General Discussions

Insurance 7 day rule

GO-953 Members:

I received a call yesterday from a member who was just told their insurance had terminated for the month of October. The rail wanted to know WHY?

The rule is that you must have 7 days of compensation on 7 different days, during a month, OR work every opportunity, in order to qualify for the next month's insurance. If you are on a Medical Leave of Absence, at the end of the month, you qualify for the next month of insurance. FMLA can also qualify you for the next month of insurance (research the FMLA that you have).

In this case, the rail had a minor surgery and was off work from August 25th, to September 25th. This time was covered by a Medical Leave of Absence (MLOA). Once the doctor OK'd the rail to came back to work on the 26th, the protection of the MLOA is gone. The rail has to work every time they can, or get 7 compensated days, to qualify for the next month's insurance.

Example: You are OK from your doctor to the board on September 28th. Work the 30th. There is NO Non-comp lay off. You have insurance for October.

The rail needed to see the doctor on a follow up from surgery. The rail laid off sick. Since the rail only had 4 compensated days in the month, the rail did not qualify for Insurance for the entire family for October, because of that one non-compensated lay off.

The rail has 2 options. Pick and choose the insurance the family wants to continue thru cobra, for that month. Or the family can go without insurance.

Cobra from Iron Road Health Care is $735 for rail's health ins.

Cobra from the National Plan is $964.44 for spouse's health ins.

Cobra from the National Plan is $782.18 for all of his children's ins.

Cobra for rail's dental will be $27.37.

Cobra for spouse's dental will be $27.37.

Cobra for children's dental will be $46.30

Vision for the rail is $3.88. Vision for the spouse is $3.88. Child 3.58.

For one month, if the rail wants to replace it all, it would be $2,594.

In addition, this rail had the supplemental through Iron Road for the family, of $105 per month. If the rail does not pay that, the family will lose the supplemental for the next 3 years. In this case, the rail cannot just pay the monthly supplemental, but has to pay the rail's $735 as well as the $105.

In the end, that was a very costly Lay Off. If the rail would have know it was going to cost a month of insurance or $2699, I am sure other arrangements could have been made.

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What if, the rail had laid off non-comp several times in the month, worked only 4 days, then went on a Medical Leave of Absence from the 15th of the month for a month? The rail would be covered, because the rail was on a MLOA at the end of the month. No loss in insurance.

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What if the rail worked a trip, then was pulled out of service medical, then returned to service later in the same month. The rail worked 2 more round trips, then laid off Union (actual case)?

The rail again only had 6 starts and was not on a MLOA at the end of the month. Since the rail was not a Local chairman, but a Vice President, his Union layoff did not count as a compensated day (Under UP Rules). The next month of insurance was terminated.

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A rail has a medical issue. The doctor releases the rail for work, but the UP will not allow the rail to come to work until UP Medical gives an OK. The rail's insurance continues, because now UP Medical has taken over the rail's care. Make sure the UP communicates this with your benefit providers.

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Whenever I talk to someone coming back to work at the end of the month, I tell them to be very careful. Once any leave of absence is over, you are back to the 7-day rule or work every opportunity. It does not matter if you are coming back from Sickness, being fired, furloughed, etc. Once you get OK for work, you are under the 7-day rule!!!

Any questions, do not hesitate to contact me. I continue to work as the benefit person for GO-953. Retirements, Disabilities, Insurance, Unemployment, etc. Benefit consultations are provided as part of your Union dues.

Fraternally,

Larry Romine

Reliable Retirement Solutions

541-910-4568