IBEW-NECA

Association:
Los Angeles County Chapter of the National Electrical Contractors Association.

Calendar Year:
The annual period commencing on the 1^st day of January each year and concluding on the 31^st day of December next following.

Collective Bargaining Agreement:
Any Agreement between the NECA and the Union which requires contributions into this Health Fund and any other Collective Bargaining Agreement requiring contribution to the Health Fund approved by the Board of Trustees.

Contribution:
The payment made or to be made to the Fund by any Individual Employer under the provisions of any of the Collective Bargaining Agreements. The term "Contribution" shall also include a payment made on behalf of an Employee of a Local Union or other contributing employer pursuant to regulations adopted by the Board of Trustees.

Co-payments:
Any amounts charged to a retiree or spouse by the HMO at the time of service for covered benefits.

Covered Charges or Covered Expenses:
Expenses incurred for benefits provided by the Plans and that are reimbursable by the individual Plans. Plan benefits (all Plans described herein) are not guaranteed and may be changed or eliminated at any time by the Board of Trustees.

Covered Employment:
Work at a job for which contributions are required under a Collective Bargaining Agreement.

Eligible Spouse or Dependent Spouse:
An individual meeting the definition in this Summary Plan Description under the Heading of "Eligible Spouse".

Eligible Employee:
An employee of an employer who worked in Covered Employment and satisfied the Plan’s rules of eligibility as forth in the Retiree Health Plan.

Employer:
Any individual employer signatory to an agreement with the Union and the Association which requires contributions by the employer into this Health Fund. The term "Employer" also includes the Union, the Southern California IBEW-NECA Trust Funds, or other participating employers as specifically permitted to participate pursuant to Agreements accepted by the Board of Trustees.

HMO Hospital/Medical Plan:
The Kaiser Permanente Foundation Health Plan and Senior Advantage, PacifiCare of California and Secure Horizons are HMO Plans. An HMO is a group of healthcare providers who have contracted with the Retiree Health Plan to provide medical services at a pre-determined cost. Under these plans, with the exception of certain life-threatening emergency medical services, you must use the doctors and hospitals associated with the individual HMO Plan to receive benefits. The HMOs maintain strict guidelines for emergency medical services. Please refer to the HMO descriptive literature and other documents provided to you by the HMO you have selected.

Illness:
Illness is a bodily sickness, disorder or disease of an eligible retiree or eligible spouse.

Injury:
Physical damage to an eligible retiree’s or eligible spouse’s body caused by an accident independent of all other causes. Only injuries, which are not employment related, are considered for benefits under any of the Plans described in the Summary Plan Description.

Kaiser Permanente:
Kaiser Permanente Foundation Health Plan is a Health Maintenance Organization (HMO) that owns its own clinics and hospitals and in certain geographic areas contracts with doctors and hospitals. For participants enrolled in Parts A and B of Medicare, coverage is provided by Kaiser Permanente's Senior Advantage Medicare program.

Medicare:
Title XVIII of the Social Security Act (Federal Health Insurance for the Aged) as it is now enacted or as it may be amended.

Medicare Supplement Plan:
This Plan pays the annual Medicare deductibles, and the 20% not covered by Medicare, up to an annual Plan reimbursement of $2,500. The $2,500 maximum applies separately to retiree and spouse.

PacifiCare:
PacifiCare is a Health Maintenance Organization (HMO) that contracts with hospitals and doctors to provide medical care. For participants enrolled in Parts A and B of Medicare, coverage is provided by PacifiCare’s Secure Horizons.

Participant:
The term "Participant" applies to all Retirees who are eligible for benefits under this Plan. This includes Retirees and eligible spouses of such Retirees.

Plan and/or Plan Document:
The Southern California IBEW-NECA Retiree Health Plan as created pursuant to the Collective Bargaining Agreements and the Declaration of Trust, and any modification, amendment, extension, or renewal of said Plan.

Premium Reimbursement Plan:
The Premium Reimbursement Plan is for those retirees who live outside the HMO service area or retirees who do not wish to elect an HMO under contract with the Retiree Health Plan. The Plan provides an option to obtain private medical insurance (including long-term care insurance) and receive a limited dollar reimbursement from the Retiree Health Plan for your cost of your private medical insurance as otherwise described in this Plan.

Qualifying Event:
A qualifying event for continuation coverage occurs when coverage is lost for any reason other than non-covered electrical employment. This entitles the qualified beneficiary to continuation coverage by self-payment.

Retiree or Eligible Retiree:
A Retiree who qualifies under the rules of the Southern California IBEW-NECA Retiree Health Plan, and meets all of the following requirements;

Fulfills all of the eligibility rules as listed under the section entitled “Eligibility Requirements”.
Authorizes the required monthly self-payment to be deducted from the retiree’s monthly pension check from the Southern California IBEW-NECA Pension Plan, except for maintenance work or work expressly permitted under the rules and regulations as may be promulgated by the Board of Trustees.
No longer works in “active employment” in the jurisdiction of the Southern California IBEW-NECA Pension Plan, except for maintenance work or work expressly permitted under the rules and regulations as may be promulgated by the Board of Trustees.

Secure Horizons:
Secure Horizons is a division of PacifiCare, an HMO. It contracts with hospitals and doctors to provide medical care to those participants enrolled in Parts A and B of Medicare.

Self-Payment:
A payment by a retiree or widow of a retiree required to maintain Plan coverage. The self-payment is either deducted monthly from the retiree’s or widow’s Southern California IBEW-NECA pension check OR by monthly health benefit payment made to the Southern California IBEW-NECA Health Plan by the 15^th of the month immediately preceding coverage effective month. (i.e. Coverage month January; payment must be received by December 15^th.) This amount varies and is subject to change (usually on an annual basis) upon review by the Board of Trustees

Senior Advantage:
Senior Advantage is the Kaiser Permanente's Medicare Advantage plan for people with Medicare parts A and B.

Summary Plan Description and/or SPD:
This document, distributed to the Southern California IBEW-NECA HealthTrust Fund participants, which contains all or substantially all of the information the average participant would deem crucial for a knowledgeable understanding of his benefits and the circumstances that may disqualify a participant from securing those benefits under the Plan.

Trust Agreement:
The Agreement and Declaration of Trust establishing the Southern California IBEW-NECA Health Trust Fund and any modification, amendment, extension, or renewal thereof.

Trustee and/or Board of Trustees:
As defined in the Agreement and Declaration of Trust establishing the Southern California IBEW-NECA Retiree Health Trust Fund.

Union and/or Local Union:
The International Brotherhood of Electrical Workers (IBEW), AFL-CIO, Local 11.

General Plan Definitions