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Question #1:
How long will the Premium Reimbursement Plan continue?

Answer:
Premium Reimbursement and the prescription drug benefit are provided as part of the Retiree Health Plan. The Retiree Health Plan will continue as long as funds are available. These Plans may be modified or eliminated, including the self-payment, at any time by the Board of Trustees as needed.

Question #2:
Can I choose to cover just myself, or just my spouse?

Answer:
You may choose to cover only yourself (or yourself and your spouse) to receive benefits under the Retiree Health Plan, but you may not choose to cover just your spouse because the rules of the Retiree Health Plan do not allow you to cover your spouse only. If you wish to no longer cover your spouse, you may cancel this coverage by writing to the Administrative Office.

Question #3:
Will my spouse still be covered when I die?

Answer:
Coverage would be made available to your surviving spouse on the same basis as any other widow covered under the Retiree Health Plan at the time of your death. The Administrative Office will provide information on benefits and costs at that time.

Question #4:
What kinds of insurance will the Premium Reimbursement Plan reimburse me for?

Answer:
The Premium Reimbursement Plan will reimburse you for the cost you pay for any kind of private or individual medical insurance, limited to no more than the maximum amount established under the Plan. For example you might buy individual coverage for yourself and your spouse through Blue Cross. Or you might pay part of the cost coverage provided to you by your or your spouse’s employer. The Premium Reimbursement Plan reimburses you for the cost you pay for your health insurance. If you spouse is also enrolled the Premium Reimbursement Plan also reimburses you for the cost you pay for your spouse’s insurance.

Beginning October 1, 2008, the Premium Reimbursement Plan will include within the meaning of “reimbursable health insurance” premiums you pay on and after October 1, 2008 for long-term care insurance. However, in no event with the total reimbursement for any month’s health insurance expense paid by you exceed the maximum monthly amount of reimbursement under the Premium Reimbursement Plan. The Trust Fund determines this maximum amount of reimbursement periodically. The Administrative Office can provide you with advice as to the monthly maximum reimbursement amount in effect from time to time.

Question #5:
What kinds of insurance will the Premium Reimbursement Plan not reimburse me for?

Answer:
The Premium Reimbursement Plan will not reimburse you for any part of the cost of any kind of medical insurance (including long-term care insurance) which is paid for by any other party, such as you or your spouse’s current or former employer. You can only be reimbursed for the cost you pay for such insurance. For example, if a current or former employer provides medical insurance that costs $500 per month and you are required to pay $100 per month toward the cost of that insurance, the most the Plan will reimburse you is $100 (your actual out-of-pocket cost) and not $500 (the cost to your employer to provide the coverage).

Question #6:
What is my prescription drug benefit?

Answer:
Under the Premium Reimbursement Plan, you are entitled to the Prescription Solutions Drug Plan. Refer to the separate section entitled Mandatory Generic Prescription Drug Plan that is listed in the Table of Contents.

Question #7:
How do I file claims in order to be reimbursed under the Premium Reimbursement Plan?

Answer:
Use the claim form provided by the Administrative Office or Allied Administrators. Follow the instruction on completing the claim form, attach copies of your cancelled check or other proof of payment for your private medical insurance, and mail the claim form with all attachments to:

IBEW-NECA Claims Administration
Allied Administrators
2831 Camino del Rio South
Suite 311
San Diego , CA 92108-3829
Telephone: 1-800-736-0401

Upon receipt of a fully completed claim form, Allied will process your claim and issue any reimbursement to which you may be entitled within the time frames established by applicable federal regulations. These timeframes are described on pages 209 – 213 in this Summary Plan Description under the heading “Claims & Appeal Rules.”