Who Must Make Self-Payments
You and your spouse (if he or she is to be covered) must make monthly self-payments to participate in this Retiree Plan. No self-payment is required to cover dependent children at this time. Self-payments are waived for disabled participants in certain situations.

Amount of Self-Payments
The Board of Trustees establishes the required self-payment amounts on an annual basis. Any changes in the selfpayment rates are made effective on September first of a given year. The self-payment rates are communicated to you in announcement letters and billings issued by your Area Administrative Office. If you need confirmation of the rate applicable to you (or your spouse) contact your Area Administrative Office.

Effect of Failure to Make Self-Payments — Self-Payments Must be Continuous
You and your spouse’s monthly self-payments must be made on a continuous basis. If you or your spouse stop making self-payments, coverage cannot be reinstated. If you cease making monthly self-payments on your spouse but continue self-payments on your behalf, your coverage will not be affected.

Reinstatement Provision
A Medicare eligible retiree or spouse participating in the Retiree Plan who, after January 1, 1994, decides to cease selfpayments to WTWT in order to obtain Medicare related coverage outside WTWT, may subsequently elect to be reinstated under this Retiree Plan. Only one reinstatement privilege shall be extended, and it shall be a condition of reinstatement that the participant has had continuity of coverage during the drop-out period. Coverage under this Retiree Plan shall be reinstated as of the first of the month following the date on which the participant submits an application for reinstatement accompanied by the required self-payment. The application shall recite the continuity of coverage.

Due Date for Self-Payments
Self-payments for you and your spouse are due at your Area Administrative Office before the first of the month for which coverage is provided. You will not be listed as eligible for a month until your self-payment is received. You and your spouse have a 30-day grace period after the first of the month to make the required self-payment.

Example: Your self-payment for the March coverage month is due no later than March first. You and your dependents will not be treated as eligible until your monthly self-payment is received. If your self-payment is not received before March 31, coverage is permanently terminated. The only exception is for Medicare eligible retirees described above.

After you are enrolled in the WTWT Retiree Plan, your Area Administrative Office will provide you with a payment coupon book for your required monthly self-payments. Alternatively you can arrange to have your self-payments automatically deducted from your checking or savings account (i.e. Sure Pay electronic transfer). If you have questions about how to make your required monthly self-payments, contact your Area Administrative Office.

Special Rule for Certain Disabled Retirees
If a retiree is not yet eligible for Medicare and is receiving Disability Insurance Benefits under the Federal Social Security Act and Disability Retirement Benefits from a Teamsters Pension Trust, no monthly self-payment is required from the retiree until the earlier of:

• The date the retiree becomes eligible for Medicare (but not to exceed 30 months from the date the retiree’s disability commenced) or
• The cessation of the disability.