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Summary Plan Description (SPD)
Introduction
You are eligible for benefits under the Integrated Member Assistance Program and Mental Health & Chemical Dependency Benefits Program as described herein, if you meet the eligibility requirements for a retiree under the Southern California IBEW-NECA Retiree Health Plan, and are enrolled in the PacifiCare HMO Plan.
This Program provides benefits only for the specific Mental Health & Chemical Dependency benefits described below. The Program requires that all benefits be pre-authorized by PacifiCare Behavioral Health (PBH).
This is a Managed Care Program, and PBH will refer you, when appropriate, to a PBH provider or facility that is under contract with PBH, called an In-Network Provider or Facility. For example, there are no benefits provided for any inpatient mental health or chemical dependency benefits unless the treatment plan is authorized in advance by PBH, and the authorized treatment is provided by an In-Network PBH contracted facility.
By having your care managed by PBH, you will be assured of receiving the treatment best suited to your particular problem. In addition, managed care means that the length and quality of treatment is monitored in order to curb any claim abuses.
| Kaiser participants are eligible for benefits under the Member Assistance Program (MAP). Mental Health and Chemical Dependency benefits are available only at Kaiser. Kaiser participants should refer to their Kaiser-provided literature for a complete explanation of benefits. |
All rules, regulations, and eligibility requirements, as contained in the Summary Plan Description (SPD), apply to retiree participants covered under this Program. For example, if you have any questions about how you become eligible for Program benefits or what the definition of "eligible dependents" is, refer to table of contents "Plan Benefits Available to You". If you have an appeal, for example, you dispute the benefit allowance under this Program, refer to table of contents "Disclosure Information" subtitled "Claims Review and Appeals Procedure" for an explanation of "Request for Reconsideration of Denial and Appeals Procedures."
If you have any questions concerning your eligibility for benefits under this Program, or your entitlement to benefits, contact the Administrative Office. The address and phone number are as follows:
Administrative Office
Southern California IBEW-NECA Trust
Fund
6023 Garfield Ave.
Commerce, CA 90040
Mailing Address
PO Box 910918
Los Angeles, CA 90091
Phone: (323) 221-5861 or (800) 824-6935