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Retiree Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Retiree Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.

Early Retirees (Under Age 62 and not eligible or enrolled in Medicare) - General Features
 
Calendar Year Deductible $500 per Individual
$1,000 per Family
Maximum Benefits Unlimited
Annual Co-Payment Maximum $4,500 per Individual
$9,000 per Family
Hospital Benefits 80% after deductible has been met
Emergency Services
Co-payment waived if admitted
$100 co-payment; deductible does not apply
Urgently Needed Services
Medically Necessary services required outside geographic area service by Primary Medical Group
$50 co-payment; deductible does not apply
Pre-existing Conditions All Medically Necessary conditions are covered provided they are a covered benefit.
Additional Information
 
Member Customer Service Number Northern California
(800) 624-8822

Out-of-state
(866) 633-2446
Website www.myuhc.com
Evidence of Coverage (EOC) Out of Area Plan – UnitedHealthcare Choice Plan Group #902027 – Early Retirees