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Active Health Summary Plan Description
As of July 1, 2022
En Español (PDF)

AMENDMENT NO. 1
TO THE SUMMARY PLAN DESCRIPTION OF THE SOUTHERN CALIFORNIA IBEW-NECA HEALTH TRUST FUND ACTIVE HEALTH PLAN
(RESTATED AS OF JULY 1, 2022)

This Amendment to the Southern California IBEW-NECA Health Trust Fund, Active Health Plan Summary Plan Description (“SPD”) (restated as of July 1, 2022, as amended) is made by the Board of Trustees of the Southern California IBEW-NECA Health Trust Fund (“Board of Trustees”) with reference to the following facts and circumstances:

  1. The Board of Trustees wishes to amend the SPD to reflect an increase to the frame and lens allowances under the in-network Vision Service Plan (VSP) benefits. The VSP allowance was increased from $150 on frames to $180 for in-network providers and from $130 to $150 on elective contact lenses for in-network providers. The VSP LightCare Benefit was added allowing participants to use their frame allowance towards non-prescription sunglasses or non-prescription blue light filtering glasses.
  2. The Board of Trustees has reserved to themselves the ability to amend the SPD from time to time.

NOW THEREFORE, effective January 1, 2023, Article 9, Vision Benefits, section 9.2 of the SPD, the Co-Payments and Schedule of Benefits is amended as follows:

9.2 Co-Payments and Schedule of Benefits

Anthem Blue Cross and UnitedHealthcare Plan Participants

Benefit

Frequency
(Based on service year)

Co-payment

Coverage from
a VSP doctor

Out-of-Network
Reimbursement

Exam

12 months

$5

Covered in full after the co-payment.

Up to $45 allowance

Prescription Eyewear and VSP LightCare1– If you choose contact lenses you will be eligible for frame 12 months from the date the contact lenses were obtained.

Lenses

12 months

$10 (lenses and/or frame)

Single vision, lined bifocal and lined trifocal lenses are covered in full after the co-payment.

Single vision up to $45 allowance. Lined bifocal up to $65 allowance. Lined trifocal up to $85 allowance

Frame
as provided by VSP

24 months

$10 (lenses and/or frame)

Covered up to $180 allowance

Up to $47 allowance

Contact Lenses2

12 months

 

Covered in full for medically necessary allowance, $150 allowance for Elective
Contact lenses

Up to $210 allowance for medically necessary and $105 for Elective Contact lenses

  1. VSP LightCare benefit allows participants to use the frame allowance towards non-prescription sunglasses or non-prescription blue light filtering glasses .
  2. Your allowance applies to the cost of your contact lens exam and your contact lenses. You'll receive a 15 percent savings off the cost of your contact lens exam from a VSP doctor. Your contact lens exam is in addition to your routine eye exam to check for eye health risks associated with improper wearing or fitting of contacts. You may get regular glasses (frames and lenses) twelve months after you get contact lenses.

Kaiser Vision Plan

Vision Benefit

Co-pay/ Allowance

Eye refraction exams to determine the need for vision correction and to provide a prescription for eyeglasses

$5 per visit

Regular plastic eyeglass lenses every 24 months

$150 Allowance*

An eyeglass frame every 24 months

Medically necessary contact lenses

No charge

*An allowance is the total expenses of an item that is covered. If the cost of the item you select exceeds the allowance, you must pay the difference.

  1. All other terms and conditions of the Summary Plan Description and Plan, shall remain in full force and effect.

Executed this 4th day of August 2022 at Pasadena, California.

BY: Signature on File
Chairman

BY: Signature on File
Secretary