

If your coverage is terminated because of the above two circumstances or because you did not make the required co-payment, you will be given the opportunity to continue your coverage under COBRA. COBRA is a federal regulation which requires us to offer you the ability to self-pay for this group coverage for a specified period of time.