Adding and Changing Coverage

Dependents

Enrolled employees can typically cover their eligible dependents under their health plans.

Dependents can include:

  • Lawful spouse, including common-law spouse 
  • Child(ren), including your biological children, step-children, adopted children or legally appointed children.

For many medical plans, including Benefit Trust Fund medical plans, children are eligible dependents until they reach age 26 if they are not covered under another medical plan as their primary coverage. 

When enrolling dependents, employees may need to submit documentation confirming dependent status. Documentation typically includes the following:

  • Adoption papers
  • Birth certificates
  • Marriage licenses
  • Death certificates
  • Guardianship documents.

Qualifying Events

Special circumstances may allow a participant to change health care coverage during the plan year. Changing coverage could mean switching to a different plan option or dropping a dependent from coverage.

For many plans, coverage for enrolled employees and their dependents may be added or changed only once a year, during a plan's annual enrollment period. Participants may also change coverage during the plan year under certain circumstances defined by the IRS. Changing coverage may mean switching to a different medical plan option (if available) or adding or removing dependents.

Benefit Trust Fund plans do not have an annual enrollment period. Plans are negotiated into a collective bargaining agreement and then all IAM members covered under that agreement are eligible to enroll in the plans.

Certain circumstances called "qualifying events" allow participants to change coverage.

Qualifying events include:

  • Marriage
  • Divorce
  • Birth of a child
  • Adoption
  • Death.

If you or a dependent have a qualifying event, you may be allowed to change coverage and add or drop a dependent from coverage. In most cases, health plans require you to notify the Fund Office and make changes to the plan within a certain period after the qualifying event occurs. For the medical plans of the Benefit Trust Fund, the period is thirty days after the qualifying event occurs.

COBRA Coverage

If an eligible participant loses medical coverage due to certain qualifying events, he or she may be eligible to continue coverage under the same medical plan by electing COBRA continuation coverage. COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act, lets individuals make personal payments to continue under their same health plan due to:

  • Voluntary or involuntary employment termination
  • Reduction in work hours
  • Divorce or separation
  • Death of a primary plan participant or dependent
  • Dependent child exceeding the maximum age limit.

Eligible participants that elect COBRA continuation coverage must do so within sixty days after the date their prior coverage would otherwise end, or the date the participant receives a notice of the right to elect continuation coverage, whichever is later. Participants in COBRA continuation coverage must pay the full cost of the premiums, and an administrative fee.

For more information on COBRA continuation coverage, visit the Department of Labor website, or contact the Fund Office for specific information about how continuation of coverage rules apply to your plan.

  • IAMNPF Image

If you or a dependent have a qualifying event, you may be allowed to change coverage and add or drop a dependent from coverage.

Frequently Asked Question (FAQ)

How many different plans does the Fund offer?

The Fund offers multiple Medical, Dental, and Vision plans. Short-Term Disability and Life and Accidental Death & Dismemberment benefits are also available.

How do I notify the Fund of my address change?

If you move, please notify the Fund of your new address. To change your address,
fill out a new Enrollment Form and mail or fax it to the Fund using the mailing address or fax number found on the form. Always complete a new Enrollment Form when you have a change in personal information.

Do Medical Plans include Prescription Drug Coverage?

Yes. Our Plans include excellent prescription drug benefits.

What is a PPO?

A Preferred Provider Organization is a type of medical plan that covers the cost of eligible medical care and services received from network and non-network providers. Network providers (primary care doctors, specialists, hospitals, and other medical facilities) agree to a discounted fee schedule for services provided. When a participant or covered family member sees a network provider for care, the participant pays less out of pocket because of the discounted fees. The Fund contracts with CIGNA Healthcare for the use of their nationwide network of participating providers. There are currently more than 750,000 participating providers in the CIGNA "Open Access Plus" Network—the network used by the Fund’s medical plans.

Are participants required to receive services only from a PPO provider?

No. Participants have the choice of selecting a non-PPO physician. However, receiving services from a physician who participates in the CIGNA network may result in significant savings for participants.

Must participants have a referral from their primary care physician in order to see a specialist?

No. Referrals are not required.

Who processes health care plan claims?

Medical claims are processed by CIGNA Healthcare. Dental claims are processed by Delta Dental Insurance Company, and Vision claims are processed by Fund Office staff.

Do the Fund plans have a waiting period for "pre-existing conditions" under the medical plans?

No. The waiting periods for pre-existing conditions were waived for all plans by the Board of Trustees.

What are the age limits for dependent children?

Children can be covered dependents until they reach age 26 providing they continue to meet provisions for dependent coverage.

Does the Fund offer COBRA coverage for health care?

Yes. The Fund administers COBRA for its Contributing Employers. Upon notification from the Employer that a participant is losing coverage due to a "qualifying event," the Fund will send notification to the participant advising him or her of COBRA rights to continue health care coverage by making payments to the Fund Office.

Does the Fund offer Retiree Health Care Plans?

Yes. Employers that have negotiated a Benefit Trust Plan for their Active employees may also establish a Retiree plan.

How Do I Find a Contributing Employer?

To find a Contributing Employer click on this link to view a map and listings by territory.

What are the age limits for dependent children?

Children can be covered dependents until they reach age 26 providing they continue to meet provisions for dependent coverage.

View All FAQs »