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Summary Plan Description (SPD)
TERMINATION OF COVERAGE FOR RETIREE
Voluntary Termination
At any time, you can terminate your participation in the Retiree Health Plan. To terminate your coverage, you must give the Administrative Office 30 days advance notice, in writing. Once terminated, however, you will not be permitted to re-enroll in the Retiree Health Plan.
If you terminate your retiree coverage, such action will also automatically terminate coverage under this Plan for your spouse.
If you request termination, the coverage will end on the last day of the month following the completion of a 30-day period beginning on the date the Administrative Office received your notice. For example, if they received your letter on May 15, the 30-day period would end on June 14, and the coverage would end at midnight on June 30. When your coverage ends, the monthly co-payment will no longer be deducted from your pension check.
Required Termination
Certain circumstances can require the termination or reduction of your retiree health coverage. For example, the Board of Trustees may end or reduce benefits or your pension benefits may be suspended. Coverage will end or be reduced on the earlier of the following dates.
- The date benefits under this Retiree Health Plan are terminated or reduced by the Board of Trustees.
- The last day of the month preceding the month in which any portion of your pension benefit is suspended by the Pension Plan. (For example, if you will no longer receive pension benefits in June, May 31 is the last day of your health coverage.)
- The first day of the next calendar month following the date in which you commence any work in Non-Covered Electrical Employment, as that term is defined under the terms of the Southern California IBEW-NECA Pension Plan. In such event, your eligibility and your spouse’s eligibility shall terminate as set forth above and no reinstatement of eligibility shall occur unless otherwise permitted by the Plan. If you and your spouse lose eligibility pursuant to this Section, the Trust will offer you non-subsidized COBRA coverage and conversion rights to the extent required by applicable law.
SPECIAL RULE FOR MEDICARE “DOUBLE COVERAGE” MEMBERS
Commencing August 1, 2008 Medicare advised the HMOs that a Medicare eligible retiree and/or spouse could not be enrolled in two Health Plans. This most frequently occurs when a retiree and spouse both receive retiree coverage from different Health Plans due to prior employment and each is enrolled in the other’s Plan as a dependent. Medicare is applying this restriction even when all enrollment is in a single HMO. Retirees and/or spouses who are in such a, “double coverage” situation will be advised by their HMO or Medicare they must terminate coverage under one Health and Welfare Plan and elect coverage under the other Health and Welfare Plan. If the retiree and/or spouse fail to make the election the HMO will terminate their coverage under one Health and Welfare Plan. This special rule is adopted due to Medicare’s actions. It provides an exception to the general eligibility rule that termination of participation in the Retiree Plan prohibits any later re-enrollment. All of the following seven conditions must be met in order for a right to re-enrollment to exist.- The Medicare Retiree and/or Spouse must have been enrolled in this Retiree Plan.
- The Medicare Retiree and/or Spouse must have received a “Double Coverage Notice” from their HMO or Medicare.
- The Medicare Retiree and/or Spouse must have, in response to the Notice, elected to terminate coverage under this Retiree Plan or had such coverage terminated by their HMO or Medicare.
- The Medicare Retiree and/or Spouse must have continued coverage under the other Health Plan.
- The Medicare Retiree and/or Spouse must have subsequently lost coverage under the other Health Plan.
- The Medicare Retiree and/or Spouse within 30 days of loss of coverage under the other Health Plan re-enrolls in this Retiree Plan.
- The Medicare Retiree and/or Spouse must submit with their re-enrollment application written proof of conditions (1) thru (6) set forth above.