A Message from the Benefit Funds Office: General Rules Regarding Health Center EligibilityHotel Voice - August 5, 2015
Did you know that you need to work at least 56 hours a month for you and your families to be eligible to use the Health Centers and certain other benefits and services available through your union contract? Did you know that employers report all employees’ hours of work to the Benefit Funds Office every month? In this way, you, your families and the Benefit Funds themselves are protected so that only eligible people can use the Health and Dental Centers and the other benefits and services available through the contract.
The way the eligibility system works is that employers have until the 10th of the next month to report hours worked. As an example, April hours must be reported by May 10th.
You should also know that the hours worked in a month give eligibility for the entire following month. As another example, April hours (as long as you worked at least 56 hours) will make you and your families eligible until May 31st.
Since the Funds Office does not receive employees’ new hours until the 10th of the month it automatically extends eligibility each month until the 15th, in order to avoid making everyone ineligible at the beginning of each month. So, in reality, April hours (as long as you worked 56 hours) will provide eligibility for you and your family members until June 15th.
For members that are continuously eligible, the system works smoothly and you and your families stay eligible each month. But there are several situations where the system causes problems for lack of accurate, timely information from employers.
Here is one example: When members go on vacation, they are paid in the payroll pay period before leaving on vacation. When they return from vacation they have immediate eligibility but the Funds Office doesn’t find out until the 10th of the following month. As an example, a member who takes vacation in April was paid in March, and that makes him eligible until May 15th. But when the employer reports April hours on May 10th, the employee becomes ineligible because of insufficient hours in April, even though he may have returned to work on May 1st. And, of course, the Benefit Funds Office will not receive the May hours report from employers until June 10th. In a situation like this, the Benefit Funds Office must contact the employer to verify that the employee returned to work.
Similar issues occur when members return to work from layoff, return to work after Workers Compensation injuries or are restored to their jobs through the grievance and arbitration process.
To handle situations like this the Funds Office has prepared an educational presentation for eligibility clerks so that they understand the system limitations and can ask the appropriate questions of employees and/or their family members who appear to be ineligible. This will allow them to give “presumptive” eligibility to certain members (returning to work) if the Funds Office cannot get a quick response from the employer.
We understand that our system isn’t perfect, because no system can be perfect. But awareness of the eligibility rules by both members and eligibility clerks will resolve the situations explained here most of the time.