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| 834 Files | Standard Eligibility files sent to carriers (health, dental, life insurance providers etc.) are called 834 files. These files follow a set format and provide an accounting of who is eligible under the plan at a given period. Frequency of the file can vary by Plan, ranging from monthly to daily. Timing errors can occur between what eligibility we show in the record-keeping system and what eligibility we sent on the 834 file. |
| COBRA | Consolidated Omnibus Budget Reconciliation Act is a federal law passed in 1985. The law allows participants and dependents to temporarily keep their health coverage after employment or coverage as a dependent end. For COBRA, the participant pays 100% of the premiums, plus an administrative fee so it is usually expensive. There are specific rules tied to it and participants can be on the plan from 18-36 months depending on the qualifying event. Self-payments are required |
| Contributions | Client Fund Accounting collects “contributions.” Contributions are any fund the Trust collects payment on, from health contributions, to pension, to vacation and 401(k) to self-payments. You should be aware of the types of contributions your group collects on and how they are received. |
| Client Fund Accounting | Client Fund Accounting or Contribution Accounting is the process of collecting contributions and enrollment information from Employers and Plan participants and posting this information for eligibility and/or benefits. The contributions can be in the form of employer payments, self-payments, hours, reports, and other documentations |
| Dollar or Hour Bank | A dollar or hour bank allows participants to “bank” hours needed above eligibility requirements (ie 150 hours a month or $1,000) to use for future months of coverage (when their hours or contributions fall below the threshold required for coverage). Most plans have a “maximum” bank or coverage period a participant can accumulate. Most plans that have banks have specific rules about acquiring, maintaining and forfeiting their banks. |
| Eligibility | Eligibility is quite literally, what a member or dependent is eligible for at a given time for a variety of coverages. A participant’s “eligibility” can vary based on client specific plan rules. |
| Employers | Most (but certainly not all) Plans at Zenith are “multi-employer” Plans. Individual Employers are part of the same entity (the Trust) but can have certain specific differences based on their CBA. |
| Qualifying Life Event | Most plans have enrollment criteria for when and how a person can enroll with coverage. The notification process can vary, from fancy electronic enrollment to good old fashioned paper forms. Plans usually place restrictions on when a person can enroll, often segmenting it to just an Open Enrollment Period. However, most plans make allowances for “qualifying life events.” You can think of this as basically life, but it is things like the Birth of a child, divorce, loss of other coverage, dependent children turning age 26, etc. that may qualify the participant to continue their enrollment. Tracking these rules is core to what you do as well. |
| Reciprocity | Basically, allows a participant to work in areas outside of their local union jurisdiction but the union and Trust office in that location can still receive payments for health and pension. There are two basic types of reciprocity but in our world, virtually every scenario will be the “money –follows-the-person” reciprocity, where the employer remits to the funds where work is performed, and those funds are then remitted to the home locals for credit and coverage. |
| Self-Pay | When a member makes a payment to make up missing hours to ensure they are eligible for healthcare coverage, self-pay also includes payment for COBRA and Retiree healthcare coverage. |
