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Eligibility Rules for Retirees

If you are a Retiree, the date you will be eligible to participate in the Plan depends on the date you retired and your benefits when you retired.

  • If you retired from active employment with one of the Employers before July 25, 2007, and have been receiving retiree health care coverage under a health plan sponsored by one of the Employers, you became eligible to participate in this Plan on January 1, 2008.   Your Spouse or Domestic Partner and any of your other Dependents who were previously receiving coverage under the Employer’s health plan for retirees also became eligible to participate in the Plan at the same time you became eligible.
  • If you retire from active employment with one of the Employers on or after July 25, 2007, you will be eligible to become a Participant on the first day of the calendar month after you retire from active employment. You will be considered to have “retired” if and only if you qualify for an immediately commencing OCU Pension Plan benefit or, if you retire from an Employer who does not contribute to the OCU Pension Plan, you would have qualified for such an OCU Pension Plan benefit had your Employer participated in that plan. You will be eligible to become a Participant pursuant to the foregoing even if you previously waived coverage under the OCU Health Plan as a Regular Employee under the terms of your Collective Bargaining Agreement.
  • If your employer is not a contributing Employer to the OCU Health and Welfare Trust when you retire, you only will be eligible for retiree health coverage under this Plan if you would have been eligible for such coverage had you retired while your employer was a contributing Employer.
  • Retirees will receive the same benefits as active employees participating in the Plan, except that they may not be eligible for wages in lieu of PPO benefits and their benefits will be integrated with Medicare, as explained in the following paragraphs.
  • Retiree benefits are suspended when you return to regular employment, with the same or any other Employer, and become eligible for coverage as a Regular Employee.  You will then be treated like any other Regular Employee for purposes of this Section 5.
  • If you return to employment as a Temporary Employee, with the same or any other Employer, and would not be eligible through your employment for the same coverage you would have as a Retiree, you may continue your retiree benefits, except that (a) Medicare will be secondary during such temporary employment regardless of your age, and (b) Employer contributions will be required to the extent they would have been required for temporary health coverage if it were being provided (e.g., after you qualify for it).
  • If you, your Spouse, or Domestic Partner are eligible for Medicare, retiree benefits will be provided first by Medicare and then by this Plan, so that when Medicare coverage (Parts A and B) and Plan coverage are combined, they are at least equal to the benefits provided to active Participants. The Plan will reimburse the amounts you, your Spouse, or Domestic Partner pay for Medicare Part B monthly premiums. This Plan will not pay benefits that Medicare would have paid but does not pay because you, your Spouse, or Domestic Partner did not timely enroll in Medicare.  It is you, your Spouse, or Domestic Partner’s obligation to enroll timely in Medicare.  If you, your Spouse, or Domestic Partner enroll late, the Part B premium likely will be higher.  The Plan will not pay the extra premiums charged because of late enrollment after July 1, 2008.

IMPORTANT NOTE: Even though you may satisfy the eligibility requirement, your coverage cannot become effective until you file a completed enrollment form with the Plan Administrator. To avoid a delay in coverage, be sure to act promptly.