Southern California IBEW-NECA Retiree Health Plan

Amendment # 13
To the Premium Reimbursement Plan And
The Medicare Supplement Plan for Retirees As Set Forth in the
Retiree Health Plan Summary Plan Description

Dated October 1, 2006

Effective for claims filed on or after October 1, 2008 under the Medicare Supplement Plan and the Premium Reimbursement Plan, Allied Administrators shall process reimbursements upon receipt of a fully completed claim form documenting either the member’s payment of the premium for private medical insurance or documenting the member’s eligible out-of-pocket expenses as indicated by the member’s Explanation of Medicare Benefits statement. Reimbursements shall be processed within the time frames required under applicable federal regulations. Additionally the scope of coverage provided under the Premium Reimbursement Plan is expanded to provide reimbursement for the member’s cost of a long-term care insurance policy where such costs are incurred and paid on or after October 1, 2008. Accordingly pages 18, 23, 52-53B and 109 of the Southern California IBEW-NECA Retiree Health Plan Summary Plan Description dated October 1, 2006 are deleted in their entirety and replaced with the pages 18, 23, 52 – 53B and 109 following this page.

APPROVED AND ADOPTED at the Board of Trustees’ meeting held on September 10, 2008.

Page 18

BRIEF SUMMARY COMPARISON OF RETIREE HEALTH PLAN BENEFITS

Early Retirees

Secure Horizons & Senior Advantage Retirees  

Medicare Supplement Plan:
An alternate to choosing one of the HMO plans above is a supplement plan for Parts A and B of Medicare.

Premium Reimbursement Plan:
Individuals who live outside the HMO service area or reject HMO coverage are eligible to participate in the Premium Reimbursement Plan. There are two benefits:

1. Periodic reimbursement of an amount equal to the lesser of your cost of your private medical insurance or a specified maximum, based on the lowest cost early retiree HMO premium available under the Plan. This maximum reimbursement amount is generally adjusted each October 1.
2. Prescription drugs through the Mandatory Generic Prescription Drug Plan - 30-day Walk-in $0 Generic/$10 Brand and Mail Order 100-day - $0 Generic/$10 Brand.

Page 23

Medicare Supplement Plan:
This Plan pays the annual Medicare deductibles, and the 20% not covered by Medicare, up to an annual Plan reimbursement of $2,500. The $2,500 maximum applies separately to retiree and spouse.

PacifiCare:
PacifiCare is a Health Maintenance Organization (HMO) that contracts with hospitals and doctors to provide medical care. For participants enrolled in Parts A and B of Medicare, coverage is provided by PacifiCare’s Secure Horizons.

Participant:
The term "Participant" applies to all Retirees who are eligible for benefits under this Plan. This includes Retirees and eligible spouses of such Retirees.

Plan and/or Plan Document:
The Southern California IBEW-NECA Retiree Health Plan as created pursuant to the Collective Bargaining Agreements and the Declaration of Trust, and any modification, amendment, extension, or renewal of said Plan.

Premium Reimbursement Plan:
The Premium Reimbursement Plan is for those retirees who live outside the HMO service area or retirees who do not wish to elect an HMO under contract with the Retiree Health Plan. The Plan provides an option to obtain private medical insurance (including long-term care insurance) and receive a limited dollar reimbursement from the Retiree Health Plan for your cost of your private medical insurance as otherwise described in this Plan.

Qualifying Event:
A qualifying event for continuation coverage occurs when coverage is lost for any reason other than non-covered electrical employment. This entitles the qualified beneficiary to continuation coverage by self-payment.

Retiree or Eligible Retiree:
A Retiree who qualifies under the rules of the Southern California IBEW-NECA Retiree Health Plan, and meets all of the following requirements;

• Fulfills all of the eligibility rules as listed under the section entitled “Eligibility Requirements”.
• Authorizes the required monthly self-payment to be deducted from the retiree’s monthly pension check from the Southern California IBEW-NECA Pension Plan, except for maintenance work or work expressly permitted under the rules and regulations as may be promulgated by the Board of Trustees.
• No longer works in “active employment” in the jurisdiction of the Southern California IBEW-NECA Pension Plan, except for maintenance work or work expressly permitted under the rules and regulations as may be promulgated by the Board of Trustees.

Page 52-53B

MEDICARE SUPPLEMENT PLAN FOR RETIREES/SPOUSES

When you become 65 or eligible for Medicare, you must enroll in the Federal Medicare Program. Your spouse must enroll as soon as eligible. The Medicare Supplement Plan then provides a reimbursement to the benefits you are entitled to under Medicare, subject to a maximum payment of $2,500 per person (employee or spouse) per year. The Medicare Supplement Plan also provides prescription drug coverage under the “Mandatory Generic Prescription Drug Plan”.

PREMIUM REIMBURSEMENT PLAN

The Premium Reimbursement Plan is for those retirees who live outside of the HMO service area; or who choose not to elect coverage with an HMO under contract with the Retiree Health Plan; or who choose not to elect coverage under the Medicare Supplement Plan. The Premium Reimbursement Plan provides an option to obtain private medical insurance (including long-term care insurance) on your own and receive a limited dollar reimbursement from the Retiree Health Plan for your cost of your private medical insurance. The Premium Reimbursement Plan also provides prescription drug benefits under the “Mandatory Generic Prescription Drug Plan”. It offers retirees participating in the Retiree Health Plan the following three benefits:

• Prescription Drug Plan
  You and your spouse, if covered, have prescription drug benefits with Prescription Solutions. Refer to the section entitled “Mandatory Generic Prescription Drug Plan”.
• Periodic Reimbursement of Your Cost of Your Private Medical Insurance
  You receive reimbursement upon submission of a fully completed claim form showing that you have paid for a private plan of medical insurance. Reimbursement is based on the lesser of:
  1. Lowest Trust Early Retiree HMO Plan cost per person; or
  2. The cost to you of your private medical insurance (including premiums for long-term care insurance).
• Future HMO Enrollment if Outside Service Area of HMOs. If you remain a participant in the voluntary Retiree Health Plan, you would later be eligible to enroll in one of the Health Maintenance Organizations (HMOs) offered (Kaiser Permanente/Senior Advantage or PacifiCare Secure Horizons) if you move into the service area of any of the HMO Plans. Also, when you (and your eligible spouse) receive Medicare benefits, either by reaching age 65 or from the Social Security Disability Benefits, you would become eligible to participate in the Medicare Supplement Plan, which is available regardless of where you live in the United States. This Plan reimburses you for the annual Medicare deductible and the 20% of charges not paid by Medicare, up to an annual maximum payment of $2,500 for you and $2,500 for your spouse (if eligible).

QUESTIONS AND ANSWERS ABOUT THE PREMIUM REIMBURSEMENT PLAN

Question #1:
How long will the Premium Reimbursement Plan continue?

Answer:
Premium Reimbursement and the prescription drug benefit are provided as part of the Retiree Health Plan. The Retiree Health Plan will continue as long as funds are available. These Plans may be modified or eliminated, including the self-payment, at any time by the Board of Trustees as needed.

Question #2:
Can I choose to cover just myself, or just my spouse?

Answer:
You may choose to cover only yourself (or yourself and your spouse) to receive benefits under the Retiree Health Plan, but you may not choose to cover just your spouse because the rules of the Retiree Health Plan do not allow you to cover your spouse only. If you wish to no longer cover your spouse, you may cancel this coverage by writing to the Administrative Office.

Question #3:
Will my spouse still be covered when I die?

Answer:
Coverage would be made available to your surviving spouse on the same basis as any other widow covered under the Retiree Health Plan at the time of your death. The Administrative Office will provide information on benefits and costs at that time.

Question #4:
What kinds of insurance will the Premium Reimbursement Plan reimburse me for?

Answer:
The Premium Reimbursement Plan will reimburse you for the cost you pay for any kind of private or individual medical insurance, limited to no more than the maximum amount established under the Plan. For example you might buy individual coverage for yourself and your spouse through Blue Cross. Or you might pay part of the cost coverage provided to you by your or your spouse’s employer. The Premium Reimbursement Plan reimburses you for the cost you pay for your health insurance. If you spouse is also enrolled the Premium Reimbursement Plan also reimburses you for the cost you pay for your spouse’s insurance.

Beginning October 1, 2008, the Premium Reimbursement Plan will include within the meaning of “reimbursable health insurance” premiums you pay on and after October 1, 2008 for long-term care insurance. However, in no event with the total reimbursement for any month’s health insurance expense paid by you exceed the maximum monthly amount of reimbursement under the Premium Reimbursement Plan. The Trust Fund determines this maximum amount of reimbursement periodically. The Administrative Office can provide you with advice as to the monthly maximum reimbursement amount in effect from time to time.

Question #5:
What kinds of insurance will the Premium Reimbursement Plan not reimburse me for?

Answer:
The Premium Reimbursement Plan will not reimburse you for any part of the cost of any kind of medical insurance (including long-term care insurance) which is paid for by any other party, such as you or your spouse’s current or former employer. You can only be reimbursed for the cost you pay for such insurance. For example, if a current or former employer provides medical insurance that costs $500 per month and you are required to pay $100 per month toward the cost of that insurance, the most the Plan will reimburse you is $100 (your actual out-of-pocket cost) and not $500 (the cost to your employer to provide the coverage).

Question #6:
What is my prescription drug benefit?

Answer:
Under the Premium Reimbursement Plan, you are entitled to the Prescription Solutions Drug Plan. Refer to the separate section entitled Mandatory Generic Prescription Drug Plan that is listed in the Table of Contents.

Question #7:
How do I file claims in order to be reimbursed under the Premium Reimbursement Plan?

Answer:
Use the claim form provided by the Administrative Office or Allied Administrators. Follow the instruction on completing the claim form, attach copies of your cancelled check or other proof of payment for your private medical insurance, and mail the claim form with all attachments to:

IBEW-NECA Claims Administration
Allied Administrators
2831 Camino del Rio South
Suite 311
San Diego , CA 92108-3829
Telephone: 1-800-736-0401

Upon receipt of a fully completed claim form, Allied will process your claim and issue any reimbursement to which you may be entitled within the time frames established by applicable federal regulations. These timeframes are described on pages 209 – 213 in this Summary Plan Description under the heading “Claims & Appeal Rules.”

Page 109

2. Use the Medicare Supplement claim form when submitting bills and claims to the Administrative Office for payment.
3. Complete parts One and Two of the Medicare Supplement Claim form.
4. Attach all Explanation of Medicare Benefit forms to the claim form.
5. Date and sign the claim form, keep the bottom portion of the claim form (Part Two) for your own personal records.
6. Claim forms should be mailed to the following:
   IBEW-NECA Claims Administration
   Allied Administrators
   2831 Camino del Rio South
   Suite 311
   San Diego , CA 92108-3829
   Telephone: 1-800-736-0401

Upon receipt of a fully completed claim form, Allied will process your claim and issue any reimbursement to which you may be entitled within the time frames established by applicable federal regulations. These timeframes are described on pages 209 – 213 in this Summary Plan Description under the heading “Claims & Appeal Rules.”

Note: Send in no more than one claim form per month, with all claims for both retiree and spouse listed on the same claim form.

BY: Signature on File
Chairman

BY: Signature on File
Secretary