RE:     MEDICAL COVERAGE, PRESCRIPTION DRUGS, DENTAL, VISION CARE AND LIFE INSURANCE

 

 

Initial eligibility is met with the accumulation of a minimum of 500 hours worked.  Coverage is to be effective on the first day of the second month after the month in which the eligibility requirements are satisfied, PROVIDED YOU COMPLETE AN ENROLLMENT APPLICATION.  Example:  If 500 hours are reached in August, coverage begins October 1^st.  Thereafter, 125 hours per month are required to continue your monthly eligibility.  If hours fall below 125 hours worked in one month, you can draw from your reserve hour bank to continue eligibility.

 

Your coverage includes Medical, Prescription Drugs, Dental, Vision Care, Member Assistance Program and a Life Insurance policy of $5,000.  Dental benefits are with the Delta Dental Plan, vision benefits are with Vision Service Plan and member assistance benefits are with PacifiCare.  Please read the attached comparison of the three medical plans available to help in your decision of which plan you want to choose.

 

            (1)     The SELF-FUNDED Indemnity Medical Plan (PPO)

            (2)     The KAISER Medical Plan (HMO)

            (3)     The HEALTH NET Medical Plan (HMO)

 

Residence in the Humboldt and Del Norte counties or out of state, the Self-Funded Indemnity Plan may be the choice.  

 

 

NOTE:  YOU MUST COMPLETE AN ENROLLMENT APPLICATION BEFORE YOU AND YOUR FAMILY WILL BE COVERED FOR BENEFITS.  THERE IS NO RETROACTIVE COVERAGE FOR LATE ENROLLMENT.               

 

DEPENDENT COVERAGE:  For dependents, coverage is effective for the dependent on the date you meet the initial and continuing eligibility requirements, so long as a completed enrollment form is received by the Administrative Office with all of the required information within 60 days of you meeting the eligibility requirements.  Otherwise, coverage is effective the first day of the month following the month in which a completed enrollment form is received and approved by the Trustees.  However, for a newborn child or an adopted child, coverage is effective on the date of birth or the date of adoption or placement for adoption with the condition that an enrollment form is completed and received by the Administrative Office within 60 days of the date of birth or the date of adoption or placement for adoption.  If the prescribed enrollment form is not received by the Administrative Office within the 60-day period, the effective date will be the first day of the month following the month in which the enrollment form is received.  Coverage for a new spouse is effective the first day of the month following the month in which an enrollment form is completed and a copy of the marriage certificate is received by the Administrative Office.  To obtain more information about these enrollment rights, please contact the Administrative Office at (707) 526-1996.