POLICY INFORMATION

IBEW 196 Enrollment Eligibility Rules

These rules outline the requirements for being initially eligible for coverage on the effective date for which you enroll.

1. Membership Requirement:

• You must be an actively working, full dues-paying member of the IBEW 196, living in the U.S.

2. Employment and Actively Working Requirement:

• You must be employed under a U.S.-based collectively bargained contract on the effective date of coverage and
• You must be actively working on or immediately before your effective date of coverage (based on when you enroll) to be eligible. This means performing your job duties for your employer on that specific date. If you are not actively working, your coverage will only start once you return to actively working status.
  • Definition of “Actively Working”: The following situations are considered as “actively working” days:
    1. Days Worked: Any day you work a full day as scheduled by your employer, performing the duties of your occupation.
    2. Scheduled Days Off: Days you are not scheduled to work but are still employed and physically able to work.
    3. Vacation Time: Paid vacation days approved by your employer, when you are still physically able to work.
    4. Paid Time Off (PTO): Any paid leave days granted by your employer, such as sick leave or personal days, when you are still physically able to work.
    5. Periods Between Jobs: Time between assignments or projects, provided you remain employed by the same employer and physically able to work.
• If you are not currently employed, meaning you do not have an employer, you are not eligible to enroll.

3. Disability Prior to Coverage:

• If your date of disability is prior to the coverage effective date, it will not be eligible for benefits, and you will not be covered under the policy until you return to actively working status.

If you have a question about eligibility, please call Union One at (224) 770-5305.

IBEW 196 Post Enrollment Eligibility Rules

These outline the requirements to maintain eligibility once you are initially covered on the plan (as determined above).

1. Membership Requirement:

• You must remain an actively working, full, dues-paying member of the IBEW 196 living in the U.S.

2. Maintaining Employment and Working Status Requirement:

• You must remain employed under a U.S.-based collectively bargained contract and meet the requirements below.
  • Work Hours Requirement: You must work at least 1,250 hours per year.
  • Continuity Requirement: You must not have a break in active work longer than 6 consecutive months.

If you have a question about eligibility or if your eligibility changes, please call Union One at (224) 770-5305.

IMPORTANT: Please note that these published rules are intended to serve as a general guide. For the precise and comprehensive eligibility criteria, please refer to the policy booklet. The policy booklet contains the exact language and details regarding eligibility requirements and conditions.

All of the available coverages are offered separately and a Member’s participation in one or all of those coverages, and the level to which he or she elects to participate, is voluntary and strictly the individual’s choice.

The purpose of this Group Insurance Plan is to give you options to supplement your income in the event that you cannot work as a result of an injury, illness or death. This group plan offers Disability Insurance and Life Insurance with Accidental Death & Dismemberment coverage.

All insurance under this Union Group Policy will cover you for as long as you continue to remain actively employed, pay premium, and be in good standing with the union.

It is your responsibility to notify the Union One administrative office if your employment, union status, contact information, or salary changes. Failure to properly notify the Union One administrative office will result in loss of premiums and/or insurance coverage. Notification to the Union One administrative office must be made by phone at (224) 770-5305 and/or by email at info@unionone.com.

Income Verification Notice

In the event you file a claim, you will be required to verify your income by providing your prior year’s W-2 and/or your last three full months of pay stubs prior to your disability. Benefit payments are subject to change based on the income you can verify at time of claim.

Benefits Offsets, Reductions and Overpayments

Benefits may be reduced where offsets apply. Benefit amounts illustrated on the Summary of Benefits & Rates guide do not reflect any applicable offsets. It is your responsibility as the claimant to notify the Union One administrative office and the Insurance Company of any other income sources you are receiving; failure to do so may result in an overpayment that you will be required to repay. Please review the Group Policy for further information. If you have any questions regarding offsets, please call the Union One administrative office at (224) 770-5305.

As an individual Member of the union, if you have voluntarily elected to participate and pay premium for coverage, it is your responsibility to understand the group policy and its provisions.

Short-Term Disability – Pre-Existing Guidelines

Short-Term Disability has a Pre-Existing Condition limitation of 12 months. In order for a pre-existing condition to be covered, you must be an eligible Member of the group and have paid Short-Term Disability premium for 12 consecutive months prior to your date of disability, or you must be treatment free for the 3 months prior to your date of disability (Look Back Period) for the disabling condition.

Long-Term Disability – Pre-Existing Guidelines

Long-Term Disability has a Pre-Existing Condition limitation of 12 months. In order for a pre-existing condition to be covered, you must be an eligible Member of the group and have paid Long-Term Disability premium for 12 consecutive months prior to your date of disability, or you must be treatment free for the 3 months prior to your date of disability (Look Back Period) for the disabling condition.

More Pre-Existing Limitation Information

These Pre-Existing Condition limitations also apply to any benefit increase.

• Pre-Existing Conditions are reviewed by the insurance carrier at time of claim, which will require disclosure of all medical records, doctors’ notes and prescription drug history.
• Failing to receive treatment does not preclude you from the Pre-Existing Condition Look Back Period.

Please review the Group Policy for further information. If you have any questions regarding Pre-Existing Condition limitations, please call (224) 770-5305.

Learn more about your Long-Term Disability Policy

If you are enrolled in Long-Term Disability, this information is intended to help you understand the transition process from own occupation to any occupation.

Your Union Long-Term Disability Policy through New Your Life contains a two year “own-occupation” period within the definition of disability; which simply means that during the first 2 years of a Long-Term Disability claim, your disabling condition must prevent you from performing the “essential duties” of YOUR specific occupation (as defined by the Department of Labor). After 2 years of receiving Long-Term Disability benefits, you would transition from “own-occupation” to “any-occupation”.

Generally, the following criteria is used when determining whether you can work in another (“any”) occupation:

• Occupations exist within your job market (approximately 60 miles commute or less, considering your length of travel to work prior to disability) that you could perform with your disability/functionality restrictions.
• Occupations exist that you can perform the majority of the substantial and material duties for and have the education, training, or experience to perform.
• Occupations exist that pay a reasonable amount in accordance to policy guidelines.

The transition from the own-occupation definition of disability to the any-occupation definition does not in itself eliminate your ability to receive benefits. This transition is a change in the criteria used to adjudicate your disability and may or may not cause benefits to terminate (depending on each unique situation and the criteria above). Job openings/availability are not guaranteed nor does the policy protect against whether you successfully secure employment.

This “own occ/any occ” provision of the policy is intended to help both those claiming disability benefits and those who are not claiming disability benefits. This policy provision incentivizes individuals who are off on disability to either rehabilitate and get back to work at their current occupation or utilize their training/education to find gainful employment in another field. For those Members who are not on disability, this provision helps to ensure that disability coverage remains affordable and in-force. It is important for the long-term sustainability of the policy that individuals on disability try to return to the workforce when the ability exists to find gainful employment as outlined in the above criteria.

Additional Return-To-Work services are typically provided by the insurance company at no cost. Among others, most insurers offer programs and services to assist disabled Members and help them return to full productivity, and their Vocational Rehabilitation Benefits provide individually tailored programs to assist Members on LTD with successful recovery and re-entry to the workplace. Additionally, the insurance company typically employs vocational rehabilitation professionals to review each claim independently and work with the claimant to determine the most appropriate course of action. Everyone wins when disabled Members are working toward re-entry into the workforce!

This is a Voluntary Group Term Life Insurance plan offered through your union. As such, this plan should not serve as your primary source of Life Insurance as the union or insurance company may terminate, cancel or change this policy at renewal. This Life Insurance Plan is designed to give you and your family a guaranteed approved option for additional Supplemental Life Insurance while working and an active Member of your union. Please review all the provisions of this Life Insurance Policy and it is highly recommended that this policy not be used to replace any existing Life Insurance coverage you may have.

When Life Insurance Coverage Ends

If disabled you may keep your Life Insurance coverage for up to 12 months provided premiums continue to be paid during that period. Beyond 12 months, your coverage will terminate unless you convert or port your Life Insurance coverage.

If you leave the union or retire, you may convert your Group Term Life Insurance to a Permanent Individual Life Insurance Policy or you may port your coverage. You must elect to convert or port your coverage within 31 days from the date of you are no longer eligible to be covered on the group plan (i.e. date of retirement or termination). Please contact the Union One administrative office office at (224) 770-5305 for questions about rates associated with converting or porting your Life Insurance coverage.

If you enroll in Child Life coverage and your child is disabled, you can retain your child’s coverage beyond age 26 by contacting the Union One Plan’s customer service center at (224) 770-5305 or by email at info@unionone.com.

Note: Typically converting your Group Term Life Insurance to an Individual Permanent Life Insurance Policy is very expensive and only recommended for people who cannot qualify for Life Insurance elsewhere.

Renewal Notice

This is a Group Insurance Plan offered through your union. As such, at renewal your rates and benefits may change or non-renew based on the overall claims experience of the group and/or participation requirements not being met. Further, any substantial change to the makeup of the group, such as a change in the Member demographics, that impacts the underwriting risk of the plan may immediately result in a change to the plan.

At renewal, if you do not call the Union One administrative office to re-enroll or discontinue coverage, you herby authorize and give permission to the Union One administrative office to auto-enroll you in the renewal plan benefits that most resemble your currently elected benefits. Auto-enrollment could result in a potential increase in your monthly or bimonthly premium drafts. Please understand, this is intended to ensure no Member loses coverage for failing or forgetting to take the time to renew or re-enroll. Given that all benefits are “Voluntary” you can cancel or lower your coverage at any time.

Loss of Premiums Notice

If you do not contact the Union One customer service center at (224) 770-5305 or by email at info@unionone.com within 90 days of your date of dismissal, date of retirement, date in which you left the IBEW 196, there will be no refund for any premiums paid.  It is the sole responsibility of the Member to contact the customer service center within the 90 day allotted time.

Failure to Make a Payment

Participating Members for whatever reason may miss a premium payment from time to time. The current plan allows for a 60 day grace period to make up any missed premium payments.

Administrative & Transaction Costs

All administrative and transaction fees (fees) are included in your monthly premium. These fees cover the costs associated with, but not limited to, premium processing, premium returns, postage, policy correspondence, claims advocacy and other ancillary expenses associated with the administration of your elections. These monthly fees are applied to all coverages shown on the Summary of Benefits & Rates.

Included when premium is collected: Payment Transaction Fee 1.00.