If you are a Retired Participant as defined in this Plan, and your former employer is or was a Contributing Employer to the Fund and you retire from employment under the jurisdiction of Bakers’ Union Local No. 19, Teamsters Local Union No. 507, or retired from Bakers’ Union Local No. 57, or from a location accepted by the Fund for participation in the Fund or one of the related Funds, or you are the surviving spouse of such retired member, you may be eligible for coverage if you satisfy the following conditions:
- Retire with at least twenty (20) years of participation in this Health Fund immediately preceding termination of Covered Employment and leave Covered Employment on or after attaining age fifty five (55), or
- Retire on a Disability Pension through the Cleveland Bakers and Teamsters Pension Fund with at least fifteen (15) years of participation in this Fund and leave Covered Employment on or after attaining age forty five (45); or
- Retire on a Thirty-Year Pension through the Cleveland Bakers and Teamsters Pension Fund with at least twenty (20) years of participation in this Fund (or through a pension fund providing pension benefits to members of Bakers’ Union Local No. 19 or Teamsters Local Union No. 507); and leave Covered Employment prior to attaining age 55 and
- Retiree (or your eligible surviving spouse, if applicable) maintains Union membership or affiliation in accordance with the rules of the participating Local Unions or entities.
You are not eligible for retiree health care coverage at any time if:
- You retire with less than 20 years of participation in this Fund; or
- You leave employment prior to attaining age 55 and retire on a Deferred Vested Pension; or
- You leave employment prior to age 45 with less than 15 years of participation in this Health Fund and retire on a Disability Pension.
The Board of Trustees is authorized and empowered to construe the meaning of any provision of the Plan; to decide on a Participant's entitlement to or application for benefits under the Plan; and to adopt any reasonable rule or regulation as may be necessary in the maintenance and administration of the Plan. Decisions by the Board of Trustees on provisions of the Plan, or a Participant's entitlement to or application for benefits, shall be final and binding upon all affected parties.
While the Board of Trustees hope to continue providing benefits for retirees and their Eligible Dependents as long as possible, it is important for you to understand that the Trustees reserve the right at any time to amend, modify, and/or discontinue the Plan and its underlying insurance contract(s). Retirees and their Eligible Dependents are not vested in any of the benefits or rights provided under the Plan. Benefits under this Plan will be paid only if the Plan Administrator decides in its discretion that the applicant is entitled to them.
If you elected family coverage, the Fund will require you to provide documents (such as birth certificates, social security cards, your marriage certificate, divorce decree, or other court orders) before coverage begins.
The Fund will only approve coverage for your family members who meet the eligibility requirements of an Eligible Dependent, as defined by the Plan. Eligible Dependents, as defined by the Plan, include your:
- Spouse* (if you are legally married, subject to the requirements of the Working Spouse Rule)
- Natural children, step-children, legally adopted children, up to the end of the month in which he/she turns 26 years of age or for whom you have the legal responsibility, under court order, to provide medical coverage
- Disabled or handicapped children
In addition, if you are appointed by a court as the Legal Guardian of a minor child (ward) of your immediate family (defined as spouse, child, sister, or brother), such child will be included as an Eligible Dependent to the age stated in the court order, provided the child resides with you and is without a natural guardian. A natural guardian is the natural mother or natural father of the child. Please note that individuals placed with you for foster care purposes are not eligible for coverage, unless the requirements stated above are otherwise met.
The Fund offers two plans, the Basic plan and the Post-Medicare plan. If you are a Retired Participant or an Eligible Dependent and you do not meet the requirements for eligibility for Medicare coverage, you will be enrolled in the Basic plan. All Retired Participants or Eligible Dependents who meet the requirements for eligibility for Medicare coverage (and are enrolled in Medicare Parts A & B), have the option to select coverage under the Post-Medicare plan. Coverage can be selected from one of the Regional Preferred Provider Organization (RPPO) plans offered by Humana.
If you are eligible under this Plan, you may enroll in coverage:
- On the day you file your application for pension benefits under the Cleveland Bakers and Teamsters Pension Fund; or
- On or after the day you file your application for pension benefits under the Central States Southeast and Southwest Areas Pension Fund, the Bakery Confectionery, Tobacco and Grain Millers International Union Pension Fund, or a company sponsored pension plan.
If you meet the eligibility requirements for Retiree health care but are not eligible for a pension through one of the plans described above, you may still be eligible for Retiree health care. Please call the Fund office at (216) 781-6858 or (800) 342-7020, to inquire about eligibility and/or to request an application for Retiree health care.
Retiree coverage for your spouse and/or children will start on the same day that your coverage begins provided they meet the definition of an Eligible Dependent, as defined by the Plan, on the date your retiree coverage becomes effective. You may only enroll family members who were covered by the Plan immediately prior to your retirement unless they meet the special enrollment rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
During Open Enrollment you may:
- Elect coverage under the Basic plan if you are not yet eligible for Medicare
- Elect coverage under one of the post 65 Medicare Advantage plans if you are eligible for Medicare
- Disenroll a dependent (unless the dependent is the subject of a Health Insurance Coverage Order, a Qualified Medical Child Support Order, or a National Medical Support Order) and/or
- Waive medical, hospital, prescription drug, dental, vision and audiology coverage under this Plan
Mid-year election changes may be allowed because of certain life event changes. However, Participants will not be permitted to change their Plan choice, which determines the level of benefits received, mid-year.
Request for changes mid-year must be made in writing within 31 days of the life event and the requested change must be consistent with the life event. Mid-year changes requested after 31 days are effective the first of the month following the Fund’s receipt and acceptance of the written request. You must pay any retroactive weekly Employee contributions, if applicable, before the requested change is effective.
Valid mid-year life events include:
- Change in marital status (marriage, divorce, legal separation)
- Acquisition of a new Eligible Dependent
- Death of a spouse or Eligible Dependent child
- Change in child’s Eligible Dependent status (for example reaching age 26)
- Change in Eligible Dependent’s employment status causing loss of eligibility for another employer’s health plan
- Significant change in health plan coverage or cost through spouse’s employment
- Spouse or Eligible Dependent child makes a change under another employer’s health plan due to qualified change in status or enrollment period that differs from this Plan
- Change in Participant’s employment (i.e. leave or reduction of hours)
- Spouse loses or gains coverage under Medicare, Medicaid, or the State Children Health Insurance Program
- Eligible Dependent child loses coverage under Medicare
- Eligible Dependent child loses or gains coverage under Medicaid or the State Children’s Health Insurance Program (and notifies the Fund within 60 days) or
- Eligible Dependent child becomes eligible under this Plan due to state subsidized coverage under a State Children’s Health Insurance Program (and notifies the Fund within 60 days)
You must notify the Fund office within 31 days if:
- You marry
- You or your spouse gives birth to a child
- You legally adopt a child
- You are ordered by a court (or through an administrative process established under state law) to provide health coverage for your child or
- Your child becomes eligible as a Disabled or Handicapped child
If you are covered under the Plan, newly acquired Eligible Dependents may be added to your coverage as of the date of marriage (in the case of marriage), as of the date of birth (in the case of a newborn child), as of the documented date a child is placed in your home for adoption, or the later of either the date your coverage begins or the first of the month following receipt of the order wherein you are ordered to provide health coverage for your child, provided required documents are received within 31 days of the event.
You must furnish the Fund office with the necessary documents to establish eligibility for your newly acquired Eligible Dependent(s); the Fund must approve the family members you enroll as Eligible Dependents before coverage begins.
You must notify the Fund office, in writing, within 31 days if:
- You divorce or become legally separated or
- Your child (or stepchild) ceases to be an Eligible Dependent, as defined by the Plan
In the case of a divorce, a journalized copy of your complete divorce decree (including any attachments or exhibits relating to the provision of custody, health care coverage or payment of medical bills) must accompany your request.
However, the Fund will not remove an Eligible Dependent for which you have a legal responsibility, under court order, to provide health insurance coverage.
If you elect Retiree coverage under the Plan, Retiree contributions are required in order to be eligible for coverage. You are required to begin paying Retiree contributions on the day your coverage becomes effective. Thereafter, you are generally required to pay Retiree contributions for each month or part of a month that you are covered under the Plan. At the time of retirement if the amount of your pension under the Cleveland Bakers and Teamsters Pension Fund is large enough to accommodate a deduction for your monthly Retiree contribution, you have the right to have your deduction made from your monthly pension benefit. You may also choose to have your Retiree contribution automatically withdrawn from your checking or savings account or you may elect to pay monthly by check, money order or cash. If you elect to pay monthly, you will receive an invoice each month.
PLEASE REFER TO THE SUMMARY PLAN DESCRIPTION FOR ADDITIONAL INFORMATION. THE SUMMARY PLAN DESCRIPTION CAN BE FOUND IN THE DOWNLOADS SECTION.