WIXLIB

6ELIGIBILITYFAST FACTS:What is CoveredEmployment?Covered employment iswork you do for whichcontributions are made bya contributing employerunder the terms of a collective bargaining agreement or signed participation agreement.What is a CollectiveBargaining Agreement?A Collective BargainingAgreement is a writtenagreement between aunion and an employerthat requires the employerto make contributions tothe Fund on behalf of itsemployees. You must work a specified number of hours in a six-month workperiod to be able to initially participate in the Plan. You must also work a specified number of hours to be eligible to receive benefitsfor you and /or your eligible dependents. When you don’t work enough hours to qualify for benefits, you may be able to purchaseContinuation Coverage under the Federal program known as COBRA. When you retire, you may be able to purchase coverage under the Retiree Plan ifyou meet all the requirements.Your eligibility to participate in Plan I or Plan II is based on the number of hours youwork in covered employment and the contribution rate your employer is required tomake to the Fund on your behalf. Plan I offers coverage for members that work 600hours or more in a six-month period. Plan II offers a lower level of coverage for membersthat work at least 350 hours (but fewer than 600) in a six-month period. These rates areoutlined in a Collective Bargaining Agreement between your employer and the NewEngland Carpenters Health Benefits Fund.Hours RequirementsYour eligibility for benefits—which is different from your eligibility to participate—depends on the number of hours you work in covered employment during a six-month“work period.” If you work the required number of hours—and your employercontributes to the Fund for those hours—you and your eligible dependents will be eligiblefor coverage for six months. The hours requirements for a six-month work period are: Plan I—600 hours in one work period or 1,250 hours intwo consecutive work periods. Plan II—350 hours in one work period Local 1996– Plan I— 750 hours in one work period or 1,550 hours intwo consecutive work periods.– Plan II— 425 hours in one work period.Work Periods and Coverage PeriodsThere are two work periods per year. The hours you work during the work period areused to determine whether you’re eligible for coverage during the six-month coverageperiod. Coverage periods begin on April 1 or October 1.Review DateIf you work the required hoursduring the work period.You’ll be eligible for coverageduring the coverage period.April 1August, September, October,November, December and JanuaryApril, May, June, July, Augustand SeptemberOctober 1February, March, April, May,June and JulyOctober, November, December,January, February and March

7MAINTAINING YOUR ELIGIBILITYOnce you gain eligibility, that will continue as long as you work at least 600 hours(Plan I) or 350 hours (Plan II) in the six-month work period prior to the coverage period.If you do not work the required number of hours, you may be able to maintain yourcoverage, as explained below, by: “Buying-In” to the Fund; orUsing the banked hours you’ve accumulated in your Hours Bank for hoursworked before 1989. Banked hours are removed once you retire.Plan I — Active MembersPlan I members may continue coverage provided they work at least 1,250 hours in theprevious two consecutive six-month work periods preceding the period they werecovered.Local 51 and Shops in Plan I OnlyShop employers contribute a set dollar amount for hours worked in the current month tobe covered for the following month. Members must work one hour and the employermust make the monthly contribution to be covered. For example, a member who worksone hour in May is entitled to full Plan I coverage for the month of June.IF YOU’RE SHORT OF HOURSIf you do not qualify for continued coverage based on your hours worked, coverage maybe continued in two other ways—through the use of a Buy-In or Banked Hours.Short Hours Buy-InIf you do not work enough hours during a work period to maintain your eligibility, youmay purchase Buy-In coverage if you were short by 30 hours or less. In order to takeadvantage of the buy-in provision, you must have been eligible during the precedingcoverage period under that plan with worked hours only.You may buy into the plan of coverage you were eligible for in the prior coverage period atthe special buy-in rate per hour. For example, if you are in Plan I and you had worked atleast 570 hours, you could buy the 30 hours you were short (600 required – 570 worked)for the buy-in rate times 30. To buy into Plan II coverage, you must work at least 320hours in a work period. For the most up-to-date buy-in rate, contact the Fund Office.Payment must be made in one lump sum. You have only until the end of April orOctober to choose this buy-in option. Otherwise, continuation coverage would beavailable under COBRA at COBRA rates. (See page 11 for information on COBRAContinuation Coverage.) If late hours are received and would bring you into 30 hoursshort, you would have 30 days from the date of notification to choose this buy-in option.Special Rule for New MembersNew members may buy into Plan II after working eight hours in the currentwork period.

8An eligibility statement with the monthly cost will be mailed to you in March orSeptember (the end of the insured period) indicating the cost for coverage starting thefollowing month, the next coverage period. Be sure to keep your address current with theFund Office so you can receive this statement.Banked HoursHours that were banked prior to August 1, 1989, may be drawn upon to maintain yourcoverage when you do not work the required number of hours in a work period foractive members. You will be permitted to use hours from your bank to continueeligibility, provided you worked some hours in covered employment during the previousor current work period. You must be eligible to buy into COBRA to exercise this option.Proving Eligibility forDependentsYou are required to furnishthe following documentation for dependent coverage if you have not alreadydone so: Marriage certificate fromCity Hall or Town Hall; Birth certificate documentshowing both parents’names, court document orwritten statement on letterhead from appropriategovernmental agencyshowing legal guardianship and date of birth ofeach child; Divorce decree ifapplicable; Proof of a dependentchild’s attendance at anaccredited school or college as a full-time studentupon attainment of age 19must be submitted to theFund Office twice eachyear, as directed by theFund Office, on an originalform which contains theaccredited institution’sseal. He or she mustprovide a letter from theregistrar.The letter should include:– Verification of his or herenrollment;– The number of coursehours for which he or sheis enrolled; and– The beginning and endingdates of the term.Banked hours are credited at 1.90, which was the actual dollar value of the contributionrate in effect at the time the hours were banked. Therefore, the total banked hours usedto maintain eligibility will reduce the actual cost of the insurance coverage. To use your banked hours, you must indicate your wishes on a COBRA form(continuation coverage) or send a letter of request to the Fund Office.ELIGIBLE DEPENDENTSWhen you become eligible for coverage in the New England Carpenters Health BenefitsFund, your eligible dependents are also eligible for coverage.Plan’s Definition of DependentThe term “dependent” means (1) your lawful spouse; (2) your unmarried children(including a legally adopted child) who are under 19 years of age; and your unmarriedchildren who are at least 19 but less than 24 years of age who are enrolled as full-timestudents in an accredited school, college or university, not employed on a full-time basisand dependent upon you for financial support.If Your Child is DisabledIf an unmarried dependent child is incapable of self-sustaining employment because ofphysical handicap or mental retardation and he or she is dependent upon you forsupport and maintenance, his/her coverage will be continued provided his/her incapabilitycommenced prior to attaining age 19 or age 24 if a full-time student. You must submitproof of your dependent child’s incapability to the Fund Office on the later of 31 daysafter the date he/she attains 19 years of age or age 24 if a full-time student or 31 daysafter you are notified of his/her eligibility. Benefits will continue to be provided for yourchild as long as you remain covered under the Fund.No person may be eligible for benefits both as a member and as a dependent.Proof of the continued existence of such incapability shall be furnished to the FundOffice yearly.The term “child” also includes a stepchild or foster child, provided the child dependsupon you for support and maintenance and has been reported to the Fund Office.

9When Coverage EndsYour dependents’ eligibility for coverage will end on: What You Need to DoIf you are adopting a child,the following is needed: A copy of the birth certificate once it is available; A copy of the paperworkfrom the adoption agencyshowing the date the childwas placed in the home.(Coverage for an adoptedchild will begin on the datethe child was placed in thehome.)If you are the legalguardian, the following isneeded: A copy of the birthcertificate; A copy of the courtdocument stating thatthe member is the legalguardian of the child.(Coverage will begin onthe date of the legaldocument.)If you have not adoptedthe child or do not havelegal guardianship andare only the stepparentby marriage, then the following is needed: A copy of the birthcertificate; A copy of the natural parent’s divorce decree, themedical insurance section,along with the front pagethat has the name of thedefendant and plaintiff’snames. A copy of the tax return.See page 20 for moreinformation. The date your child or spouse no longer meets the definitionof an eligible dependent under the Fund; orThe date your eligibility ends.IF YOUR CHILD’S ELIGIBILITY FOR BENEFITS CHANGESIf your child’s eligibility status changes, you must notify the Fund Office as soon as possible.Your child may be eligible for COBRA Continuation Coverage for up to 36 months. Seepage 11 for more information.EXTENSION OF BENEFITS FOR TOTALLY DISABLED MEMBERSIf you become totally disabled while covered for benefits under this Fund, you may beeligible for an extension of benefits for up to two consecutive coverage periods. Yourcoverage will be under the same Plan you had at the time of your disability, subject toproper documentation. This option is available only once per lifetime. If only one freecoverage period is required, the option for a second coverage period is voided. Contactthe Fund Office for an Extension of Benefits form.If you are eligible for a Social Security Disability Pension, you may be eligible forcoverage under the Retiree Health Benefits Plan for up to 24 months or until you arecovered by Medicare, whichever comes first.Widow(er) ExtensionIf a member is covered by this Fund under worked hours or buying into Plan I at thetime of his or her death, the surviving spouse and eligible dependents will be coveredby the Fund for a maximum of three additional years under Plan I. Coverage is providedat no premium cost, provided that the spouse and dependents have no other healthinsurance, including Medicare. However, if the member was buying into Plan II at thetime of his or her death, the surviving spouse and eligible dependents are only eligiblefor coverage under Plan II.WHEN COVERAGE ENDSGenerally, your coverage under the New England Carpenters Health Benefits Fund will end: For Shop Employees, the first day of the following month inwhich you stop working in covered employment;The date you do not meet the requirements for eligibility; orThe date the Plan terminates.

10RETIREE HEALTH BENEFITS PLANWhat You Need To DoIf your child is no longereligible for coverage underthe Fund, he or she mayelect to continue coverageunder COBRA. You or yourchild must: Contact the Fund Officewithin 60 days of losingeligibility; and Enroll in COBRAContinuation Coverage.Failure to contact the FundOffice and provide noticeof the “Qualifying Event”(discussed in more detailon page 11) will result in aloss of rights to COBRA.These same rules applyto a Spouse who losescoverage due to a separation or divorce.If you retire on or after April 1, 1995, with a Service, Normal, Early or Disability Pensionand meet the Plan’s other eligibility requirements, you and your eligible dependents areeligible for the New England Carpenters Retiree Health Benefits Plan. There are fiverequirements: You must be eligible for five out of the past ten coverage periods, have 3,000 hoursduring the five-year period immediately prior to retirement and be covered bythe Plan in the period immediately preceding your application for retiree coverage.You must have no other group health insurance, including Medicare.You must share the cost of coverage with the Fund. Your monthly premiums willincrease from time to time.You must obtain medical services from providers in the Carpenters Preferred ProviderNetwork unless you do not live within a 20-mile radius of the nearest networkprovider.You must obtain pre-certification for all inpatient hospital stays.Continued Eligibility for RetireesEligibility to participate ends on the earlier of: The last day of the month when you do not pay the premium when required;The date your pension benefit is suspended for any reason;The date you become eligible under another group health plan;The date you or your eligible dependent become entitled to Medicare; orThe date the Plan terminates.Local 108 cannot participate in the Retiree Plan.Eligibility for Widow(ers) and Dependent ChildrenContinuing YourCoverage Under COBRAWhen your coverageunder this Fund ends,you may be eligible tocontinue some of thesame coverage you hadunder the Health BenefitsFund for a limited timeunder COBRA. For information about COBRAContinuation Coverage,see page 11.If you were eligible for a Service, Normal, Early or Disability Pension from the NewEngland Carpenters Pension Fund at the time of your death, your widow(er) and eligibledependent children may continue coverage under the Retiree Health Plan on a selfpayment basis. If a dependent child is covered under a member who is purchasing theRetiree Health Plan and the child reaches the age limit, the dependent is eligible to buyinto Plan II under COBRA.

11CONTINUING YOUR COVERAGEFAST FACTS: You and your dependents may continue certain medical benefits if your coverage ends due to a“Qualifying Event.” Your children are eligible to continue coverage under COBRA when they no longer satisfy theFund’s definition of eligible dependent because of age, marriage or student status. To keep your coverage under COBRA, you must make monthly payments to the Fund Office ontime. You are fully responsible for the payment of your benefits through COBRA.COBRA CONTINUATION COVERAGEIf your coverage under the New England Carpenters Health Benefits Fund ends due to a“Qualifying Event” (see below), you and/or your covered dependents may be eligible tocontinue your health care coverage under the Consolidated Omnibus BudgetReconciliation Act of 1985 (COBRA).By making monthly payments, you and/or your dependents may continue the samemedical, dental, vision and prescription drug coverage that you had before your coverageended. Your coverage can last for up to 18, 29 or 36 months, depending on theQualifying Event that resulted in your loss of coverage.Qualifying EventsTo be eligible to elect COBRA Continuation Coverage, you (as the member) and/or yourdependent(s) must lose coverage due to any one of the Qualifying Events, which arelisted in the first column in the table below. The last column indicates how individualsfind out that they’re eligible for continuation coverage, which are explained below.Qualifying EventWho May Purchase(Qualified Beneficiary)EligibilityNotification RequirementsMember terminated forother than gross misconduct(including retirement)Member, spouse and/ordependent children18 monthsFund Office willadvise eligible participantsMember reduction in hoursworked (making Member ineligible for coverage or the samecoverage under the Plan)Member, spouse and/ordependent children18 monthsFund OfficeMember becomesentitled to MedicareSpouse and/ordependent children36 monthsFund Office will adviseeligible participants whenmember reaches 65. Ifmember becomes eligiblebefore 65, he or she mustadvise Fund OfficeMember becomeseligible for disability throughSocial SecurityMember, spouseand/or children11 months inaddition to the18 monthsMember must adviseFund OfficeDeath of MemberSpouse and/ordependent children36 months minus Family member mustthe number ofnotify Fund Officemonths coveredsince the divorceMember is divorced or legallyseparated from spouseSpouse and/ordependent children36 monthsMember or Spouse mustadvise Fund Office sonotification can occurChild ceases to be adependent child underPlan definitionDependent child36 monthsMember must adviseFund Office sonotification can occur

12Who May Elect COBRA?Under the law, only “Qualified Beneficiaries” are entitled to elect COBRA ContinuationCoverage. A Qualified Beneficiary is any member, his or her spouse or dependent whowas covered by the New England Carpenters Health Benefits Fund when a QualifyingEvent occurs. A child who becomes a dependent child by birth, adoption or placementfor adoption with the Member during a period of COBRA Continuation Coverage is alsoa qualified beneficiary. However, a dependent purchasing COBRA who acquires a spouseduring COBRA Continuation Coverage is not a qualified beneficiary.!! One or more of your family members may elect COBRA even if you do not.Additionally, one member may elect COBRA for all Qualified Beneficiaries. However,in order to elect COBRA Continuation Coverage, the members of the family musthave been covered by the Plan on the date of the Qualifying Event. A parent mayelect or reject COBRA Continuation Coverage on behalf of dependent children livingwith him or her.How to Elect COBRA Continuation Coverage In order to elect COBRA Continuation Coverage, the Fund Office must be notifiedwhen you experience a Qualifying Event. You must notify the Fund Office within 60days from the date that the Qualifying Event occurs, or the date that you would losecoverage under the Fund because of the Qualifying Event, whichever is later. See thefollowing Notification Procedures. When the Fund Administrator receives notice of the Qualifying Event, he or she willmail you an election form, information about COBRA and the date on which yourcoverage will end.Under the law, you and/or your covered dependents have 60 days from the later of the date: You would have lost coverage because of the Qualifying Event; orYou and/or your covered dependents received the election form and COBRA information.If you and/or any of your covered dependents do not elect COBRA within 60 days of theQualifying Event (or, if later, within 63 days from the mailing date), you and/or yourcovered dependents will not have any group health coverage from this Fund after yourcoverage ends.COBRA Notification ProceduresAs a covered Member or Qualified Beneficiary you are responsible for providing the FundAdministrator with timely notice of certain qualifying events. You must provide the FundAdministrator notice of the following qualifying events: The divorce or legal separation of a covered Member from his or her spouse.A beneficiary ceasing to be covered under the Plan as a dependent child of a member.The occurrence of a second qualifying event after a Qualified Beneficiary has becomeentitled to COBRA with a maximum of 18 (or 29) months. This second qualifyingevent could include a Member’s death, entitlement to Medicare, divorce or legalseparation or child losing dependent status.

13In addition to these qualifying events, there are two other situations when a coveredMember or Qualified Beneficiary is responsible for providing the Fund Administrator

Vision Care Carpenters Vision Center 617-782-0100 250 Everett Street Allston, MA 02134 Davis Vision 800-999-5431 www.davisvision.com 159 Express St. TTY: 800-523-2847 Plainview, NY 11803 Prescription Drugs Ullicare Rx/Medco 800-818-6602 www.medcohealth.com 100 Parsons Pond Drive Franklin Lakes, NJ 07417 Carpenters 350 Fordham Road 978-694-1000