The Board of Trustees of the Santa Monica UNITE HERE Health Benefit Fund announced a series of improvements and changes to the Plan in a Summary of Material Modifications (SMM) document mailed out in June. This SMM supplements the Summary Plan Description dated July 1, 2021 (“SPD”). 

You can download a copy of the SMM for your records. You should retain this document with your copy of the SPD. Unless stated otherwise, these changes will go into effect on August 1, 2025.

June 2025 SMM – Health Plan Changes – English

June 2025 SMM – Health Plan Changes – Spanish

The following changes apply to members who are currently in the Hotel Plan*

  • Lower cost for coverage! $20 → $0

If you currently pay $20 per month for Kaiser coverage, the cost will go down to $0 starting with the August 2025 work month, which provides November 2025 medical coverage. This change does not apply to members of the Event Center Plan.

  • Easier to stay covered! 80 hours → 60 hours

If you currently need 80 hours per month to be eligible for coverage, you will now only need 60 hours per month. This change does not apply to members of the Event Center Plan**

The following changes apply to all plans

  • Easier to get coverage! 5 months → 3 months

If you need to build up eligibility as a new hire, or re-establish your eligibility after losing eligibility, you will only need 3 consecutive months of working the minimum number of hours before you can enroll, rather than needing 5 consecutive months. This rule is now the same for all plans.

  • Better life insurance for all plan members! $20,000 → $50,000

If you (or a dependent) were to die, the payment your beneficiary (or you) will receive has increased from $20,000 to $50,000, effective March 1, 2025. In order for you or your

beneficiary to receive a payment, you must be eligible for benefits at the time of the death, but it is not necessary for you to be enrolled for medical benefits to be eligible for a payment. If you are on disability credit, you are now eligible for life insurance as well! This applies to all plans.

  • Easier to stay covered! 3 → 11 months with low hours

This improvement will help you if you work low hours or work seasonally. Under the current plan, if you have worked fewer than the minimum hours needed for eligibility for more than 3 consecutive months, you must start over like a new hire to build up your eligibility (i.e. re-establish your initial eligibility). Starting August 1, 2025, you can maintain eligibility while

working fewer than the minimum hours needed for up to 11 consecutive months before having to start over like a new hire to build up your eligibility (i.e. re-establish your initial eligibility). This applies to all plans.

  • Keep your coverage longer if you are disabled! 4 months → 6 months

If you become sick or disabled and can’t work, under the current plan rules and the Family and Medical Leave Act (“FMLA”) law, your employer must pay for the first 12 weeks of your coverage if you qualify for FMLA leave (and if your employer is covered by the FMLA). After that coverage expires, you may apply for disability credit and the Fund will provide coverage for you. Right now,

you are eligible for up to 4 months of disability credit, unless you were injured on the job. Effective August 1, 2025, this will increase to up to 6 months of disability credit. This applies to all plans.

  • Better Coverage for Accidental Death or Dismemberment!

If you (the employee) are killed in an accident, your dependents will receive $20,000, increased from $10,000, as part of the Accidental Death or Dismemberment benefit, in addition to any life insurance payment.

If you don’t die, but instead lose a limb or your sight, you will be paid between $10,000 and

$20,000 depending on the loss. These payments are double what they were before! Members must be eligible for medical coverage, either through hours reported, FMLA reported and paid by the employer, or disability credit. This applies to all plans. 

  • Anytime Enrollment!

If you are eligible for benefits but not enrolled, you may enroll at any time. You don’t have to wait for open enrollment! This applies to all plans.

  • No dual coverage

Members will no longer be allowed to have an enrolled dependent who is already covered under the Plan. In other words, dual coverage under this Plan as both an employee and a dependent is no longer allowed, effective August 1, 2025. Members affected by this plan change will be sent a letter with detailed instructions. This applies to all plans.

  • COBRA

Members who elect to receive COBRA will no longer be offered the choice between core coverage or dental/vision coverage for each individual family member. Only one option must be chosen to cover the member and any dependents. This applies to all plans.

Applies to all plans except workplaces that ONLY offer Health Net and MLK Care

  • Kaiser Permanente coverage

Kaiser Permanente coverage continues to be offered as an option, but members will need 24 (up from 12) consecutive months of coverage in MLK Care or Health Net before they will be given the option of enrolling in Kaiser at the next open enrollment. This does not apply to workplaces that only offer Health Net and MLK Care.

  • Dental Office — Additional Information

Scaling and Root Planing and similar procedures (“Deep Cleanings”) will have a $25 copay per quadrant.

Starting with the month of August, new enrollees will be offered Delta as one of their options only if they live more than 20 miles from the UNITE HERE Health Center and are members of the UNITE HERE Plan or the UNITE HERE Event Center Plan.

*New UNITE HERE Plan: The current Hotel plan will be merged with the Legacy Plan and will be called the UNITE HERE Plan moving forward.

**UNITE HERE Event Center Plan: The current Event Center Plan will be renamed the UNITE HERE Event Center Plan.

UNITE HERE Restaurant Plan: Members who work for employers that do not contribute at least the minimum amount per hour required for coverage under the Kaiser HMO Plan will be considered to be part of this plan.