To qualify for coverage you, and your eligible Dependents, must be insured under a provincial health plan. Members cannot participate in the Trust Fund after December in the year in which they turn 71. You must also maintain your membership in good standing with Insulators Local 95. The Trust Fund’s Administrative Agent keeps an account for you of the hourly contributions made by your employer(s) on your behalf. The balance in this account determines your eligibility for benefits. Each month a deduction is taken from your account to “pay” for your benefits. From time to time the Trustees will alter the amount of the monthly deductions when required to prudently manage the Trust Fund.

You become eligible for coverage under the Trust Fund when you have accumulated three monthly deductions in your account. Your coverage for all benefits except Long Term Disability becomes effective on the first day of the second month following that accumulation. You become eligible for Long Term Disability if you are under age 60 and after you have accumulated 4,000 hours with a contributing employer.

Your coverage continues for each month your account contains the required monthly deduction. The maximum account balance is twelve monthly deductions. Retirees may run out their accounts but cannot accumulate additional contributions after retirement.

If you are absent from work because of disability due to illness or injury on the date your coverage, or any increase in your coverage, would otherwise become effective, such coverage will not become effective until the date you return to active full-time work for 1 full day.

NOTE: The above example is based on a regular work month of 120 hours. Any hours worked in excess of that amount, such as overtime, may entitle you to benefits earlier than shown in the example. When you do not work continuously during the month, your eligibility for benefits may be delayed.

Your account balance is allowed to build to a maximum equal to 12 monthly deductions, which represents the equivalent of 12 months' coverage. If you have credits in excess of 12 months, the credits are transferred to the general reserve of the Trust Fund.

Change of Your Status

It is your responsibility to notify the Administrative Agent of any change of your status (married, separated, divorced, new Dependents, etc.) to ensure that proper coverage for you and your eligible Dependents is maintained.

Dependent Eligibility

Your Dependents becomes eligible for coverage when you become eligible or, if acquired later, upon becoming your Dependent. To qualify for coverage your eligible Dependents must be insured under a provincial health plan. Newborn Children are eligible for Hospital Indemnity Benefit from 15 days of age and for all other coverage from birth, provided you advise the Administrative Agent within 31 days of the birth. All Dependents must be listed on the Dependent section of your Member Information Card and this Card must be filed with the Administrative Agent.

Coverage for Dependents will be made effective on the date of notification or registration. A new enrolment card must be submitted to the Administrative Agent for all additions or deletion of dependents in order for the change to take effect.

You must be a covered Member of the Trust Fund and eligible for benefits in order for your Dependents to be covered.

Coverage or any increase in coverage, for your eligible Dependent who is confined for medical treatment in any institution or at home on the date such coverage would otherwise become effective, will not become effective until he or she has been given a final release by the Physician from all such confinement. This shall not postpone the effective date for a child born while the Member’s Dependents are insured under the Trust Fund.

Definitions

“Dependent” means a Spouse or unmarried Child who is under 21 years (under 25 years, if regularly attending school and solely Dependent upon the Member for support).

“Spouse” means a person married to the Member as a result of a valid religious or civil marriage ceremony; except that, a person living with the Member in a common-law relationship for a minimum period of twelve consecutive months will be deemed to be the Member's Spouse, if such person is publicly represented as the Member's Spouse. It follows therefore, that to change the covered common law spouse requires a twelve month period where no spouse is covered. Spouse includes persons of the same or opposite sex who are under the age of 71.

“Child”means:

• Your unmarried children (over 14 days of age with respect to the Hospital Indemnity benefit only) under 21 years of age provided they are not employed on a regular full-time basis.
• Your unmarried children under 25 years of age provided they are not employed on a regular full-time basis and they are in full-time attendance at a university or similar institution. Annual proof of student registration is required after the child attains age 21.
• Your legally adopted children, stepchildren, foster children, or children of your common-law Spouse, provided your Spouse or common-law Spouse lives with you and has custody of the child, and provided they meet the requirements set out above.

The term Dependent does not include:

• any Child who is working more than 30 hours per week, unless he/she is a full-time student.
• any person who is not a resident of Canada or the United States.
• any person who is not covered under a Provincial Health Care Program.

NOTE: You may be required to submit proof that your Dependent children are not working on a full-time basis, or that they are in full-time attendance at a university or similar institution.