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Life Events

This section provides advice on what you should do to ensure continuation of your Health and Welfare benefits if you experience a “life event” (such as marriage, divorce, disability, or retirement).

If you have additional questions, contact the Administrative Office at (714) 898-2200.

Are You Moving?

If you move, it is your responsibility to keep the Administrative Office informed about where it can reach you. Otherwise, you may not receive important information about your benefits.

The Administrative Office should also be notified of a change of address for any covered dependent.

Generally, once you are enrolled in your selected health plan(s), you may not change your election outside of the Open Enrollment period. However, if you are in an HMO or prepaid dental plan and you move out of the service area, you may appeal to the Board of Trustees for an exception to this rule.

Are You Getting Married Or Having A Baby?

If you get married, or if you have or adopt a child, your dependents are eligible for benefit coverage. However, you must enroll new dependents within 31 days of the date they are acquired in order for coverage to be provided, except as provided under the “HIPAA Rules for Special Enrollment” provided in the Summary Plan Description.

Your eligible dependents include, but are not limited to, the spouse to whom you are legally married, your natural children, and children who are legally adopted by or placed for adoption with you.

Proof of dependency is required. A certified copy of your marriage certificate, a child’s birth certificate, or a court order showing legal responsibility is acceptable proof.

Have You And Your Spouse Divorced or Separated?

If you divorce or legally separate from your spouse, you must notify the Administrative Office in writing within 60 days of the event.

If you do not immediately notify the Administrative Office and claims and/or premiums are paid on behalf of an ineligible dependent, you and/or the dependent is responsible for reimbursing the Trust for such claims and/or premiums, including attorney’s fees, interest, and reasonable collection costs.

If you become divorced or legally separated, your spouse may be eligible for COBRA Continuation Coverage for up to a maximum of 36 months. Please refer to the COBRA Continuation Coverage section for more details.

Has Your Child’s Eligibility Status Changed?

If your child loses eligibility for coverage, you must notify the Administrative Office in writing within 60 days of when the dependent status change occurs.

As a result of the Affordable Care Act, children under age 26 are eligible for coverage, whether a student, married or unmarried. An adult child will not be eligible for coverage if they have or are eligible for employer-sponsored coverage, or if the child is age 26 or older — unless he or she is incapable of self-sustaining employment by reason of mental retardation or physical handicap, per the Plan’s rules. See your Summary Plan Description for more information.

If you do not immediately notify the Administrative Office and claims and/or premiums are paid on behalf of an ineligible dependent, you and/or the dependent is responsible for reimbursing the Trust for such claims and/or premiums, including attorney's fees, interest, and reasonable collection costs.

Are You Taking A Leave Of Absence From Work?

If you qualify for a leave of absence from your employer in accordance with the provisions of the Family and Medical Leave Act of 1993 (FMLA) and the employer makes contributions to the Fund on your behalf, coverage may continue uninterrupted. You should contact your employer for details of the requirements and benefits under the Family and Medical Leave Act.

Are You Entering The Military?

If you enter full-time active duty with the armed forces of the United States, your eligibility for benefits will terminate on the day that you do so. (Your coverage will be provided by the armed forces.) If you return to work with a contributing employer of the Plan within the time period required by law, you will be reinstated for benefits on the first day of your re-employment.

If you enter full-time active duty with the armed forces of the United States, your eligibility for benefits will terminate on the day that you do so. (Your coverage will be provided by the armed forces.) If you return to work with a contributing employer of the Plan within the time period required by law, you will be reinstated for benefits on the first day of your re-employment.

Active participants who enter into full-time active duty with the armed forces of the United States, and their eligible dependents, may also elect to continue their coverage by submitting to the Administrative Office, within 60 days after entering the armed services, a written election to continue coverage. Participants (and their dependents) who elect to continue coverage must pay for such coverage in the same amount and in the same manner as provided for under COBRA Continuation Coverage.

Have You Become Disabled?

If you become disabled and are unable to work while covered by the Plan, benefits for you and your eligible dependents will stay in effect. You will be required to submit acceptable proof of the disability to the Administrative Office. Both you and your attending physician should fill out the Disability Extension Form.

Do You Plan On Retiring?

If you plan to retire, generally you must apply for coverage within 180 days of the date of your retirement. When you are initially eligible, and each year during the Open Enrollment period, you will be provided with an enrollment form, which you should complete and return to the Administrative Office. If you do not apply for coverage within 180 days of retirement, you will not be eligible to enroll at a later date and you will no longer be covered under the Plan. If you are married and are enrolling your spouse, you must submit a certified copy of your marriage license and the enrollment form to the Administrative Office.

Will Your Dependents Need Coverage In The Event Of Your Loss?

If you should die, your spouse and/or your dependent children may be eligible for COBRA Continuation Coverage for up to a maximum of 36 months. Please refer to the COBRA Continuation Coverage section for more details.

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