Article 1: General Information >>

1.2 Assistance

This booklet contains a summary of your Plan rights and benefits under the Southern California IBEW-NECA Health Trust Fund. It is also part of the Plan document. The Plan is set out in this document and in all of the documents listed in the section titled “Governing Benefit Documents” below.

If you have difficulty understanding any part of the Summary Plan Description, or if you have any questions, please contact the Administrative Office for assistance. We are here to help you obtain all of the benefits to which you may be entitled. Below is the necessary information to contact us.

Southern California IBEW-NECA Health Trust Fund
Administrative Office
100 Corson Street, Suite 200
Pasadena, CA 91103
(323) 221-5861
(800) 824-6935 – Toll-free Nationwide
(323) 726-3520 – Fax
www.scibew-neca.org

Office Hours: Monday through Friday, 8:30 a.m. - 5:30 p.m., excluding holidays.

A. Governing Benefit Documents

The extent of each Active Participant's benefits is governed by the complete terms of the Southern California IBEW-NECA Health Trust Fund Plan Documents, the Evidence of Coverage, Summary of Benefits and Coverage, Insurance Contracts, and Agreements issued to the Trust Fund by the Kaiser Permanente Foundation Health Plan Inc., Southern California Region, UnitedHealthcare of California, Anthem Blue Cross of California, Delta Dental of California, United Concordia, and Vision Service Plan, and any rules and regulations for eligibility which the Trustees may adopt from time to time. This booklet describes these benefits in general terms. If there is any difference between this booklet and the Insurance Contracts, the Evidence of Coverage documents, and Agreements issued by any of the above providers, the terms and conditions of the Evidence of Coverage, Insurance Contracts or Agreements shall prevail. The Summary of Benefits and Coverage documents are distributed to Participants based upon their enrollment in the Plan. The other documents are available at the Administrative Office, or on the Trust’s website, www.scibew-neca.org.

B. Keep Your Records Current

Notify the Administrative Office immediately in writing of any change of address or if you have a change of dependents. Failure to notify the Administrative Office promptly may result in ineligibility for proper benefits or liability for benefits erroneously paid.
For example:

• You get married
• You have a new baby, adopt or become a legal guardian of a child
• You get divorced
• The death of an eligible dependent

Refer to Article 4.10 Eligible Dependents for further information.

C. Appeals

Any appeals related to insured benefits are handled directly by the respective insurance company. Please refer to the insurance vendor’s Evidence of Coverage booklet for the claims and appeals procedures pertaining to each benefit plan.

The Fund Office makes all initial determinations as to basic eligibility under Article 4: Eligibility and General Plan Provisions, COBRA and comparable eligibility provisions of this document. Appeals of denial of eligibility by the Fund Office are handled by the Board of Trustees upon timely notification to the Administrative Office. Individuals will be notified in writing of all adverse determinations as to eligibility and appeal decisions within the time required by federal law and regulations.

Coast Benefits, Inc. is a claims fiduciary and handles all Medical Body Scan claims, Specialized Footwear claims and Health Reimbursement Arrangement claims under its claims and appeal rules. In the event that a claim is denied based upon a lack of medical necessity and an appeal brought, Coast Benefits, Inc. will use an IMR company licensed in the State of California for any appeals related to medical necessity issues. Participants will be notified in writing of any adverse determinations within the time required by federal law and regulations.

For more information on appeals, see Article 17.2 Claims and Appeal Rules.