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Eligibility For Benefits

Employers contribute to the Plan for every hour that you earn. Your dollar bank is credited with contributions reported and paid on your behalf. You are eligible to participate in the Plan on the first of the second month after a total credit of $615 has accumulated in your dollar bank. This is equivalent to 3 months’ deductions. For example, if your bank is credited as follows:

Work Month Amount Remitted/Credited
January 2015 $215 February 2015
February 2015 $200 March 2015
March 2015 $205 April 2015

then your benefits coverage would commence on May 1, 2015. Contributions earned in a particular month are usually reported and credited to your bank in the following month. There are times when contributions are remitted late. In such cases, your eligibility may be delayed or you could run out of coverage. Eligibility may be reinstated when contributions are received.

For every month of health plan coverage you receive, your bank will be charged $205. Your bank balance therefore goes up or down depending on whether you earn contributions of more or less than the amount charged to your bank. Balances in excess of one year’s deductions will be transferred to the general account to help fund the assisted coverage for unemployed and retired members. If you are paying direct, you have to contribute $400 a month, plus tax. The amounts charged to your bank, or required for pay direct, may be revised from time to time.

When you terminate employment, are laid off or you become disabled, your bank will continue to be charged the monthly deduction until the balance is less than one month’s deduction.

When your bank balance falls below one month’s deduction for the first time, you will be sent a notice from the Benefits Office. You must make direct monthly payments of $400, plus tax, to maintain your coverage. Alternatively, you may become eligible for assisted coverage in which case if no further contributions are earned, your coverage will be continued at a subsidized rate as long as the Trustees continue to approve this coverage. When your assisted coverage stops, you must begin to pay direct at the $400 rate, plus tax. Refer to page 8 for additional details.

If you receive benefits from the Workplace Safety Insurance Board (WSIB) as a result of an accident at the job site, your bank will, upon proper notification from your employer or the WSIB, be credited with the equivalent monthly bank deduction for a period of up to 12 months from the date of accident.

If you are receiving disability benefits and your bank falls below one month’s deduction, you will be sent a notification from the Benefits Office. Upon receipt of this notification you should apply for assisted coverage. If your benefit coverage lapses, your disability payments will continue to the end of their normal term but your coverage against future events covered by the Plan (i.e. life insurance, accidental death and dismemberment, future disabilities, major medical, drug and dental) will cease. Once you begin to receive long term disability benefits from the Plan, your benefit coverage is maintained as long as you are receiving long term disability benefits and provided you continue paying for assisted coverage.

When you return to work after a disability, termination of employment or layoff, your benefit coverage begins again on the first of the second month after the balance in your bank reaches one month’s deduction or more. Until then, if you were previously receiving assisted coverage, then assisted coverage will continue provided you receive approval from the Trustees and you make the required contributions each month.

If you retire prior to age 65, your bank will continue to be charged monthly deductions until its balance is less than one month’s deduction, or until you reach age 65. During this period your benefits coverage will continue as though you were an active member except for short term and long term disability benefits. When your bank falls below one month’s deduction, you must pay the assisted coverage rate to receive pensioner coverage to age 65. You are not eligible for assisted pensioner coverage unless you start your pension from the Local 46 ICI/ High Rise or Barrie Pension Plans or take a distribution from the Low Rise Pension Plan and have had contributions at the full Local 46 rate made on your behalf to the Health Plan (includes the Barrie Health Plan) for a continuous period of 15 years before you retire (and you did not retire on an early reduced pension prior to 2013). Periods on pay direct not exceeding 12 months in the 5 years immediately preceding retirement count towards the 15 year requirement. If you do not meet the 15 year requirement you may still qualify provided contributions on your behalf averaged at least 1,500 hours a year at the full Local 46 ICI rate from 1985 to your date of retirement. You will not qualify for assisted or free pensioner coverage if you paid direct for more than 12 months in the 5 years immediately preceding retirement. If you return to work after age 65 and are already receiving pensioner coverage, this will continue. You will not be eligible for Active Member coverage.

If you do not qualify for assisted or free pensioner coverage, you must pay the full pensioner premium to receive pensioner coverage, provided you were covered by the Local 46 Health Plan immediately prior to your retirement and there was no break in coverage. Any residual in your bank may be applied towards the premium (max. 12 mos.) if you retired at or after 65.

You will not be eligible for assisted or free pensioner coverage, nor will you be able to pay the full pensioner premium rate to receive pensioner coverage, if you retire and then go on to work in the Plumbing and Pipefitting Industry anywhere in Canada on a job that is not covered by a collective bargaining or reciprocal agreement with Local 46.

If your Union Membership ceases, the balance in your bank is cancelled and you will be required to accumulate three months’ deductions after being reinitiated before you are eligible again. If you are reinitiated within 3 months of your expulsion, your bank will be restored in full.

If you should die, your coverage will stop at the end of the month in which death occurs regardless of the balance remaining in your bank. However, coverage for your spouse and dependent children, if any, is continued without charge for up to 12 months after your death. Coverage can be continued beyond the twelve months by paying a monthly contribution, currently $210 plus tax for active coverage and $130 plus tax for pensioner coverage. This coverage is continued on the same basis as that which applied on your death. Pensioner coverage will apply after the date your spouse reaches age 65.

If you transfer to another U.A. Local, sufficient monies may be transferred to that Local’s health plan to enable you to establish immediate eligibility, all in accordance with the National Reciprocal Agreement and provided you have sufficient balance in your bank.


DEPENDENTS ARE DEFINED AS:

  • your legal or common-law spouse, and
  • your unmarried children under the age of 21 years, and
  • your unmarried children aged 21 and over who were continuously covered under the Plan and who are full time students and under the age of 26 years or who are unable to support themselves because of mental or physical handicap,
  • but excluding any children who are not financially dependent on you or a handicapped or unmarried child who was not covered under the Plan up to his or her 21st birthday.Your common-law spouse and dependents are only eligible six months after notice of cohabitation is received by the Benefits Office.

For coverage purposes you and your dependents are deemed to be covered under the Hospital and Health Insurance Acts in your province of residence. For Quebec residents, all aspects of RAMQ, the Act respecting prescription drug insurance, relating to drug coverage, including the Act’s provisions regarding maximum coinsurance, out-of-pocket maximums, eligible drugs and exception drugs will be considered part of this Plan.