Qualifications for Self-Payments for continuing eligibility

 You may make self-payments to continue your eligibility. The length of time for which you can

make self-payments depends on how many hours you work each month:

Banquet workers

  • 48 hours or more per month as long as you work at least 48 hours each month
  • Less than 48 hours per month for up to 3 months (or 6 months with approval) *

 Non-banquet workers

  • 70 hours or more per month as long as you work at least 70 hours each month
  • Less than 70 hours per month for up to 3 months (or 6 months with approval) *

* If you work less than 48 or 70 hours per month, you may be able to make self-payments for 3 more months if your reduction in hours was involuntary, as determined by UNITE HERE HEALTH.

The amount of the required monthly self-payment to continue eligibility is:

  • For May through October: 130 hours minus the number of hours you actually worked.
  • For November through April: 100 hours minus the number of hours you actually worked.

Self-payments must be mailed to UNITE HERE HEALTH and post marked no later than the 15th day of the month immediately before the coverage period for which the self-payment is intended.

Self-payments during remodeling or restoration

If your workplace closes or partially closes because it’s being remodeled or restored, you may make self-payments to continue your coverage until the remodeling or restoration is finished for up to 18 months from the date your workplace began remodeling or restoration.

If the participant meets the above qualifications, the below payment chart applies

Plan Unit 175 Self- Payments

Coverage Tier Self-Payment Amount (*Includes Medical, Dental and Vision)
Family Coverage for Continuing Eligibility (May – October) $7.93 per hour/$1030.90 per month
Family Coverage for Continuing Eligibility (November – April) $7.93 per hour/$793.00
Single Coverage for Continuing Eligibility (May – October) $7.93 per hour/$1030.90 per month
Single Coverage (May – October) $7.93 per hour/$793.00

 

Plan Unit 175 COBRA Payments

Coverage Tier Medical Dental Vision
Family Coverage for Continuing Eligibility (May – October) $1,459.94 $63.67 $6.04
Family Coverage for Continuing Eligibility (November – April) $1,459.94 $63.67 $6.04
Single Coverage for Continuing Eligibility (May – October) $599.34 $26.14 $2.48
Single Coverage (May – October) $599.34 $26.14 $2.48