If you become disabled from working in the trade while you are eligible for benefits under the Hour Bank or Subsidized Self-Payment rules described on page 5 of the SPD & Formal Plan Rules, you will remain eligible for 6 months of coverage for any one disability at no charge. After that, you will continue to be eligible by reason of your remaining Hour Bank credits, if any, and after that by means of subsidized self-payments for up to 6 months.

If you return to work after receiving this disability extension, you must earn a minimum of 3 months of Hour Bank coverage through active employment before you can be eligible for another disability extension, and you may not receive more than 18 months of such coverage during your lifetime.

This section contains a brief summary of the eligibility rules for active and retired members and their eligible dependents.  For complete eligibility rules, refer to the SPD & Formal Plan Rules.

 Basic Eligibility Rules for Active Members

Whenever you perform an hour of covered employment under a collective bargaining agreement of U. A. Local No. 159, you receive one Hour of credit under the Plan's Hour Bank. This is true, regardless of whether you are working in commercial or industrial plumbing or residential plumbing, or as a residential specialist, so long as your employer is contributing the standard contribution for your classification of work. You also receive credit for hours worked under other U.A. collective bargaining agreements, through reciprocity, but your Hours are adjusted proportionally to reflect any difference between the actual contribution rate, and the standard rate then in effect for your classification of work.

To qualify for benefits as a new employee, you must perform 300 hours of covered employment in a six-month period. Once you have qualified for benefits, your Plan Hour Bank is charged a fixed amount each month for that month's coverage. Any excess Hour Bank credit is accumulated, up to a Maximum Hour Bank Amount, to be used when you have low hours of covered employment. The Plan's Monthly Charge is currently 130 Hours for a month's coverage for employees who are covered by Kaiser, and 140 Hours for a month's coverage for employees who are covered by Blue Shield of California. The Maximum Hour Bank Amount is currently six times the Monthly Charge (that is, 780 Hours for employees who are covered by Kaiser, and 840 Hours for employees who are covered by Blue Shield of California). These amounts are set by the Board of Trustees, who may change the Hour Bank rules from time to time and may adjust the amounts of hours in participants' Hour Bank reserve accounts. If the Monthly Charge and/or Maximum Hour Bank Amount are changed, or if your Hour Bank is adjusted, you will be informed by the Trust Fund Office.

Your employer reports the hours you work each month in the following month, and they can be used to pay for coverage in the month after that ("the skip-month system"). For example, your hours of covered employment in January are reported in February and are used to provide coverage in March. This may cause a delay in your initial eligibility or create a gap in coverage even after a month in which you worked the number of hours required to maintain coverage.

 Initial Eligibility for Newly Organized Employees

At the sole discretion of the Board of Trustees, a new member enrolled as part of an organizing drive sponsored by the Local Union may be granted 300 Hours credit upon completing the first 40 hours of covered employment. However, this grant is conditioned on the employee's continuing to be employed in covered employment. If a newly organized member leaves covered employment before working 300 hours, then his or her Hour Bank will be cancelled, even if the employee is not found to have committed misconduct. The benefits provided under this rule are limited to medical coverage, until the Employee has completed 300 hours of covered employment and qualifies for full benefits under the Plan.

 Public Employees

There are special Hour Bank rules for persons who leave covered employment to work for a public agency that provides medical benefits which provide minimum value within the meaning of Internal Revenue Code Section 36B(c)(2)(C)(ii). If you take this type of job, and you notify the Trust Fund Office within 30 days, you may have your Hour Bank frozen. Then, when you leave that public employment, you may have your Hour Bank reinstated if: a) you either become employed in covered employment or registered for work (and actually available for work) through the Union’s Hiring Hall, or retire, within 30 days; and b) you were a member in good standing of the Union the entire period of your public employment.

 Dependent Eligibility

Your Eligible Dependents are generally covered whenever you are covered, if they have been properly enrolled. Your Eligible Dependents are your spouse or domestic partner, and your children, up to the Plan's limiting age, as described below.

For purposes of this rule, “children” means:

• Your natural children;
• Your stepchildren, foster children, children of your domestic partner, or children under your legal guardianship;
• Any minor child placed with you for the purpose of legal adoption, from the moment the child is placed in your physical custody, or from the moment you have assumed and retained a legal obligation to provide total or partial support for the child in anticipation of adoption, whichever is earlier.

The Plan also covers your natural or adopted children when you have been ordered to maintain their coverage in a court order called a "Qualified Medical Child Support Order" ("QMCSO") or equivalent. If the Plan receives a Medical Child Support Order, it will review it promptly to determine if it is qualified. The determination that an order is not a QMCSO is appealable to the Board of Trustees. The Plan procedures for review of QMCSOs are available free of charge from the Trust Fund Office

For Plan Years beginning before January 1, 2014, no coverage is available to any dependent who is in full-time military service.

 Retirees and their Dependents

A retired member of U. A. Local No. 159 is eligible to participate in the Plan if:

1. he or she was covered under the Hour Bank rules for at least 12 of the last 18 months before his or her retirement; and
2. he or she had accrued at least 10 Years of Vesting Credit under the U.A. Local 159 Defined Benefit Plan (or its prior plans); and
3. he or she is receiving a pension from the U. A. Local No. 159 Defined Benefit Plan; and
4. he or she is a member in good standing of the Union; and
5. if pre-Medicare, he or she resides within the service area of the Plan HMOs.

There are exceptions to the 12-months-coverage rule and/or the 10 Years of Vesting Credit rule for disabled participants, qualifying employees on the out-of-work list during the years 2009 through 2012, and employees of qualifying public employers. For complete rules, refer to the Formal Plan Rules, Section II, Rule A.1.

You must enroll in a Plan HMO, and comply with the HMO's rules, to be eligible for any medical, hospital, surgical or prescription drug benefits. Effective January 1, 2012, new members who enroll in the Plan, and all Residential Specialists, shall be enrolled in Kaiser, and must remain enrolled in Kaiser. At open enrollment, members who enrolled prior to January 1, 2012, may elect to enroll in either Kaiser or Blue Shield of California.

Be sure to enroll all of your dependents, or they will not be covered. Once you have enrolled in an HMO, you are automatically covered under the other benefits applicable to you.

New dependents must be enrolled within 30 days, or 60 days as applicable, to guarantee their right to immediate enrollment.  For example, you must enroll a new spouse within 30 days of your marriage, and a new child within 30 days of his or her birth, adoption, etc.  If you fail to enroll a dependent in a timely manner when you or the dependent is first eligible for benefits, your dependent may not be able to receive medical benefits until the next open enrollment. 

For complete information about enrollment rights and requirements, refer to the SPD & Formal Plan Rules.

 Enrollment Form