Amendment No. 4
To the Summary Plan Description of the Southern California IBEW-NECA Health Trust Fund Retiree Health Plan

This Amendment to the Southern California IBEW-NECA Health Trust Fund, Retiree Health Plan Summary Plan Description ("SPD") (restated as of February 1, 2018, 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 the termination of the CIGNA DHMO Plan and the implementation of the upgraded Delta Dental DHMO Plan 40R effective for all claims incurred on and after January 1, 2022.
2. The Board of Trustees has reserved to themselves the ability to amend the SPD from time to time.

NOW THEREFORE, effective January 1, 2022, the SPD is amended as follows:

1. All references in the SPD appearing at Article 8, subsections 8.1 and 8.2, Benefits for Disabled Retirees as of April 1, 2017, Article 9, Important Federal Laws, and Article 10, Plan Amendment Procedures and Disclosure Information, and elsewhere in the SPDare amended by removing "CIGNA DHMO Dental".
2. Article 8.2, Comparison of Dental Benefits, is amended as noted in the updated table set forth below.

   Dental Provider Name	United Concordia	DeltaCare USA 40R	United Concordia
   Plan Type	PPO	DHMO	DHMO
   Member Customer Service	(800) 332-0366	(800) 422-4234	(866) 357-3304
   Website Address	unitedconcordia .com	deltadentalins .com	unitedconcordia .com
   Claims Filing Address Applies to PPO plan only	P.O. Box 69421, Harrisburg, PA. 17106-9421
   Description	MEMBER CO-PAYMENT
   Network	In-Network/ Out-of-Network	In-Network Only	In-Network Only
   Annual deductible
   Per individual	$0/$25	N/A	N/A
   Per family	$0/$75	N/A	N/A
   Annual Maximum Waived for diagnostic and preventive
   Per individual	$5000/$5000	N/A	N/A
   Per family	N/A	N/A	N/A
   Diagnostic/Preventive X-rays, exams, cleanings	0%/0%, plus balance billing	$0	$0
   Basic Fillings, sealants, oral surgery, root canals	5%/20% plus balance billing	$0 (for white fillings)	$0-$140 (for white fillings)
   Major Crowns and casts, dentures, bridges and implants	25%/50% plus balance billing Implants only: 25%/25% plus balance billing	$0 (no added metal fees) (Implants not covered)	$0 ($125 metal fee may apply for noble and/or high noble metals on crowns) (Implants are not covered)
   Emergency Services Emergency exam	0%/0% plus balance billing	$0	$0

All other terms and conditions of the Plan shall remain in full force and effect.

BY: Signature on File
Chairman

BY: Signature on File
Secretary