Member Benefits - RI Health Fund

Rules of Eligibility

1. The Plan of benefits will be Blue Cross HealthMate Coast-to-Coast, Blue Cross Dental and Life Insurance.

2. Participants who accumulate 1,200 or more credited hours of employment during the calendar year 2001 shall be eligible for annual coverage for the twelve month period beginning March 1, 2002 whether or not he is still in the trade.

3. Participants who are available for work at the trade who accumulated more than 400 hours but less than 1,200 credited hours of employment during the calendar year 2001 shall be eligible for annual coverage for the twelve month period beginning March 1, 2002 provided they self pay the difference between their credited hours of employment and 1,200 hours at the rate of $3.75 per hour. Any member who accumulates between 400 and 1200 hours and has left the trade and is not available for work as determined by registration on the unemployment list maintained by the Union, will be eligible under COBRA only and not eligible to self pay hours.

4. Bank hours resulting from having more than 1,500 credited hours of employment during the calendar year 2000 will be added to a participant's 2001 credited hours of employment in determining eligibility.

5. Participants who were available for work at the trade with less than 400 credited hours of employment will not be eligible to self pay hours but will receive one month of health coverage only for each 100 credited hours and then will be eligible to self pay premiums under the Fund.

6. Apprentices with credited hours in 2001 will receive one month of health coverage only for each 100 credited hours of employment and then will be eligible to self pay premiums under the Fund. This applies to an Apprentice's first year only. Thereafter, they will be treated the same as Journeymen.

7. Participants who become permanently and totally disabled from a nonoccupational accident or illness while eligible for coverage under the Fund and prior to reaching age 62 shall be eligible for extended health coverage for a maximum of 2 years upon the termination of regular coverage, provided:

a. Participant has been eligible under the Fund continuously in the 5 preceding years.

b. Participant has filed for Medicare and Social Security Disability.

8. Participants who become injured from an occupational accident or illness while eligible for coverage under the Fund and collect worker's compensation benefits will be eligible to self pay premiums while collecting worker's compensation benefits.

9. Single participants who have 400 or more hours can elect to self pay hours provided the election is timely. Single participants can elect to receive one month of health coverage only for each 100 credited hours of employment after which participants will be eligible to self pay premiums.

10. Rules for self payment of premiums/hours.

a. Participants can exercise the option to self pay hours even though the prior year's coverage was terminated because of failure to make payments.

b. Participants self paying hours will be eligible for full benefits including health, dental, and life benefits.

c. Participants eligible to self pay premiums, except for options available under COBRA, will be eligible for health benefits only.

d. The qualifying event for determining maximum coverage under COBRA will be the date of last employment. If a participant is available for work, the qualifying event for determining maximum coverage under COBRA will be when coverage ends.

11. Participants who qualify for self payment of premiums under the Fund may also elect an alternate health care plan that the Fund may make available.

12. Participants retiring with a Normal pension (age 62) will receive a maximum of 24 months extended health coverage only provided the participant has been working at the trade for a period often consecutive years prior to retirement and has 10,000 or more credited hours of employment with a minimum of 250 hours in each year (Exception for any 3 of the 5 years during the period 1991 - 1995 if continually covered under the plan and available for work in covered employment). There will be an additional 36 months spousal coverage only if a member self-pays through the Health Fund until his 65th birthday. The additional 36 months will begin when the members' 24 months extension ends. In the case of both participant and spouse, coverage ceases at age 65.

13. Service Pension retirees who have accumulated a minimum of 10,000 hours in the ten consecutive years immediately preceding the year of retirement with a minimum of 250 hours in each of the preceding 10 years will receive extended coverage for a period of 2 years (24 months) to become effective when the retiree's coverage terminates based upon credited hours of employment.

14. Any retired member who has enough hours to qualify to buy hours at the next open enrollment is allowed to buy hours to continue health coverage. Also, any member retiring on any type of pension with less than 400 credited hours of employment is allowed to self pay premiums only at the next open enrollment.

15. Rules for new employees

a. A new employee is determined to be an employee who has no credited service in the previous three calendar years, and will be eligible only one time as a new employee.

b. Upon accumulating 400 recorded hours within a consecutive six month period, the members would be eligible to receive four months of coverage commencing on the first day of the 2nd month following the month in which he accumulated 400 hours.

c. The member would then be eligible to self pay premiums for individual or family coverage,

d. The member would also use the total hours worked m the current year toward his next year's eligibility under the 1,200 hour rule (but would not be eligible under the 400 hour rule of one month's coverage for 100 hours.) If a member elects not to self pay premiums, the member will not be credited with the hours.

e. If a new employee does not receive four months of coverage due to becoming eligible shortly before the annual coverage period (March 1), the member will receive credit for the unused coverage by reducing the number of hours needed for annual coverage by 100 hours per month of unused coverage.

f. A new member will not receive the four months of coverage until he/she attends new member orientation.

Amendments to the Rhode Island Carpenters Health Fund's Rules of Eligibility

Please be advised that pursuant to Sections 4.12 and 5.4(14) of the Rhode Island Carpenters Health Fund Trust Agreement the Trustees have voted to amend the Rhode Island Carpenters Health Fund's Rules of Eligibility as follows:

First Rule Change (Re: Suspensions)
Effective July 1,2001, health plan coverage under the Rhode Island Carpenters Health Fund will be suspended for any Participants, Members (including Disabled or Retired Members), or their eligible Beneficiaries found to be engaged in Non-Covered Employment in the Carpentry Industry. Defining Non-Covered Employment in the Carpentry Industry. Non-Covered Employment in the Carpentry Industry (NCECI) means:

• Employment in the Carpentry Trade or Craft for an employer that is not signatory to a collective bargaining agreement with respect to that work;
• acting as an officer, director, or supervisor of, or being an owner of an interest in, such an employer; or
• engaging in self-employment, whether as a partner, proprietor, or otherwise, in the Carpentry Trade or Craft.

When Suspension Begins: Health coverage will be deemed suspended on the first day of the first month following the date the individual engages in NCECI. Suspensions shall be effective with respect to claims incurred on or after the first day of the first month following the date the individual engages in NCECI.

When Suspension Ends: Suspension of health coverage will proceed on a month- to-month basis and upon a showing that the individual is no longer engaged in NCECI, said individual's health coverage will be reinstated the following month. If we find that the individual has not engaged in NCECI, we will reinstate the individual's eligibility retroactively.

Second Rule Change (Re: Terminations)
Effective March 1,2002 health coverage under the Rhode Island Carpenters Health Fund will terminate for any Participant, Member (including Disabled or Retired Members), or their Eligible Beneficiaries found to be engaged in NCECI, as this term is defined above. Said termination shall be considered a termination "for cause."

When Termination Begins: Health coverage will be deemed terminated on the first day of the first month following the date the individual engages in NCECI, Terminations will be effective with respect to claims incurred on or after the first day of the first month following the date the individual engages in NCECI. Regaining Eligibility Following Termination. In order to gain eligibility for health plan coverage following a termination, an individual must meet the requirements specifically set forth within the Rhode Island Carpenters Health Plan's Rules of Eligibility, based on credited hours of work after the termination.

Applicability to COBRA Continuation Coverage. This rule change shall also apply to those Participants, Members or their Eligible Beneficiaries who are receiving health plan coverage under COBRA. Furthermore, under no circumstances shall either a suspension or termination of health plan coverage based on NCECI entitle a Participant, Member or Eligible Beneficiary to COBRA Continuation Coverage.

Once again, if we find that the individual has not engaged in NCECI, we will reinstate the individual's eligibility retroactively.