During a total disability you may* receive a continuation of coverage of your health and welfare benefits through the Trust Fund. Below you will find information regarding your eligibility for disability benefits.
Continuation of Coverage for Employees who are Totally Disabled
If you are unable to work because you become totally disabled, the Plan will continue your coverage for up to three (3) months in any twelve (12) month period, for all disabilities combined, without self-payment. In addition, your “Collective Bargaining Agreement” may stipulate an additional extension of coverage or may require an Employer to make contributions on your behalf for an additional period of time.
If you remain totally disabled following the three (3) month extension of benefits described in the above paragraph, you may extend coverage by self-payment for “COBRA” continuation coverage. However, please be advised that COBRA coverage does not include life insurance or disability benefits and is not available to participants entitled to “Medicare.” To receive more information on COBRA, please visit the COBRA section of this website or see your Summary Plan Description (SPD) for a full explanation.
If you experience a second disabling condition during a period of extended eligibility, you will not be entitled to an additional extension beyond the period described in the above paragraph.
If you are totally disabled, you are required to provide the Plan Administrative Office with a proof of disability for an extension of coverage due to the disability. You can download a Proof of Disability Claim Form from the Forms section of the website or you can contact the Plan Administrative Office to request that a form be mailed to you.
The Trust Fund’s disability waiver policy is not applicable to employees while they are eligible for, and/or receiving, FMLA leave. However, if you remain totally disabled at the conclusion of your FMLA leave, the Trust Fund may then continue coverage for up to three (3) months in accordance with the Trust Fund’s disability waiver policy.
Extended Coverage Under the Family and Medical Leave Act
Your employer must continue to pay for your health coverage during any approved leave under the federal Family and Medical Leave Act (FMLA). In general, you may qualify for up to 12 weeks of unpaid FMLA leave per year if:
1. Your employer has at least 50 employees;
2. You worked for the employer for at least 12 months and for a total of at least 1250 hours during the most recent 12 months; and
3. You require leave for one of the following reasons:
- Birth or placement of a child for adoption or foster care;
- To care for your child, spouse or parent with a serious medical condition;
- Your own serious health condition.
Details concerning FMLA leave can be obtained from your Employer. All requests for FMLA leave must be directed to your Employer; the Plan Administrative Office cannot determine whether or not you qualify. If a dispute arises between you and your Employer concerning your eligibility for FMLA leave, you may continue your health coverage by making COBRA self payments. If the dispute is resolved in your favor, the Trust Fund will obtain the FMLA-required contributions from your Employer and will refund the corresponding COBRA payments to you.
Please be advised that if your Employer continues your coverage during an FMLA leave and you fail to return to work, you may be required to repay the Employer for all contributions paid to the Trust Fund for your coverage during the leave.