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Summary Plan Description (SPD)
Southern California IBEW-NECA Retiree Health Plan
Amendment # 5
To the Self-Funded Indemnity Plan as Contained
In the Retiree Health Plan Summary Plan Description
Dated October 1, 2006
Effective for prescriptions filled on and after October 1, 2006 the Mandatory Generic Prescription Drug Plan will contain the following co-payments:
|
Co-Payment |
Walk-In Pharmacy Plan |
|
Generic 30-day supply |
$0 |
Brand 30-day supply (no generic equivalent) |
$10 |
Brand 30-day supply (generic equivalent available) |
$10 + ingredient cost differential |
Maintenance Drugs 100-day Supply: |
|
Brand (generic equivalent available) |
$20 + ingredient cost differential |
Mail Service |
|
Maintenance Drugs 100-day Supply: |
|
APPROVED AND ADOPTED at the Board of Trustees’ meeting held on September 18, 2007.
BY: Signature on File
Chairman
BY: Signature on File
Secretary