Rights & Protections

The Family Medical Leave Act (FMLA) provides that employers of fifty (50) or more Employees must grant family medical leave to Employees who qualify under the Act and must continue the medical coverage of Employees who are on FMLA leave.

Neither the Trustees nor the Fund determine whether you are entitled to FMLA leave with continuing medical coverage. Any disputes regarding your entitlement to FMLA leave and / or continuing medical benefits while on such leave must be resolved by your Employer and your Union.

To the extent that you are entitled to FMLA leave with continued medical coverage, the Fund will continue your medical coverage under the Plan, provided your Employer makes the required monthly Contributions to the Fund. Your rights under the FMLA are independent of your rights to COBRA Continuation Coverage or the Plan’s provisions for continuing medical care in the case of disability. 

You may experience a COBRA Qualifying Event if you do not return to work at the end of your FMLA leave or, if during such leave, you give your Employer notice that you do not intend to return to work.

Note: If you are on an approved FMLA leave of absence, only failure to return to work at the end of the approved leave constitutes a COBRA Qualifying Event.

Your FMLA Leave ends at the end of the month in which the earliest of the following takes place.:

• you inform your Employer you are not returning to work;
• you do not return at the end of the approved leave; or
• you reach the end of the leave period granted under FMLA.

The Uniformed Services Employment and Re-Employment Rights Act (USERRA) provides that you can continue your coverage if you leave your job for active military duty or training for a period not to exceed 31 days. If your military service extends beyond 31 days, you may self-pay for your coverage for up to 24 months from the date the leave started or the date you do not return from your leave, whichever occurs first.

If your coverage terminates by reason of service in the uniformed services, an exclusion or waiting period may not be imposed in connection with the reinstatement of your coverage when you return to work. However, this requirement does not apply to the coverage of any illness or injury determined by the Secretary of Veteran Affairs to have been incurred in, or aggravated during, performance of service in the uniformed services.

Regardless of whether you elect to self-pay for extended coverage, your coverage will be reinstated immediately when you return to employment immediately following your leave and your Employer will be charged for the cost of your coverage even though you did not work the prior month.

You must elect this coverage; it is not automatic. If you do not give advance notice of your military leave, you will not be eligible to elect USERRA coverage unless your failure to provide such notice is excused under USERRA because it was impossible, unreasonable, or precluded by military necessity, in which case your coverage will be restored retroactively upon payment of all unpaid amounts due. If you give advance notice of your leave, you may elect USERRA coverage at any time within the first 60 days after your last day of employment. You may elect either “Core-Only” or “Core-Plus” coverage, as described on page 19 of the SPD.

Your first self-payment for USERRA coverage is due within 45 days of the date of your election and must be retroactive to the date your Employer-paid coverage ends. Subsequent payments are due on the first of the month and are delinquent if not received by the 30th day of the month. If your payment is significantly less than the actual payment due (as described under “COBRA Continuation Coverage“) your coverage will be terminated immediately.

The duration of the leave combined with all your previous periods of military leave under the same Employer must not be more than five years (unless extended by national emergency or similar circumstance). You may not “stack” USERRA Continuation coverage and COBRA – they run concurrently.

For more information about USERRA, please contact the Fund Office at (855) 690-7250.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. 

Surprise Billing Notice (English)
Surprise Billing Notice (Spanish)

Waiver of Contribution During Total Disability

If you or your Dependent suffer a Total Disability, as defined below, that prevents you from working, you will remain eligible under the Plan even if your Employer stops contributing to the Fund on your behalf until the earlier of:

• the date on which you or your Dependent is no longer Totally Disabled; or
• four (4) calendar months after the date the Total Disability commences.

If you are still Totally Disabled after the four month “Waiver of Contribution” period, you may purchase COBRA Continuation Coverage from the Plan for an additional 14 months (or up to 25 months if you qualify for a COBRA disability extension.) If you remain Totally Disabled and choose not to continue your coverage under COBRA, you may still be eligible for an Extension of Benefits (see below) but only for the treatment of the disabling condition.

You are Totally Disabled when prevented, by reasons of physical or mental injury or illness, from engaging in any occupation for wages or profit. Your Dependent is Totally Disabled when he / she is prevented by reason of physical or mental injury or illness from engaging in the normal activities of a person of similar age and sex.

If a Physician determines that you are no longer Totally Disabled during or after the four month “Waiver of Contribution” period and releases you to return to work, your new eligibility date will be the first day of the month immediately following the first month during which you work eighty (80) hours for a participating Employer and the Employer makes the Contribution on your behalf, provided that:

• you return to work within three (3) months after the date of your Doctor’s release; and
• your Employer makes the required Contribution to the Plan on your behalf.

If you do not return to work with your Employer as described above, you will be subject to the eligibility requirements for new Employees. You are entitled to only one (1) disability waiver during any twelve (12) month period.

Extension of Benefits for Disabling Condition (not applicable to Kaiser HMO Plan participants)

If you or your Dependent is Totally Disabled when your coverage under the Plan terminates, the Plan will continue to pay benefits for treatment related to the disabling condition. Benefits are payable only for expenses arising from the disability and the extension of benefits will end the earlier of:

• the date you or your disabled Dependent becomes covered under any other group medical benefit or services plan;
• twelve (12) months after the date on which your active coverage under the Plan terminated; or
• the date on which you or your Dependent recovers from the Total Disability.

You or your dependents may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).

For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.

This coverage is subject to the plan’s deductibles, coinsurance, or copayment provisions.

WHCRA Notice