Plan C of the Teamsters Life Insurance Trust Fund was established to provide life, accidental death and dismemberment insurance benefits to active employees of contributing employers and death benefits to eligible retirees and are generally applicable to employees working at the employers listed below, different rules apply in some instances.  The Eligibility & Benefit Insert will describe any different rules that may affect you.  

Plan C Contributing Employers:

If you do not know your PLAN, contact the Trust’s Administrative Office. 

Employer-paid Coverage 

To be covered under the Plan by your employer, you must,

1. be covered under a collective bargaining agreement between your local union and your employer or covered under the terms of a subscriber agreement between the employer and the Trust;
2. be working in an employee classification eligible for benefits (i.e. normally a full-time employee); and
3. meet a work or compensation test for your employer to contribute to the Plan on your behalf For example, your collective bargaining agreement requires that your employer make a contribution on your behalf only if you work 80 hours or more in the preceding month. The specific work, compensation or other tests that are applied to determine your eligibility for life coverage are described in the Eligibility and Benefit Insert.  (link to Plan Documents & Forms page)

When Employer-Paid Coverage Ends 

Employer-paid life insurance coverage ends 31 days after the last day of the month in which you do not meet the work, compensation or other requirements contained in your collective bargaining agreement. This additional 31 days of coverage is referred to as the "extension period."

Example:  Your bargaining agreement states that you will be covered for life and accidental death and dismemberment insurance in the month following each month you worked 80 hours. You worked 80 hours in January and February (and your employer submitted the contributions required by the collective bargaining agreement on your behalf for those months) but only 40 hours in March and no hours in April. You are covered in February because of the 80 hours you worked in January and in March because of the 80 hours you worked in February. Although you failed to meet the work test for April coverage (you did not work 80 hours in March) you are nevertheless covered for life insurance during April because of the 31-day "extension period." You are not covered in May.

There is no 31 day "extension period" coverage for Accidental Death and Dismemberment coverage. In the example above, unlike your life insurance coverage, your AD&D coverage ends on the last day of the month following the month you last worked 80 hours or March 31^st.

When employer-paid coverage ends you may only continue coverage by making self-payments or by converting your group coverage to an individual plan.

Continuing Group Coverage by Making Self-Payments 

If you are laid-off or go on an approved leave of absence, you may continue your life and AD&D coverage for up to 24 months by self-payment. As explained on page 13 of the SPD, one of the requirements for the retiree death benefit is 120 months (ten years) of continuous -­ uninterrupted - coverage as an active employee prior to retirement. Therefore, if you fail to self-pay for coverage when you are not working, you will not preserve the continuity of your coverage and, as a result, may fail to meet the 120-month test that would otherwise qualify you for the retiree death benefit. 

Self-payments must be made to your employer who will submit them to the Trust together with premiums for working employees. Self-payments must begin the month after employer-paid coverage (excluding the "extension period" ends and must be continuous. If you skip a month you cannot resume self-pay coverage without returning to covered employment and regaining eligibility. Payments are due on the first day of the month for which coverage is being purchased. Payments are considered late if they are not received within 30 days of the due date. There is no grace period. If a payment is late, self-pay coverage is cancelled. As of January 1, 2013, the premium is $.85 per $1000 of coverage. See your Eligibility and Benefit Insert for your self-pay premium rates.  

Example:  The last contribution made by your employer paid for March coverage. Although life is extended an additional 31 days (the extension period), if you want to continue group coverage by making self-payments, you must begin by paying for April coverage. Your first self-payment is due on April 1^St and will not be accepted if it is received by the Trust after April 30^th . There is no grace period. If the payment for April is not received by the end of the month, your life coverage will end April 30^th (AD&D coverage will end March 31^5t) and you will have lost the right to continue coverage by making self-payments. 

You do not have the right to make self-payments if you quit, retire or are terminated from employment. However, you may be able to continue life coverage by converting to an individual policy.

When Self-Pay Coverage Ends 

Self-pay life coverage ends 31 days after the end of the month in which you: 

• make your last self-payment;
• terminate employment; or
• come to the end of your 24-month self-pay period, 

whichever is earliest. Once the 24-month period expires, you cannot self-pay for coverage until you earn coverage again based on hours worked. 

Example: Because of lay-off or personal leave, your employer does not provide coverage during April, May, June and July. You self-pay for April and May but make no payment in June. Your AD&D coverage will end on May 31^st. Because of the 31-day "extension period," your life coverage will not end until July 1^st (i.e. 31 days after May 31^st). Because a timely payment was not made for June, you cannot later self-pay for June or any subsequent month. 

Conversion to an Individual Policy 

So long as MetLife underwrites the group policy, if your life insurance coverage terminates, you have the right to purchase an individual policy from MetLife. You must apply for this coverage in accordance with the following deadlines:

If you convert to an individual policy, you will make your premium payments directly to MetLife. The cost of the policy will depend on your sex and age. If you return to covered employment in the industry within two years, you must surrender your individual conversion policy (and you will be paid the cash surrender value thereof) before you can resume coverage under the Active Plan. Note, the time you are covered by the conversion policy does not count in meeting the 120-month requirement for coverage under the retiree plan. 

 Retirees who lose Retiree Plan coverage may also convert their group coverage to an individual policy.

Standard Benefit Amount

The Plan pays benefits to active employees, or their beneficiaries based on the level of contributions made by the Employer. The benefit paid upon your death is referred to as the “Standard Benefit Amount (SBA).”  The Standard Benefit Amount for seasonally employed participants may be different from that for full-time employees. In addition to benefits payable upon your death, benefits are also paid if you lose a limb or your eye sight. The benefit payable in these instances is expressed as a percentage of the Standard Benefit Amount. For example, the benefit paid when a limb or sight in one eye is lost is 50% of the Standard Benefit Amount. So, if your beneficiaries receive $4,000 when you die then the amount payable to you upon losing a limb or sight in one eye is $2,000. Under the Plan, once you retire the death benefit is $1,000, regardless of your Standard Benefit Amount as an active employee. See the Eligibility & Benefit Insert for the Standard Benefit amount for your coverage. 

The chart below shows the benefit (expressed as a percentage of the Standard Benefit Amount) for each type of loss covered under the Plan.

To qualify for benefits under the accidental death and dismemberment policy, the accidental injury must occur while you are covered under that policy and the loss must occur within 12 months of the accidental injury and must be the direct result of the accidental injury, independent of any other cause.

 Accidental Death & Dismemberment Exclusions 

Appealing a Denied Life, AD&D or Retiree Death Benefit Claim

If a claim for Life, AD&D or retiree death benefits is wholly or partly denied, the claimant or his or her authorized representative may submit a request for a review of the claim. The request for review will be considered by the Board of Trustees. Requests for review must be sent to the Administrative Office which will refer the appeal to the Board. Any appeal must be filed within 180 days after the date the claim is denied. Appeals filed after 180 days will be dismissed as untimely. The claimant may submit written comments, documents, records, etc., with regard to his or her claim to the Administrative Office which will forward such information to the Board. The claimant will also have an opportunity to review and obtain copies of all documents, records, and other information relevant to his or her claim, free of charge from the Administrative Office.

The review by the Board of Trustees will take into account all information submitted by the claimant, regardless of whether it was reviewed as part of the initial determination. The Board of Trustees will render a decision within 60 days of receiving the appeal from the Administrative Office unless special circumstances require an extension of time of up to an additional 60 days. If such an extension is required, the claimant will be notified in writing by the Board before the initial 60-day period ends.

If the appeal is denied, a notice of determination will be provided to the claimant that will include:

• Specific reasons for the denial;
• Specific references to the Plan provisions upon which the denial is based;
• A statement regarding the claimant's right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits, and
• A statement of the claimant's right to bring a civil action under ERISA § 502(a) following an adverse benefit determination on review.

The decision on appeal is FINAL AND BINDING on all persons.

Appealing a Denied Request for Disability Premium Waiver

If a claim for a disability premium waiver is denied, the claimant or his or her authorized representative may submit a request for a review. The request for review will be considered by the Board of Trustees. Requests for review must be sent to the Administrative Office which will refer the appeal to the Board. Any appeals regarding a disability premium waiver must be filed within 180 days after the date the claim is denied by the Administrative Office. Appeals filed after 180 days will be dismissed as untimely. The claimant may submit written comments, documents, records, etc., relating to his or her claim to the Administrative Office which will forward such information to the Board. The claimant will also have an opportunity to review and obtain copies of all documents, records, and other information relevant to his or her claim, free of charge from the Administrative Office.

The Board of Trustees will take into account all information submitted by the claimant, regardless of whether it was reviewed as part of the initial determination. Where an appeal is based on a medical judgment, the Board of Trustees will consult with a professionally trained health care professional. The health care professional will not be the same individual who was consulted in connection with the initial determination nor a subordinate of that individual. The identity of any medical or vocational expert whose advice was obtained in connection with the appeal will be provided upon request.

Within 45 days after the Administrative Office receives a request for review, the Board will:

1.  Grant the disability premium waiver; or
2. Send written notice to the claimant explaining that special circumstances require additional time (up to 45 days) to process the claim and give the date by which a decision is expected to be made. If additional information is needed to decide the claim, the notice will specify the needed information. If additional information is requested, the claimant will have 45 days to provide the information. If the claimant does not provide the requested information within 45 days, a decision will be made on the basis of the previously submitted information; or
3. Send written notification to the claimant that the appeal has been denied, in whole or in part. This notice will include:
   
   • Specific reasons for the denial;
   • Specific references to the Plan provisions upon which the denial is based;
   • A statement regarding the claimant's right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits; 
   • A statement of the claimant's right to bring a civil action under ERISA § 502(a); and
   • The notice may also specify:
     
     • Whether an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination, and either the specific rule or guideline, protocol, or other similar criterion or a statement that such information is available upon request free of charge. or
     • Whether the determination was based on an exclusion or limit, and either an explanation of the scientific or clinical judgement for the determination or a statement that such information is available upon request free of charge. 

The decision on appeal is FINAL AND BINDING on all parties.

Naming Beneficiaries

It is important that you name one or more beneficiaries when you first become eligible for Active Plan coverage. You can do this by filing out the Trust’s Beneficiary Designation form and mailing it to the Administrative Office. BE SURE TO SIGN AND DATE the beneficiary form. Unsigned forms or forms received by the Trust after you die are not valid.

You may change your beneficiary any time you want by filing out a new form. For a change to be valid, the form must be received by the Trust prior to your death. You cannot change your beneficiary by calling the Administrative Office. The change must be made in writing on a form approved by the Trust.

Enrollment - Beneficiary Designation Form 

Preference Beneficiary Rule

If you do not designate a beneficiary, your death benefit under either the Active or Retiree Plan will be paid to beneficiaries in the following order:

1. To your spouse (a domestic partner registered as such with the State of California is considered to be a spouse).
2. To your children, equally, if you have no spouse.
3. To your parents, equally, if you have no children.
4. To your brothers and sisters, equally, if you have no parents.
5. To your estate.

ANY PAYMENT MADE IN GOOD FAITH TO ANY OF THE ABOVE BENEFICIARIES DISCHARGES THE TRUST’S LIABILITY TO THE EXTENT OF SUCH PAYMENT.

How To File a Life Claim & Retiree Plan Death Benefit

If you are a beneficiary of an active or retired employee who has passed away, you or your authorized representative may claim your benefit by completing a claim form.

Fill out the Claimant's section. Be sure to list any other beneficiaries (name, address, Social Security number).

1. Attach a CERTIFIED copy of the deceased employee's death certificate. (Photocopies will not be accepted.)
2. If the benefit is to be shared (for example by the children of the deceased) and one of the beneficiaries has died, attach a photocopy of the deceased beneficiary's death certificate.
3. If you are applying on behalf of the deceased employee's estate, attach a certified certificate of appointment or other document appointing the estate representative.

Forward this package of material to the union local. The Union will fill out the section of the claim form covering work history and then forward the entire application to the Administrative Office for processing.

The Administrative Office will check work history and process the claim. If there is no card on file naming a beneficiary you will be sent a "Claimant's Affidavit." This form must be completed and returned before the preference beneficiary rules are used to distribute the death benefit.

Claimants Affidavit 

Benefits are normally paid within 90 days of receiving a fully completed claim. If you file a claim and have not received a response from the Administrative Office within 90 days, please contact us.  

Claim Form

If you or your authorized representative is filing an accidental death claim, in addition to the death certificate you will need to furnish the Administrative Office with a copy of the police report, if there is one. The insurance carrier, MetLife, may also request a toxicology report.

If the claim is for the accidental loss of your hand, foot or eyesight, you will need to furnish the Administrative Office with a statement from your doctor detailing the loss.

Responding To Life, AD&D and Retiree Death Benefit Claims

Within 90 days after the date the Administrative Office receives a fully completed claim for benefits, including any required attachments or requested additional information, the Administrative Office will: 

1. Pay the claim; or
2. Send written notice to the claimant explaining that special circumstances require additional time (up to 90 days) to process the claim and give the date by which a decision is expected to be made; or
3. Send written notification to the claimant that the claim has been denied, in whole or in part. This notice will include:

• Specific reasons for the denial;
• Specific references to the Plan provisions upon which the denial is based;
• A description of any information or material necessary to perfect the claim and reasons why that information is necessary;
• An explanation of how the claimant may appeal the denial, including applicable time limits; and
• A statement of the claimant’s right to bring a civil action under ERISA §502(a) following an adverse benefit determination on review.

Payments

In the event the Plan erroneously (1) makes benefit payments to a participant or beneficiary in excess of amounts provided for by this Plan; (2) makes benefit payments to a participant or beneficiary for which benefits are not payable under this Plan; or (3) erroneously makes benefit payments to an individual who fraudulently participates in the Plan based on a misrepresentation of facts, the amount so paid shall be repaid to the Trust by the participant, beneficiary, estate or individual.  If such amounts are not repaid, the Trustees may file suit to recover any amount due.

As described under Total Disability (Disability Waiver Coverage) on page 8 your life insurance coverage continues if you are totally disabled. Except as described below, the death benefit under disability waiver coverage is $1,000 regardless of your Standard Benefit Amount as an active employee. Exception: Effective for disabilities that occur on or after November 19, 2012, if you are in a non-seasonal job or seniority classification, your disability waiver death benefit is equal to the Standard Benefit Amount during the 12-month period following the last month you earned coverage based on hours worked. Thereafter your disability waiver coverage benefit is $1,000. 

Example:

You are a full-time non-seasonal employee. After working more than 80 hours in February 2013 (and your employer submitted the contributions required by the collective bargaining agreement on your behalf for that month) you are disabled and remain so for more than one year. The collective bargaining agreement between your union and employer provides for employer-paid health coverage during the month that follows each month you work 80 hours. In this example, you have active life coverage in March because of the 80 hours you worked in February. Your disability waiver coverage begins April 1, 2013. If you pass away on or before March 31, 2014, your beneficiaries will receive the Standard Benefit Amount. Thereafter, the benefit they receive is $1,000. 

Under the same circumstances, if you were a seasonal employee your disability waiver coverage also begins April 1, 2013, and your death benefit under waiver coverage is $1,000 regardless of your Standard Benefit Amount as an active employee.

Retiree Plan Death Benefit Eligibility

 When you die, your beneficiaries are eligible for a death benefit if you meet either of the following two tests and are not affected by any exclusion.

 Test 1  You retired prior to April 1, 1988, AND EITHER:

             1. Began receiving a pension from a pension plan maintained under a collective bargaining agreement with a local union or joint council affiliated with the International

                 Brotherhood of Teamsters (a Qualified Pension) within 24 months (or 11 months for retirees who died before July 1, 2000) of the last day you were covered under the

                 Active Plan (grace period rule), OR

            2. You were age 65 when you retired.

 Test 2  You retired on or after April 1, 1988, AND you were continuously covered by the Active Plan for 120 months (120-month rule) AND EITHER

             1. Began receiving a Qualified Pension within 24 months (or 11 months for retirees who died before July 1, 2000) of completing a period of 120 months of continuous

                coverage under the Active Plan (grace period rule), OR

            2. You are covered under the Active Plan for a reason other than disability waiver on or after your 65^th

 Exclusions: Even if you meet test 1 or test 2, you are NOT eligible for a retiree death benefit if:

           - You retired prior to February 1, 1973, the date the Trust started, or the date your employer first participated in the Trust, whichever is later.

           - You retired on or after April 1, 1988, and your employer (or a successor to that employer) no longer contributes to the Trust. (This exclusion does not apply

             to certain employers who have agreed to be subject to the withdrawal liability provisions of the Trust.  A list of such employers is available from the

             Administrative Office.)

Refer to the guidelines used in applying Tests 1 and 2. 

Conversion to Individual Policy

 If you lose retiree coverage (because, for example, your former employer no longer contributes to the Trust) you have the right to purchase an individual policy from MetLife.

 So long as MetLife underwrites the group policy, if your life insurance coverage terminates, you have the right to purchase an individual policy from MetLife. You must apply for this coverage in accordance with the following deadlines:

If you convert to an individual policy, you will make your premium payments directly to MetLife. The cost of the policy will depend on your sex and age. If you return to covered employment in the industry within two years, you must surrender your individual conversion policy (and you will be paid the cash surrender value thereof) before you can resume coverage under the Active Plan. Note, the time you are covered by the conversion policy does not count in meeting the 120-month requirement for coverage under the retiree plan.

The death benefit under the Retiree Plan is $1,000. 

If after the effective date of your Qualified Pension you return to work your death benefit will be the higher of your Active Plan benefit or your Retiree Plan benefit (but not both). Once your Active Plan coverage ends you will continue coverage under the Retiree Plan.