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Summary Plan Description (SPD)
Southern California IBEW-NECA Retiree Health Plan
Amendment #7
To the Kaiser Permanente HMO Medical Plan for Early Retirees
As Set Forth in the
Retiree Health Plan Summary Plan Description
Dated October 1, 2006
Effective for prescriptions filled on or after February 1, 2008 the benefits for prescription drug coverage provided under the Kaiser Permanente HMO Medical Plan for Early Retirees are changed. Accordingly page 55 of the Southern California IBEW-NECA Retiree Health Plan Summary Plan Description dated October 1, 2006 is deleted in its entirety and replaced with the following page:
| Service | Co-payment |
Anesthesia, prescribed drugs, and medical supplies |
No charge |
Blood, blood products, and their administration |
No charge |
Respiratory therapy |
No charge |
Ambulance Co-payment |
|
Ambulance services and supplies |
No charge |
Prescription Drug Coverage |
|
Most covered outpatient items in accord with our drug formulary when obtained at Plan Pharmacies: |
|
Generic Items |
$0 for up to a 100-day supply |
Brand name Items |
$10 for up to a 100-day supply |
Chemical Dependency Services |
|
Inpatient detoxification |
No charge |
Outpatient individual therapy visits |
$15 per visit |
Outpatient group therapy visits |
$5 per visit |
Transitional residential recovery services (up to 60 days per calendar year, not to exceed 120 days in any five year period) |
$100 per admission |
Dialysis Care |
|
Inpatient care |
No charge |
Physician office visits |
$15 per visit |
Dialysis treatment visits |
$15 per visit |
Durable Medical Equipment |
|
Durable medical equipment |
No charge |
Family Planning |
|
All services related to family planning |
$15 per visit |
Health Education |
|
Education for specific conditions:
|
$15 per visit |
Education not addressed to a specific condition |
Charges vary |
Health education publications |
No charge |
Hearing |
|
Hearing tests |
$15 per visit |
Home Health Care |
|
Covered home health care, including physical, occupational, and speech therapy |
No charge |
Hospice Care |
|
Covered hospice care |
No charge |
APPROVED AND ADOPTED at the Board of Trustees' meeting held on November 20, 2007.
BY: Signature on File
Chairman
BY: Signature on File
Secretary