Summary Plan Description

Special Enrollment Rights

Most retirees and dependents who satisfy the eligibility requirements of this plan enroll directly in Retiree Coverage as described above. Special enrollment is also allowed if certain requirements are met.

Loss of Other Health Care Coverage

You or your dependents who are otherwise eligible for Retiree Coverage but not enrolled may enroll for coverage if all of the following requirements are met:

  • Enrollment in Retiree Coverage was declined because you or your dependents were covered under another group health plan or other health insurance coverage.
  • When enrollment was declined, a Notice To Decline Coverage Agreement was completed which reserved enrollment rights for you or your dependents in Retiree Coverage after loss of eligibility under the other group health plan or other health insurance coverage.
  • The other health care coverage terminated due to (1) loss of eligibility including loss due to legal separation, divorce, death, termination of employment or reduction in work hours; (2) termination of employer contributions; (3) if the other coverage was under a COBRA Coverage provision, the maximum coverage period was exhausted; or (4) disenrollment from another group health plan or other health insurance coverage. Loss of eligibility does not include a loss due to failure to pay premiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan.

To enroll, you must complete and submit a Retiree Coverage Application for you and/or your dependents no later than 60 days after your and/or your dependents' other health care coverage terminates. If the completed application and required documentation is not received within 60 days, the right to enroll is forfeited. A copy of the other plan's termination of coverage notice must be provided to Carpenters Trusts with your application. You cannot have a gap in coverage.

If you do not meet all of these criteria, you permanently forfeit your right to Retiree Coverage.

Enrollment of Newly Acquired Dependents

If you are enrolled in Retiree Coverage and you acquire a new dependent child through birth, adoption, or placement for adoption, the newly acquired dependent child may be enrolled in Retiree Coverage. You must request enrollment no more than 60 days after the date of birth, adoption, or placement for adoption, and coverage becomes effective on the date of birth, adoption or placement for adoption.

If you are enrolled in Retiree Coverage and you acquire a new dependent spouse or child through marriage, that dependent may be enrolled in Retiree Coverage. You must request enrollment no more than 60 days after the date of marriage, and coverage becomes effective the first of the month following the month in which Carpenters Trusts receives the request for enrollment.

Disenrollment and Reenrollment

If you are covered under Retiree Coverage, you may disenroll from Retiree Coverage and reenroll in Retiree Coverage at a later time if you meet all of the following requirements:

  • You are covered under another group health plan or other health insurance coverage when you disenroll.
  • Coverage between Retiree Coverage and the other group health plan or other health insurance coverage was continuous from the original date of disenrollment from Retiree Coverage to reenrollment in Retiree Coverage. There can be no gap in coverage.
  • You are otherwise eligible for Retiree Coverage.

To reenroll in Retiree Coverage, you must complete a Retiree Coverage Application and submit it to Carpenters Trusts within 60 days after your or your dependent's coverage under the other group health plan or other health insurance coverage terminates. A copy of the other plan's termination of coverage notice must be provided to Carpenters Trusts with your application. Coverage must be reinstated the first day of the month immediately following the month coverage was terminated under the other plan, and can only be reinstated if the appropriate monthly contribution is made. There can be no gap in coverage.

If you or a dependent voluntarily leave Retiree Coverage and cannot meet all the reenrollment requirements described above, you or your dependent forfeit your right to reenroll in Retiree Coverage.