Eligibility Issues

Eligibility for plan coverage is explained in the "Summary Plan Description" under the section entitled "Eligibility & General Plan Provisions" of the Summary Plan Description.

The Administrative Office is responsible for maintaining eligibility. Each month the Administrative Office provides a listing of eligible participants to the benefit providers (Kaiser, and UnitedHealthcare).

There may be instances where a Trust Fund Participant has a claim denied because he or she has not met the plan rules to be eligible for benefits under the Trust Fund. There are many reasons why this can happen.

Most eligibility issues are resolved quickly with a call or a letter to the Administrative Office. The Administrative Office is there to assist you and provide you with exact information on the status of your eligibility and entitlement to benefits under the various plans.

If you have a claim denied because you do not meet the eligibility requirements of the Trust Fund you have the right to appeal this denial. Your appeal should be in writing, and be sent to the Administrative Office. You should state in your appeal why you believe you meet the eligibility requirements (refer to "Eligibility & General Plan Provisions" of the Summary Plan Description), and provide any factual information you believe is important in having your appeal reviewed.

Your appeal will be considered within the appropriate time parameter described in the sections above entitled "Pre-Service Claims" and "Post Service Claims".

Generally, the Board meets no less frequently than quarterly.