Eligibility / Non-Actives
Non-Active Classification and BenefitsThe non-active classification allows qualified members and their dependents to continue coverage under the Plan after they do not qualify under the active classification, by making self-payments. To be eligible in the non-active classification, you must have previously had coverage as an active member in the Outside or Inside Eligibility class (or must be a dependent of such member), within one of the following categories:
- Retired members
- Non-pension members
- Retired self-employed members
- Disabled members
- Surviving spouses
The benefits provided under the non-active classification are the same as those provided under the active classification as long as the required premium is paid, with the following exceptions:
Benefits for Medicare-eligible individuals: If you are covered in the non-active classification as a member or dependent and become eligible for Medicare, you will lose eligibility for any benefit from the Plan. If you enroll in the UHC Medicare Advantage Program immediately upon becoming eligible for Medicare (see UHC Group Medicare Advantage Program as listed below), you will remain eligible for the Plan’s Life and Accidental Death benefit. You will also have the option to remain eligible for the Plan’s Dental benefits at an increased premium. If you are a member and enroll in the UHC Medicare Advantage Program, you will also have the option to maintain family coverage in the non-active classification of this Plan for your dependents by paying the applicable premium.
Weekly Accident and Sickness benefits: If you become disabled while covered in the non-active classification, you are not eligible to receive Weekly Accident and Sickness benefits.
Dental benefits: Members covered in the non-active classification, and members or dependents enrolled in the UHC Medicare Advantage Program, have the option to purchase the Plan’s Dental benefits at an increased premium. You must enroll for optional Dental benefits at the time you first enroll in the nonactive classification; otherwise, you must wait for the next Open Enrollment period of October 1 through December 15. If you drop the Dental benefit after initially electing it, you may not elect it again later.
Dependent coverage: Members covered in the non-active classification may elect single coverage (for the member only), or family coverage (for the member and dependents) at a higher premium. An election of single coverage is irrevocable, except that you may change to family coverage in the following circumstances:
- Upon reinstatement to non-active coverage after a gap in coverage, as described under Non-Active Eligibility After a Gap in Coverage; or
- By applying for family coverage within 30 days after one of your dependents becomes entitled to a special enrollment period as permitted under federal regulations.
Self-Payment Provisions - Non-Active MembersTo pay for coverage, members and dependents in the non-active classification must pay the required premium directly to the Benefit Office. Click here for the current Self-Pay rates.
Your premium amount is determined based on your coverage selection and your length of service with the Plan. Your premium for coverage under the nonactive classification and for individuals participating in the UHC Medicare Advantage Program is due on the first day of the month prior to the month of coverage. If your payment is not received on time, your coverage will terminate at the end of the last month for which timely payment was made.
All premiums under the self-pay provisions are due on the first day of the month prior to the month of coverage, and must be received in the Benefit Office within 15 days of the due date to be accepted.
The Self-Pay Guidelines can be found on the carpdc website here.
UHC Group Medicare Advantage ProgramIf you become eligible for Medicare while covered as a member or dependent in the non-active classification and you take no further action, you lose eligibility for any benefit from the Plan. To assist your transition to Medicare, the Plan has arranged for UnitedHealthcare to offer the UHC Medicare Advantage Program, at group premium rates and with benefits that may be attractive to you. The UHC Medicare Advantage Program is a group-type insurance program providing Medicare Part C benefits, and is available only to individuals who become eligible for Medicare while covered in the Plan’s active or non-active classification.
If you choose to participate in the UHC Medicare Advantage Program upon first becoming eligible to enroll, you will remain eligible for the Plan’s Life and Accidental Death benefit. You will also retain the right to elect coverage under the Plan’s Dental benefits. In each case, a monthly premium will charged to you.
Benefits under the UHC Medicare Advantage Program are not Plan benefits — they are provided entirely independently of the Plan under an insurance contract with UnitedHealthcare, in return for which a premium is charged to members. The Plan’s role is strictly to collect and remit monthly premiums to UnitedHealthcare on behalf of individuals who choose to participate, and to report to UnitedHealthcare the individuals who have paid such premiums. The Plan’s monthly charge for an individual who participates in the UHC Medicare Advantage Program includes the following:
- 100% of the premium due from the individual to UnitedHealthcare;
- an administrative fee for the Plan’s services;
- the Plan’s own premium for Life and Accidental Death and Dismemberment benefits; and
- the Plan’s own premium for optional Dental benefits, if elected.
To be accepted for participation in the UHC Medicare Advantage Program, you must be enrolled in Medicare Parts A and B. You must actively enroll in the UHC Medicare Advantage Program prior to your Medicare effective date or no later than 60 days after first becoming eligible for Medicare. If you wish to maintain optional benefits under the Plan, you must make that election at the same time. Your dependent may participate in the UHC Medicare Advantage Program only if, and so long as:
- You have elected family coverage;
- You were covered in the non-active classification before becoming eligible for Medicare; and
- You enrolled in the UHC Medicare Advantage Program after becoming eligible for Medicare.
Need to contact UHC?
UnitedHealthcare Group Medicare Advantage PPO website: www.UHCRetiree.com
Mailing Address: UnitedHealthCare Medicare Solutions, PO Box 29830, Hot Springs, AR 71903-9830
Customer Service Hours: Monday - Friday 8:00 am - 8:00 pm
Customer Service Phone: 1-800-758-4885 TTY 711
NurseLine: 1-877-365-7949 TTY 711
Behavioral Health: 1-800-453-8440 TTY 711
Pharmacy Claims: OptumRx, PO Box 29045, Hot Springs, AR 71903
For Pharmacists: 1-877-889-6510
Retired MembersFor purposes of eligibility for retiree coverage in the non-active classification, a member “retires” when he or she begins to receive pension benefits from any of the following Carpenters’ Pension Plans: St. Louis, Kansas City, Kansas Building Trades, or Geneva. Eligibility for retiree coverage in the non-active classification of the Plan occurs on one of the following dates, depending on the member’s personal circumstances:
- The date the member retires;
- The date when the member’s eligibility in the active classification is exhausted; or
- When the member satisfies the requirements described under Retired Self-Employed Members and Non-Pension Members.
Retired Self-Employed Members and Non-Pension MembersSelf-employed members: If you are a self-employed member and not eligible to receive a pension from the Carpenters’ Pension Plan, you can still qualify for retiree coverage in the Plan in the non-active classification if you meet all of the following conditions:
- You have reached age 62;
- You have stopped working; and
- You have been covered by the Plan as an active member for the five consecutive years preceding enrollment for retiree coverage.
- You have permanently stopped working in any employment and you have notified the Plan.
- You were covered in the Outside or Inside Eligibility class immediately before beginning retiree coverage.
- You enroll for retiree coverage by the first day after your active coverage ends; or if earlier, immediately following the day you stopped working. If you participate in the non-active classification and then terminate that participation for any reason, you have a one-time option to re-enroll in that program if you qualify for all the provisions for non-active eligibility after a gap in coverage.
Disabled MembersIf you become totally disabled while covered in the Outside or Inside Eligibility class, you qualify for coverage in the non-active classification during your disability if you meet all of the following conditions:
- You must provide satisfactory medical evidence of total disability. For purposes of this eligibility provision, “total disability” means that the member is prevented, due solely to sickness or injury, from engaging in any of the usual activities of his or her specific, customary occupation.
- You must provide such evidence to the Trustees as soon as reasonably possible after it becomes available to you.
- You must enroll in non-active disability coverage by first day after your active coverage ends.
- You must provide medical evidence of the continuation of total disability as often as requested by the Plan.
Union Affiliation of Non-Active MembersAs a condition of eligibility for benefits under the non-active classification, all non-active members (except surviving spouses and retired employees of the St. Louis-Kansas City Regional Council or Carpenters’ Benefit Funds), including retired self-employed, non-pension and disabled members, must maintain membership in the Regional Council or its affiliated Locals at all times to be eligible for non-active coverage.
Surviving SpouseIn the event you die as a member in the active or non-active classification, in any class except Special Participation Eligibility, if your spouse had dependent coverage at the time of your death, your surviving spouse may qualify for surviving spouse coverage in the non-active classification. This coverage will continue for your surviving spouse’s lifetime, except if your surviving spouse remarries; the coverage will terminate upon your surviving spouse’s remarriage. To obtain this coverage, your surviving spouse must enroll no later than 30 days after termination of coverage as your dependent.
Your surviving spouse may elect single coverage or family coverage, at the respective applicable premiums. An election of family coverage provides coverage only for your surviving spouse and those persons who were your dependent children at the time of your death. Your stepchildren are not eligible for benefits under the surviving spouse coverage.
A surviving spouse covered under the Plan in the non-active classification is generally considered to be a member for purposes of the Plan.
Working in the Non-Active ClassificationPlease note that some pension plans do not allow participants to work, or limit the number of hours worked while the participant draws a pension benefit.
Members covered in the non-active classification (other than as disabled, retired self-employed or nonpension members) are not prohibited from earning credit hours in this Plan during non-active coverage. Note, however, that some pension plans do not allow participants to work, or limit the number of hours worked while the participant draws a pension benefit. Members who earn credit hours during non-active coverage will receive a credit against their selfpayment on account of the hours worked. Your credit for hours worked in a month is limited to the amount of the premium self-payment due for that benefit month and is paid twice a year from the Benefit Office.
Once you enroll in non-active coverage you may not reestablish active coverage except for a one-time opportunity to reestablish coverage in the Active classification under the following conditions:
- You must provide advance written notice to the Benefit Office of the intent to have credit hours applied to reinstate active eligibility. At that time, employer contributions for you will stop being credited against your premium self-payments and will begin to be credited toward initial active eligibility;
- You must satisfy the requirements for initial Outside or Inside eligibility while maintaining continuous non-active coverage through premium self-payments; and
- Only credit hours earned during non-active coverage as outlined above will be applied to satisfy initial eligibility requirements. You may move from non-active to active coverage only once, except that if you are a member whose non-active coverage is due to total disability, you are not bound by this limitation when you are no longer totally disabled.
Termination of Non-Active EligibilityAs a non-active member, your coverage will end on the earliest of the following dates:
- In case of non-payment at the end of the month for which your last timely payment was received.
- The date of your death.
- The date you falsify any information in connection with a claim for benefits or commit any action with the intent to defraud the Plan.
- The date the Plan terminates.