Beneficiaries and Benefits

The Plan provides for two categories of Beneficiaries: “Regular Beneficiaries” and “Limited Beneficiaries.” It is possible to belong in one or both of these categories.

A “Regular Beneficiary” is entitled to monthly benefit payments for life at a certain set amount, in reimbursement for Covered Expenses as defined in the Plan, up to a certain level, because he/she met the eligibility requirements listed below:

  • He/she earns five (5) years of Active Service in the Trust;
  • Contributions are made to the Trust on his/her behalf;
  • He/she attains age 55; and
  • He/she ceases all employment (including per diem employment) with a participating employer in the Trust.

A “Limited Beneficiary” is entitled to benefit payments in miscellaneous amounts for reimbursement of Covered Expenses from his/her individual Employee Account as needed, up to the balance in the Employee Account. These reimbursements may not last for life if the Employee Account is exhausted. An Employee will have an Employee Account if one of the circumstances listed below applies:

  • The Employee has less than five years of Active Service credits and is no longer working in a participating hospital or institution; or
  • The Employee has an accrued leave transfer to the Trust, pursuant to a collective bargaining agreement; or
  • The Employee has five or more years of Active Service but less than $5000 of contributions were made to the Trust on his/her behalf, and the Employee is no longer working for a participating hospital or institution.

 

What Medical Expenses will be Reimbursed by the Plan?

The following medical expenses are considered Covered Expenses, under the Plan, when they are incurred for a Beneficiary (retiree, spouse, child as defined under the Plan): 

  • Premium or contribution payments for coverage under health, dental, or vision insurance plans.
  • Medical expenses excludable from gross income under Internal Revenue Code Section 213(d), in other words, costs for diagnosis, cure, mitigation, treatment, or prevention of disease or injury, including insulin, but not including other non-prescribed drugs. For a complete list, see IRS Publication 502, which can be found at www.irs.gov/pub/irs-pdf/p502.pdf.
  • Premium payment for qualified long-term care (LTC) insurance.