Participating in the Health and Benefit Trust Fund
If you work for an employer who contributes to the Local 94 Health and Benefit Trust Fund under the terms of a collective bargaining or other written agreement, you are eligible to participate in the Health and Benefit Trust Fund’s benefit plans provided you meet certain requirements listed below.
Eligibility for New Members
Effective January 1, 2014 in accordance with the applicable requirements under PPACA the Fund will implement new initial eligibility requirements for new participants as follows:
New members of the Union and new employees of Contributing Employers will have to accrue 400 paid hours in Covered Employment within a six (6) consecutive month measurement period commencing as of their start date of covered employment to become eligible for benefits under the Fund. You will become eligible for benefits under the Fund as of the first day of the second month following the date that you accrued the 400 paid hours in Covered Employment within the applicable six (6) month measurement period. If you don't meet the eligibility requirements in the initial six month measurement period, a subsequent six month consecutive period will begin as of the first date of any subsequent month following your start date. As such, subsequent measurement periods can overlap, in part, with prior measurement periods. This will enable you to apply the relevant covered hours that span over multiple measurement periods in order to meet the 400 paid hours requirement.
For example, if you begin Covered Employment on January 15, 2014 and accumulate at least 400 hours on February 28, 2014, you will be eligible to participate in the Plan on April 1, 2014. If, however, you begin Covered Employment on January 15, 2014 and do not accumulate at least 400 hours through June 15, 2014 (i.e., the last day of the initial measurement period), you will not be eligible for coverage under the Fund until you satisfy the hours requirement for a subsequent measurement period. As an example, this could be achieved by accumulating the necessary hours in a subsequent measurement period that for instance runs from March 1, 2014 through August 31, 2014. If, during this subsequent measurement period (i.e., March through August), you accrue the required 400 hours on August 17, 2014, you will be able to participate in the on October 1, 2014.
Exception: If you were affiliated with Local 94B and were transferred to Local 94 or 94A you will have a waiting period of one (1) month before becoming eligible to first participate in the Plan. Additionally, if you were affiliated with an employer from the School Division and transferred to an employer with the Commercial Division you will have a waiting period of one (1) month before becoming eligible to first participate in the Plan. For purposes of the one (1) month waiting period, if you begin employment before the 16th of any month you will be deemed to have commenced employment on the first of that month and if you began after the 15th you will be deemed to have started the first of the next month.
After meeting this initial eligibility requirement, you must meet the continuing quarterly eligibility/work requirements to continue to be eligible for coverage under the Plan. The Plan's continuing eligibility requirements are not impacted by the above-discussed changes. However, eligibility will cease as of the last day of the month following the month in which you terminate covered employment or, if earlier, the last day of the month in which you fail to accumulate at least 400 paid hours of covered employment in accordance with the continuing eligibility requirements under the Plan.
Eligibility for Dependents
Your dependents, such as your spouse or children can participate in the Health and Benefit Trust Fund benefit plans. They are eligible for coverage as soon as you are, provided you comply with all the documentation required for your spouse or children.
Effective as of January 1, 2014, you will have 90 days to enroll all new eligible dependents (e.g., spouses and/or children) as of their applicable date (i.e.,the date of marriage, the child’s birthdate, date of adoption or placement for adoption or foster care, or, in the case of step-children, the date of marriage to the step-child’s parent) that establishes their spousal relationship or dependent status with you. If you fail to do so within the applicable 90-day period, dependent coverage will not be available under the Plan for your dependent child until the first day of the month following the date in which you provide the Fund Office with the required documentation and any other verifying information requested.
Effective January 1, 2014 the Plan will extend coverage to a participant’s eligible children up to the end of the month in which the child attains age 26 regardless of the child’s marital status, student status, employment status, eligibility for other health insurance coverage, financial dependency on the participant, or any other factor other than the relationship between the child and the participant. Effective January 1, 2014, your otherwise dependent child is not excluded from dependent coverage under the Plan solely because the child has access to health insurance coverage through an employer (as was previously the case). However, if your dependent child has other group health insurance including coverage through an employer, the Plan will generally consider that other coverage to be primary and the Plan’s coverage for such child will be secondary in accordance with its Coordination of Benefit (“COB”) rules which can be found in the SPD. You must complete a Coordination of Benefits Form. If you fail to do so within the applicable 90-day period, dependent coverage will not be available under the Plan for your dependent child until the first day of the month following the date in which you provide the Fund Office with the required documentation and any other verifying information requested.
Your dependents (other than your spouse) over age 19, who are incapable of self-sustaining employment by reason of being mentally and/or physically disabled (as such terms are defined by the New York Mental Hygiene Law), will remain eligible for benefits provided they became so incapable prior to their 19th birthday, were covered as Eligible Dependents under the Plan prior to their 19th birthday and are primarily supported by you. For more information on extending eligibility for disabled dependent children, contact the Health and Benefit Trust Fund Office.
If you are a retiree, you are eligible for certain benefits under the Health and Benefit Trust Fund’s Retiree Benefits Plan. Click here to find out more about your benefits if you are a retiree of the Commercial Division or the School Division (in the Eligibility and Enrollment sections).
If you are retired, you are eligible if:
- You have 15 years of Total Credited Service (as defined in the Central Pension Fund);
- You are receiving a pension from the Central Pension Plan;
- You have had five years of continuous coverage under the Health and Benefit Trust Fund for the 5 years immediately preceding their respective retirement date under the Central Pension Fund; and
- You pay the required premiums for retiree coverage (Commercial Division only).
Enrolling in the Fund
To enroll new dependents, such as a newborn child or a spouse if you get married, contact the Health and Benefit Trust Fund Office.
When enrolling dependents, or when making a change in a dependent’s status, the Fund Office may contact you asking for documentation to confirm dependent eligibility. Types of documentation include:
- a birth certificate (or court-certified declaration or acknowledgement of paternity);
- a marriage certificate;
- a court-certified judgment of adoption or placement for adoption;
- a divorce decree.
Coordination of Benefits
If you or your dependent has medical coverage elsewhere (for example, if your spouse has coverage through an employer), the Health and Benefit Trust Fund will coordinate benefits. That means the Fund will determine which medical plan provides primary and secondary coverage.
When enrolling dependents, you must download and fill out Coordination of Benefits forms.
After filling out the Coordination of Benefit forms, mail them to the Health and Benefit Trust Fund Office at:
Health and Benefit Trust Fund
Local 94-94A-94B AFL-CIO
331-337 West 44th Street
New York, NY 10036
Enrollment for Retirees
Once you have applied for your pension and your application has been approved and processed by the Central Pension Fund, the Health and Benefit Fund will receive notification of your retirement date. The Health & Benefit Fund Office will then verify if you meet the eligibility requirements for medical coverage. You will receive notification advising you whether you are eligible for medical coverage as a retiree and what coverage options you have.
To get more information on participating in the Health and Benefit Trust Fund, you can download the SPD for Actives and Retirees in the Commercial Division or contact the Fund Office.
Need to Find a Doctor, Dentist or Vision Specialist?
Why did I receive a bill for medical services?
While the Plan offers medical, prescription drug, dental and vision coverage, it does not pay 100% for all of these services. There are co-payments and coinsurance that you or your covered dependents may be responsible for paying. For more information about your benefits, please visit the Health and Benefit Trust Fund section of this site.