Health & Welfare Eligibility

Initial Eligibility

In order to become initially eligible for benefits as an Active Covered Participant from the Plan, you must be in the Eligible Class and reach 600 or more Credited Hours in a 6 month time-frame. Your coverage would begin the first day of the second month following the month after your 600th hour was worked.

  • For example: If you work your 600th hour in November, your coverage will start on January 1st. 

Continuing Eligibility

In order to continue to receive benefits as an Active Covered Participant from the Plan at the beginning of any Benefit Period, you must be in the eligible class and have a Qualifying Work Period.

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Click for November Example

Eligibility Video

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Key Words and Definitions

Eligible Class

"Eligible Class" means those persons whose chief source of livelihood is work at Covered Employment, and who, at any given time, are working in Covered Employment; are ready, willing, and able to work at Covered Employment; or, are seeking work in Covered Employment. 

Health & Welfare Credited Hours

Credited Hours are used to determine your eligibility to receive benefits under the Plan. Credited Hours are a combination of:

  • Payment Hours, also called “Contribution Hours” (hours you worked for which employer contributions are made to the Health and Welfare Fund for your work).
  • Delinquent Hours are hours you worked for which employer contributions are due but which have not been paid (through no fault of yours) to the Health and Welfare Fund for your work by the delinquent employer. You must provide evidence of your work such as a pay stub or similar record to the Fund Office to receive credited hours.
  • Weekly Disability or Workers’ Compensation Hours. (Currently, you may receive credit for up to 30 hours per week to a maximum of 104 weeks),
  • School hours for Apprenticeship training with the Joint Apprenticeship Committee of Philadelphia and Vicinity after April 30, 1988.
  • Qualifying Family and Medical Leave of Absence, and
  • Qualified Military Service. Military service up to 5 years for the United States is credited if you leave work with a contributing Plan employer for military service and return within the periods provided by law. You must present yourself for work in Covered Employment:
    (a) within 90 days after your discharge from military service over 180 days, (b) within 14 days for military service between 30 and 180 days and (c) immediately for service under a month. For military service before 1994, you had to return to Covered Employment within 90 days of discharge regardless of the length of your military service. Military service for the United States is also credited if you leave work with a contributing Plan employer for military service and you either pass away or become disabled after December 31, 2006 while performing military service. Service is credited as though you had returned to work on the date of your passing or on the date of the onset of your disability. Hours credited for Qualified Military Service are treated the same as “Payment Hours.”
Health & Welfare Covered Employment

Covered Employment is any type of work in the carpentry or related trade - within our geographic area - for which an Employer is required to make contributions (including contributions under a reciprocal agreement from another geographic area) for your work to the Carpenters Health & Welfare Fund of Philadelphia and Vicinity. Covered Employment also includes work as an employee of an employer which is required to contribute to the Plan under a participation agreement.

Health & Welfare Vested Eligibility

If you are an Active Covered Participant who was eligible in the preceding Benefit Period, and have five years of Credited Service under the the Carpenters Pension and Annuity Plan of Philadelphia and Vicinity ("Carpenters Pension Plan") as of May 1 preceding the beginning of the the Benefit Period, but would otherwise cease to be an Active Covered Participant at the beginning of the Benefit Period, you may still be Eligible for benefits under the Vesting Benefit privilege. This means you could continue to to receive full health coverage under the Plan if you have:

  • 300 or more Credited Hours within the 6-month Work Period, or
  • 600 or more Credited Hours within the 12-month Work Period corresponding to such Benefit Period.

This privilege applies to you only once in your lifetime if you have at least 5 years but less than 10 years if Credited Service under the Carpenters Pension Plan as of the May 1 preceding the beginning of the Benefit Period. If you have 10 or more years of Credited Service, this privilege applies to you only twice in your lifetime. Note that this privilege will not apply to you for two or more consecutive Benefit Periods - it can only be used for one Benefit Period at a time.

Health & Welfare Basic Eligibility

If you are an Active Covered Participant who was eligible in the preceding Benefit Period, and have 5 or more years  of Credited Service under the Carpenters Pension Plan as of May 1 preceding the beginning of the Benefit Period, but you  would otherwise cease to be an active covered participant at the beginning of the Benefit Period, and you have also exhausted your twice-in-a-lifetime, 5-year Vesting Benefit privilege, you may receive limited health coverage (“Basic. Benefit Coverage”) for a third, fourth or fifth Benefit Period. This Basic Benefit Coverage is limited solely to the Health Benefits Program provided under the Fund’s contracts with  Independence Administrators.

You must meet the Credited Hours and Credited Service requirements under the Pension Plan, as follows:

  • 300 or more Credited Hours within the 6-month Work Period corresponding to such Benefit Period, or
  • 600 or more Credited Hours within the 12-month Work Period corresponding to such Benefit Period, and
  • You have completed 15 or more years of Credited Service under the Carpenters Pension Plan as of the May 1 preceding the beginning of the Benefit Period to receive to receive Basic Benefit Coverage for two additional Benefit Periods, or 25 or more years of Credited Service to receive Basic Benefit Coverage for three additional Benefit Periods. 

Again, you may only receive additional coverage for one Benefit Period at a time - you are not permitted to receive additional coverage for two or more consecutive Benefit Periods.

The Credited Service requirements for both Full and Limited additional coverage are shown in the chart below. Please note that the coverage periods shown below are the maximum number of additional benefit periods that you will be eligible to receive during your lifetime. 

 

Active Eligibility FAQs

What are the requirements to be eligible for active health coverage?

In order for Active Members to be eligible for Health Benefits, you must be in the eligible class and have the required amount of hours in the qualifying work periods:

To be eligible for May 1st:

600 hours between August 1st through January 31st, or

1200 hours between February 1st through January 31st

 

To be eligible for November 1st:

600 hours between February 1st through July 31st,

1200 hours between August 1st through July 31st

 

Please be sure to check your hours regularly for discrepancies. You can view them on the Work Record Report that is mailed out quarterly. If hours are not reported on your behalf please click here to have the Fund Office review your hours.

 

If I or one of my dependents become ineligible for Health Coverage, does the Fund Office have any coverage we may elect to enroll in?

Yes, you may elect to enroll in COBRA coverage. COBRA information is sent to any eligible member or dependent who is losing Health Coverage. You may elect to enroll in the COBRA coverage up to 18 months if you are losing eligibility due to lack of hours. A dependent may elect COBRA for up to 36 months in the event of a divorce, the death of the Member, or if a dependent child turns 26 and is no longer eligible to be covered under the Member.

I am losing my coverage. What are my options?

COBRA is sent to any Participant who is losing their coverage, as well as any Qualifying Beneficiary. You may also elect to purchase coverage through the Health Insurance Exchange at https://www.healthcare.gov.

What is the cost of COBRA Coverage?

The type of coverage you elect will determine your cost for COBRA coverage. For additional information, please contact the Fund Office at (215) 568-0430 and ask for the Medical Department.

How long does COBRA coverage last?

18 or 36 months, depending on the reason for loss of coverage.