Summary Plan Description Table of Contents
- Important Contact Information
- Introduction
- Table of Contents
- Plan A Schedule of Benefits
- Plan B Schedule of Benefits
- Plan C Schedule of Benefits
- Plan 11 Schedule of Benefits
- Plan 11-C Schedule of Benefits
- Eligibility for Active Participants
- Eligibility for Retiree Coverage
- Insurance Coverage
- Weekly Loss of Time Benefit
- Medical Benefits
- Prescription Drug Program
- Medicare Part D Prescription Drug Plan (PDP) for Retirees
- Members Assistance Program (MAP)
- Dental Benefit
- Vision Benefit
- Hearing Benefit
- Special Fund Program
- General Plan Exclusions and Limitations
- Other Limitations on Your Benefits
- Definitions
- Claim and Appeal Procedures
- General Plan Provisions
- Information About the Plan
- Board of Trustees
Weekly Loss of Time Benefit
Eligibility for Loss of Time Benefits
Weekly Loss of Time Benefits are disability benefits for active employees covered under Plan A or Plan C (only). Benefits are not provided for employees in Plan 11, or for employees who are making self-payments for Plan B or COBRA. Retirees and dependents are not eligible for Loss of Time Benefits.
If your total disability starts before your effective date of eligibility, your Loss of Time Benefits will not begin until after your initial eligibility date. Benefits are also not payable if your disability begins during a coverage quarter for which you made a full 300-hour self-payment, unless you were available for work, not turning down calls and eligible for SUB Fund benefits.
Definition of Totally Disabled - Benefits are payable if you are “totally disabled,” which means you are wholly and continuously disabled by an accidental bodily injury or an illness which prevents you from working at your occupation, and which requires the regular care and attendance of a legally qualified physician. The disability must begin while you are eligible for benefits as an active participant.
Non-Occupational Disabilities
If your disability is due to a non-occupational cause, benefits will begin on the first day of a disability due to accidental bodily injury and on the fourth day of a disability due to an illness.
The benefit amount will be equal to 2.5% of your reported earnings for the twelve (12) consecutive months preceding the month in which your disability begins, up to the maximum shown in your Schedule of Benefits. “Reported earnings” are wages paid by a contributing employer (whether or not contributions were made to the Fund). No other earnings will be counted, even if the result is a lower weekly benefit because you have fewer than 12 months of reported earnings.
Occupational Disabilities
If your disability is due to occupational causes, benefits will begin on the first day of a disability due to an accidental bodily injury and the eighth day of a disability due to an illness. Loss of Time Benefits for occupational causes is payable up to the maximum shown in your Schedule of Benefits.
Length of the Loss of Time Benefit
The maximum number of weeks payable for any one period of disability is 26 weeks.
Successive periods of disability resulting from or contributed to by the same or related causes will be considered one continuous period of disability unless the second period of disability starts after you have returned to active full-time employment for at least 30 days.
If the second period of disability is due to an injury or illness entirely unrelated to the cause of the first disability and begins after you have returned to work for a contributing employer for one full day of active full-time employment, then the second disability will begin a new period of disability.
If you have two or more disabilities at the same time while receiving disability benefits, the benefits payable for all of the disabilities will be limited to a maximum of 26 weeks. Successive periods of disability due to injuries received in one accident will be considered one period of disability.
How Benefits Are Paid
Loss or Time benefit checks are issued every two weeks, and are made payable to you, the disabled participant.
Benefits will be paid at a daily rate of one-fifth of the weekly benefit during partial weeks of disability. As required by federal law, your share of the applicable taxes will be deducted from each disability benefit check. You may also elect to have federal income taxes withheld from your check beginning with the fifth week of disability.
Exclusions and Limitations
Loss of Time Benefits are not payable for any disability during which you are not under the direct care of a legally qualified physician. You are required to provide the Fund Office with updated certification of the continuation of your disability upon request. You may also be required to submit to an independent medical examination. Loss of Time Benefits are not payable for any period of time:
- After you retire;
- During which you are actively working for any employer; or
- For which you are receiving state unemployment benefits.
Longer Periods of Disability
If you continue to be disabled beyond 26 weeks, your Loss of Time Benefits will cease, but you could continue receiving disability hours for up to 30 months following your original disability date. Your disability hours will count the same as worked hours for the purposes of maintaining your eligibility while you are disabled. Refer to the rules starting on page 19 for additional information.