Some people in unions work for someone full time and the employer offers insurance or they make contributions to the employess account and they in turn use those contributions to purchase a group plan that the union offers. The group plan might be offered by the local or the international. There are different levels of coverage with the group plans but it is the same price for everyone no matter age or if you smoke. Mostly the people who work for different employers during a year, who don't work for one person or company full time but the union finds them work at different places and they all contribute to a health account based on contracts. But say you don't work enough to have the employers make enough contributions, you need to pay the difference. Or you don't have insurance. Before obamacare it wasn't like that. We could buy insurance and be reimbursed from our union account that the employers contributed to. Instead of having options to buy insurance from anyone now we have 1 option. My union has over 100000 members and we are afl-cio affiliated.