Any injuries suffered in an automobile accident or any injuries suffered involving an automobile, must first be submitted to your automobile insurer who will serve as the primary payer of any claims incurred. Only a deductible of $250.00 and the 20% copayment of the first $5,000.00 in total eligible charges will be considered for reimbursement through the Northeast Carpenters Health Fund. Benefit payments are subject to the limits and guidelines of the Plan.
You cannot waive your Personal Injury Protection (PIP) to have the Northeast Carpenters Health Fund be the primary payer for automobile related claims.
To be considered an Active Covered Participant, you must be in the Eligible Class and either have 600 or more Credited Hours in the consecutive 6 calendar month period or have 1,200 or more Credited Hours in the consecutive 12 calendar month period.
Credited Hours are used to determine your eligibility to receive benefits under the Plan. Credited Hours are a combination of:
Payment Hours, also called "Contribution Hours" (hours you worked for which employer contributions are made to the Health Fund for your work).
Delinquent Hours are hours you worked for which employer contributions are due but which have not been paid (through no fault of yours) to the Health Fund for your work by the delinquent employer. You must provide evidence of your work such as a pay stub or similar record to the Fund Office to receive credited hours.
Weekly Disability or Workers' Compensation Hours. (Currently, you may receive credit for up to 30 hours per week up to 52 weeks per year),
School hours for Apprenticeship training
Qualifying Family and Medical Leave of Absence, and
Qualified Military Service. Military service up to 5 years for the United States is credited if you leave work with a contributing Plan employer for military service and return within the periods provided by law.
"Eligible Class" means those persons whose chief source of livelihood is work at Covered Employment, and who, at any given time, are working in Covered Employment; are ready, willing, and able to work at Covered Employment; or, are seeking work in Covered Employment.
You will be considered an "inactive" participant if you have less than 200 Credited Hours during any Plan Year. You may also become "inactive" earlier if you cease to be available for and seeking Covered Employment. When you work again in Covered Employment for 800 or more Credited Hours in a Plan Year, you will become an active participant at the end of the Plan Year.