This section contains the basic eligibility rules. However, you should consult the Eligibility Insert for your Plan and Employer to determine whether there are any additional eligibility requirements applicable to your Plan.
Important Note About Your Collective Bargaining Agreement
The rules described here are the Plan’s generally applicable conditions required to establish and maintain eligibility. Your Collective Bargaining Agreement (or in some cases a subscriber agreement) may contain eligibility rules which modify or replace the rules explained below. If such special rules apply, they will be described in the Eligibility Insert of your Benefits Booklet. If you are not sure whether special rules apply to you or whether your agreement is up to date (e.g. whether you have a copy of the latest Collective Bargaining Agreement for your workplace) you should call the Administrative Office to verify which rules apply to you. In the event of any conflict between the Benefits Booklet including the related Eligibility Insert and the subscriber or Collective Bargaining Agreement, the most recent subscriber or Collective Bargaining Agreement will control. Contact the Administrative Office immediately if you do not have a copy of the Insert containing the eligibility rules applicable to you.
If your Employer (1) is obligated under an agreement accepted by the Trustees to make the monthly contribution to the Fund on behalf of employees who have satisfied the waiting period (if any) described in your Collective Bargaining Agreement and have worked the required number of hours in the current month as stated by the applicable Labor Agreement and (2) makes the required contribution on your behalf, on time and in full, you will be covered for the upcoming month.
If you are employed by more than one Participating Employer and more than one Employer contributes on your behalf for any one month, your benefits will be no greater than those you would receive if you were employed by only one Participating Employer.
Effective Date of Coverage
Your Labor Agreement may specify a waiting period before you become eligible for some, or all of the benefits described in this Benefits Booklet. To find out whether a waiting period applies to you, check the Eligibility Insert that came with this Benefits Booklet.
If your Labor Agreement does not specify a waiting period your coverage will become effective on the first day of the month following the first month of employment in which you worked the hours required and your employer has made the required contribution on your behalf.
If your Labor Agreement specifies a waiting period your eligibility for coverage will become effective on the first day of the month after you have satisfied the waiting period and current month’s hours requirement.
Example You start working for a Participating Employer in July and the Labor Agreement says
(1) your Employer makes a contribution to the Plan for your coverage in any month in which you work 80 hours or more and (2) there is no waiting period. If you work 80 hours in July and your Employer makes a timely contribution payment to the Fund, your eligibility for coverage is effective August 1.
Example You start working for a Participating Employer in July and the Labor Agreement says
(1) your Employer must contribute to the Plan for your coverage in any month in which
you work 80 hours or more and (2) coverage will not be effective until Employer contributions have been made on your behalf for three months in any six-month period. If you work 100 hours in July, 50 hours in August, 80 hours in September, 60 hours in October, 70 hours in November and 150 hours in December and your Employer makes timely contributions for the three months (July, September, and December) in which you worked 80 or more hours, then your eligibility for coverage is effective January 1.
Keeping Your Eligibility
Contributions paid for hours worked in one month pay for coverage in the following month. Once you have satisfied the initial eligibility requirements and have enrolled in the Plan, you will remain covered from month to month if you work sufficient hours each month and your employer submits the contributions on your behalf to the Fund.
Example You work 80 hours in March, the contribution your employer makes for those hours will cover you in April.
Your eligibility for benefits depends on the continued and timely payment of contributions on your behalf. If your employer fails to make a contribution when it is due, your eligibility will automatically cease at the end of the last month for which a contribution was paid.
Example You continue to work 80 hours in April and May. Your employer makes the contribution for April hours but does not make the contribution due for May hours. Your coverage ends May 31st because May is the last month for which coverage was paid—the contribution made for April hours. Eligibility will be restored if and when the employer makes the required contributions.
Eligibility will be restored if and when the employer makes the required contributions.
Example Your employer makes the contribution for May hours late. When the contribution is received, you will be covered for June.
Your eligibility will also continue while you are not working if the Labor Agreement requires your Employer to make payments on your behalf (for example, if you are on leave due to disability).
Qualified Medical Child Support Order
If a Qualified Medical Child Support Order (“QMCSO”) issued in a divorce or legal separation proceeding requires you to provide health coverage to a child who is not in your custody, the Fund will conform to the order for each month in which you are eligible for coverage. A medical child support order will not be deemed “qualified” unless it includes all of the following:
- name and last known address of the parent who is covered under the Plan,
- name and last known address of each child to be covered under the Plan,
- period of time the coverage is to be provided.
Medical child support orders should be sent to the Administrative Office. Upon receipt, the Plan Administrator will notify you and give you a copy of the Fund’s procedures for determining whether the order is a QMCSO.
With respect to a child named in a QMCSO, if the child is not already covered by the Plan, the date the child qualifies for coverage as your dependent is the date specified in the court order. If you do not enroll your child as required by the QMCSO, the Plan Administrator will enroll the child as soon as you satisfy the Plan’s eligibility requirements. You may not terminate health care coverage for the child or children covered by the QMCSO unless you submit written evidence that the QMCSO is no longer in effect.
When both husband and wife are covered under the Plan as eligible employees: (1) each may cover the other as a dependent spouse; and (2) each may cover their dependent children.
The Plan covers a domestic partner on the same basis as a lawful spouse and your domestic partner’s children on the same basis as stepchildren acquired through marriage. To enroll a domestic partner on your plan:
- Your domestic partner must meet the requirements for domestic partnership under the State of California or applicable municipal law (for example, the domestic partnership requirements applicable to persons who live or work in the City and County of San Francisco); ‘
- You must have and provide the Plan with a copy of a current, valid Certificate of Domestic Partnership from the State of California Secretary of State or a municipality in which you live or work; and
- You must complete and provide the Plan with the Bay Area Automotive Group Domestic Partnership Application.
To obtain a Certificate of Domestic Partnership, you and your domestic partner must:
- have a common residence,
- agree to be jointly responsible for each other’s basic living expenses incurred during the domestic partnership,
- not be married or a member of another domestic partnership,
- not be related by blood in a way that would prevent you from being married in California,
- be over 18 years of age,
- be capable of “consenting to the domestic partnership” (in other words be of sufficiently sound mind to be able to knowingly enter into a contract).
After establishing a domestic partnership, you and your domestic partner must notify the Administrative Office when any of the above conditions are no longer satisfied or when the domestic partnership has terminated. If you fail to notify the Administrative Office, you may be responsible for any claims and/or premiums paid on behalf of your domestic partner. If you terminate the domestic partnership, your domestic partner and his or her dependents lose coverage upon the termination of the domestic partnership. Domestic partners and their children who lose coverage upon termination of the partnership are eligible to elect COBRA continuation coverage on the same terms as would apply to a spouse upon divorce.
According to the requirements of the Internal Revenue Code, if your domestic partner is not your “dependent” for federal income tax purposes, the “fair market value” of the part of the employer’s contribution to the Plan made on your behalf which funds the domestic partner coverage is treated as additional taxable income. The Plan calculates the fair market value of the coverage each year. The employer portion of the payroll taxes attributed to this income is paid by the Plan. You will be billed for and must pay the employee portion of the payroll taxes. If you fail to pay the employee portion of payroll taxes attributable to domestic partner coverage, your domestic partner will be disenrolled effective immediately and will be barred from re-enrollment for two years.
If you are prevented from working enough hours to maintain your coverage because you are disabled, you may elect to extend the medical, prescription drug, dental, and accidental death and dismemberment coverage provided under your Plan for you and your dependents for up to three months once during the life of your Labor Agreement if you become totally and continuously disabled such that you are unable to work. For this purpose, Totally Disabled means the complete inability due to disease or bodily injury to perform your regular and customary work. In no event will you be considered totally disabled if you are engaged in any gainful occupation.
To elect to extend your coverage in the event you become totally and continuously disabled, you must complete and provide the Plan with the Bay Area Automotive Group Disability Form no later than one year from the first day you were unable to work due to the disability. Once the Plan receives the completed form, the three-month extension period begins on the first day of the month following the last month for which your Employer contributed on your behalf.
Refer to “Continuation of Coverage if Totally Disabled” on page 9 of the Summary Plan Description/Plan Document.
Document Required in Order to Enroll Dependents
To enroll your spouse and/or dependent children, you must furnish a copy of your marriage certificate and/or applicable birth certificates along with the Bay Area Automotive Group enrollment form. If you divorce, your ex-spouse and stepchildren lose coverage upon entry of a final divorce decree (see COBRA COVERAGE). You must notify the Administrative Office and furnish a copy of the divorce decree with a revised enrollment form that excludes your former spouse. If you fail to notify the Administrative Office of your divorce, you may be responsible for any claims and/or premiums paid on behalf of your ex-spouse.