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Summary Plan Description (SPD)
Definitions
General Plan Definitions
Association
Los Angeles County Chapter of the National Electrical Contractors
Association.
COBRA
The continuation of health care coverage when Plan eligibility coverage
ends as provided for by the Consolidated Omnibus Budget Reconciliation Act
(COBRA) and any changes or amendments to this law which may be enacted by law or
regulation.
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.
Covered Employment
Work at a job for which contributions are required under a Collective
Bargaining Agreement.
Credited hours and/or hours worked means work hours reported under Covered Employment for which contributions are actually received. Contributions for hours worked in Covered Employment received more than three months subsequent to the month in which the hours were actually worked are credited to your hour bank in the month the contributions were received rather than being credited as hours worked in the month the work was actually performed. These delinquent employer contributions are credited to your hour bank because various contracts with service providers prohibit the Fund from providing you with retroactive eligibility. The normal 600 hour limit for your hour bank does not apply to the extent the delinquent hours are credited to your hour bank account.
The term credited hour and/or hours worked also includes any hour that is worked by an Employee for which contributions are paid to a Health Fund which is signatory to the International Brotherhood of Electrical Workers (IBEW) Reciprocal Agreement to the extent such reciprocal contributions are received by this Fund.
Reciprocal contributions and delinquent contributions are converted to hours under this Plan by dividing the monies received by the then existing hourly contribution rate under the IBEW Local 11 Inside-Wiremens' Collective Bargaining Agreement. An example of this calculation is set forth on page 13.
Dependent
This is as defined in this SPD booklet. Refer to table of contents titled "Eligibility & General Plan Provisions" subtitled, "Eligible
Dependents."
Electrician
Includes any Employee who works in any classification covered by a
Collective Bargaining Agreement participating in this Plan, negotiated between a
participating IBEW Local and a participating NECA chapter.
Eligible Employee
An Employee of an Employer (as defined below) who works in Covered
Employment and satisfies the rules of eligibility adopted by the Fund.
Employer
Any individual Employer signatory to any Agreement with the Union and the
Association, which requires contributions by the Employer into this Health Fund.
The term "Employer" also includes the Union and other contributing employers
pursuant to regulations adopted by the Board of Trustees.
Family Member
An Employee or dependent of an Employee.
Fund or Health Fund
The Southern California IBEW-NECA Health Trust Fund.
HMO Hospital/Medical Plan
The Kaiser Foundation Health Plan or PacifiCare of California Plan. Under these
Plans, you must use the doctors and hospitals associated with the HMO Plan you
have selected. Both Kaiser and PacifiCare have special rules for emergency care
obtained outside the HMO. Refer to their specific Evidence of Coverage for
complete details.
Participant
The term "Participant" applies to all individuals who are eligible for
benefits under this Plan. This includes Employees and eligible dependents of
such Employees.
Plan and/or Plan Document
The Southern California IBEW-NECA 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.
Qualifying Event
A qualifying event for continuation coverage occurs when a qualified
beneficiary loses coverage under this Plan for any of the reasons provided by
COBRA. This entitles the qualified beneficiary to continuation coverage by
self-payment.
Self-Funded Hospital/Medical Indemnity Plan
Under this Plan, you and your eligible dependents may go to the doctor of
your choice and the Plan will pay for those services, based on a schedule of
benefits established by the Fund's Trustees, after receipt of a properly
completed claim form. Any differences between what the Fund pays and what is
charged is the participant's responsibility.
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 to 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 Active Health Trust Fund.
Union and/or Local Union
The International Brotherhood of Electrical Workers (IBEW), AFL-CIO, Local
11.