Plans Available by Work Categories
Your Work Category determines when you are eligible to participate in this Plan, how you maintain coverage and when your coverage may end. If you qualify in more than one category, the category that provides the higher level of benefits will apply. You will not be entitled to receive benefits under more than one category.
You and your Eligible Dependents are eligible to participate in this Plan if you meet the requirements under one of the following Work Categories:
- Active Electrical Worker
- Active Non-Bargaining Unit Employee
- Pre-Medicare Retired Employee
- Medicare Eligible Retired Employee
The chart below shows the Work Categories and the benefits available to employees, and their Eligible Dependents, that meet the Plan’s eligibility requirements for each category.
|Active Electrical Worker|
Bargaining Unit Employee (Office Worke
|Retired Employee NOT Eligible for Medicare||Retired
Employee Eligible for Medicare
|You work 80 or more hours in a month||Must make self-payments for coverage||Must make self-payments for coverage|
|Medical (office visits, lab and x-ray, physicals, chiropractic care)||Benefits Supplement Medicare Coverage Only (reimbursement of Medicare annual deductible and Medicare coinsurance)|
|Hospitalization and Surgery|
|Maternity and Gynecological Care|
|Employee Assistance Plan|
|Substance Misuse and Mental Health||No Coverage|
|Prescription Drugs||No Coverage|
|Death Benefit||No Coverage|
|Accidental Dismemberment and Loss of Sight||No Coverage||No Coverage||No Coverage|
|Weekly Accident and Sickness||No Coverage||No Coverage||No Coverage|
Termination of Coverage for Participants in All Categories
Generally, once your coverage terminates, benefits will not be paid for expenses you incur after your coverage terminates. However, if you are totally disabled when your coverage terminates, you will continue to be eligible for benefits for Covered Medical Expenses relating to the illness or injury causing the disability for a period of one year or, if sooner, until you recover from the disability. There are other circumstances when you may be allowed to continue Plan coverage for a specific amount of time. These circumstances are described in more detail in the section “Continuing Your Coverage”, on page 42.