Article 4 Buy-Up Provision (Self-Payment) >>

4.15 Buy-Up Provision (Self-Payment)

Buy-Up provision (self-payment) allows participants to self-pay for short hours to maintain eligibility for health coverage. Participants who do not have the health hours required under this Health Plan to meet eligibility even with the Hours Bank Reserve, can make up to three (3) consecutive monthly self-payments to cover the difference between your health hours and the number of hours needed to satisfy the eligibility requirement.

The Buy-Up provision is subject to the following rules and conditions:

1. Eligibility for Buy-Up Period:
   1. The Buy-up option is only available if the participant was eligible for coverage in the preceding month (i.e. was previously eligible for coverage).
   2. Participant must have a minimum of 100 health hours (after proration) reported and paid on their behalf in the Buy-Up month and does not have enough hours in the Hours Bank Reserve to qualify for coverage (i.e., the Hours Bank Reserve is exhausted before calculating the short hours).
   3. Participant may Buy-Up hours for up to three (3) consecutive months in a rolling 12-month period. The three (3) consecutive months begin when the participant first becomes eligible for the Buy-Up benefit. The participant may only buy the short hours that month, no additional hours will be allowed.
      
      Example 1: Participant buys-up in January, February and March: Participant is eligible for buy-up again the following January.
      
      Example 2: Participant buys-up in October and November, chooses not to buy-up for December (or has sufficient health hours for December eligibility such that the buy-up is not necessary): The Participant receives only two buy-up months and is not eligible for buy-up again until the following October.
      
      Example 3: Participant is eligible for the buy-up in April and doesn't buy-up the short hours for April: Participant is not eligible for the buy-up again until the following April.
   4. A Participant who reciprocates a minimum of 100 health hours (after proration) to the Southern California IBEW-NECA Health Trust Fund in the Buy-Up month and does not have enough hours in their Hours Bank Reserve to qualify for coverage (i.e., the Hours Bank Reserve is exhausted before calculating the short hours) may have the ability to buy up to 60 health hours in one month in a rolling 12-month period if doing so will help achieve eligibility.
   5. The total maximum a Participant may buy-up in a rolling 12-month period is 60 health hours.


2. Calculation and Payment of Buy-Up:
   The following applies to the calculation and payment of the Buy-up option:
   
   
   1. The Participant's self-payment to Buy-Up the short hours is calculated using the current Inside Wireman health contribution rate (excluding Health Reimbursement Arrangement Account and Supplemental Unemployment Benefit Plan) at the time of the Buy-up or the Alternate Kaiser Permanente Plan rate (excluding Health Reimbursement Arrangement Account), if applicable, times the number of hours needed for eligibility.
      
      Example: A participant works 110 hours (and has no Hours Bank Reserve) and needs an additional 10 hours to qualify. The self-payment is 10 hours X $13.64 = $136.40.
   2. The minimum a participant may buy-up is one whole hour (i.e. no fraction of an hour will be permitted).
   3. The due date for Buy-Up self-payment is the last day of the eligibility month for which the payment is being made. Benefits will not become effective until buy-up self-payment is received. Participants may use their HRA account to pay for the Buy-Up self-payment.
   4. A Buy-up payment shall be refunded for month in which late reciprocal hours or delinquent contributions credited to the Hours Bank Reserve and those hours provide eligibility by work hours for a month for which a Buy-Up payment was made.


3. Exclusions:
   A Participant is not eligible for the buy-up option if:

   1. Receiving a pension from the Southern California IBEW-NECA Pension Plan;
   2. Classified as a Designated Working Member;
   3. Employed by an employer and permitted to receive increased wages in lieu of health coverage;
   4. Declined to reciprocate contributions to the Southern California IBEW-NECA Health Trust Fund while employed by an Employer that contributes to a trust fund or fund that is signatory to the International Reciprocal Agreement;
   5. Eligibility is terminated due to Non-Covered Electrical Employment.