Disclosure Information

Also In This Section:

• Claims & Appeal Rules
• Pre-Service Claims
• Post-Service Claims: Prescription Drug Benefits
• Eligibility Issues
• Exhaustion of the Appeal Process
• Some Questions Common to all Claims and Appeals

As Required by the Employee Retirement Income Security Act of 1974 (ERISA)

1. Name and type of administration of the Plan:
   The name of the Plan is the Southern California IBEW-NECA Health Trust Fund. The Plan is administered by the Board of Trustees of the Southern California IBEW-NECA Health Trust Fund, a collectively bargained, jointly-trusteed labor-management Trust Fund.
   
   
2. Name and address of the person designated as agent for the service of legal process:
   Joanne M. Keller, Administrator
   6023 Garfield Avenue
   Commerce, CA 90040
   (Service of legal process may also be made upon any Trustee)
   
   
3. Administrative Office of the Plan Administrator:
   6023 Garfield Avenue
   Commerce, CA 90040
   Administrator: Joanne M. Keller
   
   
4. Names, titles, and addresses of the Trustees:
   
   View an updated list of Trustees >>
    
   
5. Source of financing of the Plan and identity of any of the organizations through which benefits are provided:
   Payments are made to the Trust by individual Employers under the provision of the applicable Collective Bargaining Agreements and self-payments are required for participation in the Retiree Health Plan.
   
   The Trustees provide a choice of hospital/medical programs.
   
   The following organizations provide benefits by virtue of contracts with the Board of Trustees as follows:
   
   Kaiser Foundation Health Plan, Inc. – HMO Hospital/Medical Benefits
   UnitedHealthcare of California – HMO Hospital/Medical Benefits
   Citizen's Rx – Self-Funded Prescription Drug Benefits
   CIGNA – DHMO Dental Benefits
   Delta Dental (DeltaCare USA) - DHMO Dental Benefits
   United Concordia – PPO AND DHMO Dental Benefits
   Vision Service Plan – Vision Benefits
   MedExpert – Advocacy and Assistance Services
   
   
6. Date of the end of the Plan Year: June 30
   
   
7. Internal Revenue Service Plan Identification Number: No. 95-6140101
   
   
8. A description of the relevant provisions of any applicable collective bargaining agreement:
   The Plan is maintained pursuant to Collective Bargaining Agreements between Local #11 of the International Brotherhood of Electrical Workers, AFL-CIO and the L.A. County Chapter of the National Electrical Contractors Association. Copies of Collective Bargaining Agreements may be obtained by Plan participants from the Union or Administrative Office without charge upon written request. Additionally, Collective Bargaining Agreements may be examined by Plan participants at the Administrative Office of the Trust Fund during regular business hours.
   
   
9. Remedies available under the Plan for the redress of claims, which are denied in whole or in part, including provisions required by Section 503 of Employee Retirement Income Security Act of 1974: