- News
- Active Health
- Retiree Health
- DB Pension
- Defined Benefit Plan
- Benefit Tabs™
- SPD
- Plan Document
- FAQs
- Forms
- Life Events
- Links
- DC Pension
- Defined Contribution Plan
- SPD
- Plan Document
- Forms
- Life Events
- Links
- SUB Plan
- Supplemental Unemployment Benefit Plan
(IBEW Local 11 and LA NECA only) - Benefit Tabs™
- SPD
- FAQs
- Forms
- Life Events
- Supplemental Unemployment Benefit Plan
- Contact
New Participant Portal
You can enroll for the new Participant Portal experience. Click here for instructions on how to access the new Participant Portal.
Register for New Participant PortalActive Health Summary Plan Description
As of July 1, 2022
En Español (PDF)
AMENDMENT NO. 2
TO THE SUMMARY PLAN DESCRIPTION OF THE SOUTHERN CALIFORNIA IBEW-NECA HEALTH TRUST FUND ACTIVE HEALTH PLAN
(RESTATED AS OF JULY 1, 2022)
This Amendment to the Southern California IBEW-NECA Health Trust Fund, Active Health Plan Summary Plan Description ("SPD") 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:
- The Board of Trustees wishes to amend the SPD to reflect the following changes to the Anthem Blue Cross PPO and United Healthcare HMO Plans.
Anthem Blue Cross- Annual Copayment Maximum –Increase to $2,500 per individual and $5,000 per family.
- Calendar Year Deductible – Increase to $1,000 per individual and $3,000 per family.
- Co-Insurance – Increase the out-of-network coinsurance to 70%/30%.
- Prescription Drug Copayments – Increase the prescription drug copayments to $10 per generic retail prescription up to 30-day supply and $20 per brand-name prescription, 30-day fill. $20 generic through mail order service up to 90-day supply and $40 brand name through mail order service up to 90-day supply.
- Annual Copayment Maximum –Increase to $2,500 per individual and $5,000 per family.
- Emergency Services – Increase to $250 per visit.
- Hospital Admission Copayment – Increase to $250 per admission.
- Appointments/Services other than PCP Visits (specialty services) – change to $5 per visit for most primary care visits; $25 per visit for most physician specialist visits.
- Prescription Drug Copayments – Increase the prescription drug copayments to $10 per generic retail prescription up to 30-day supply and $20 per brand-name prescription per 30-day supply. $20 generic through mail order service up to 90-day supply and $40 brand name through mail order service up to 90-day supply.
- The Board of Trustees wishes to amend the SPD to reflect the changes in the hours requirement for initial and reinstatement of eligibility.
- The Board of Trustees has reserved to themselves the ability to amend the SPD from time to time.
NOW THEREFORE, effective January 1, 2023, the SPD is amended as follows:
- Article 6, Comparison of Anthem Blue Cross PPO, Kaiser Permanente HMO and UnitedHealthcare HMO Medical/Prescription Plans, Section 6.1, Medical and Prescription Benefits Comparison: Anthem Blue Cross, Kaiser Permanente and United Healthcare is amended as follows:
Medical and Prescription Benefits Comparison: Anthem Blue Cross, Kaiser Permanente and UnitedHealthcare
| Comparison of Medical/Prescription Plan Offerings | ||||
| This is only a summary of the benefits available to you under the Anthem Blue Cross PPO Plan and the Kaiser and UnitedHealthcare HMO Plans. For a complete description of the respective PPO or HMO’s benefits, please refer to the carrier’s EVIDENCE OF COVERAGE AND DISCLOSURE DOCUMENT. The EVIDENCE OF COVERAGE AND DISCLOSURE DOCUMENT is the legal document that describes the benefits, exclusions and limitations and other coverage provisions including claims appeals, claims review and adjudication procedures. Additionally, the Summary of Benefits and Coverage (SBC) are available, routinely distributed and appear on the Trust Funds’ website at www.scibew-neca.org. | ||||
| Vendor | Anthem Blue Cross PPO | Kaiser Permanente HMO | UnitedHealthcare | |
| In Network | Out-of-Network | In Network Only | In Network Only | |
| Member Customer Service Number | (800) 543-3037 | (800) 464-4000 | (800) 624-8822 | |
| Website | www.bluecrossca.com | www.members.kp.org | www.uhcwest.com | |
| General Features | ||||
| Calendar Year Deductible | $1,000 per individual, $3,000 per Family | None | None | |
| Maximum Benefits | Unlimited | Unlimited | Unlimited | |
| Annual Co-payment Maximum | $2,500 per individual, $5,000 per family | $1500 per Individual, $3,000 per family | $2,500 per Individual. $5,000 per family | |
| Hospital Benefits | 10% co-payment. Hospital Pre-Certification Required. | 30% co-payment. Additional $200 deductible for non-Anthem Blue Cross PPO Hospital or Residential Treatment Center and $500 no-preauthorization penalty (waived for emergency services) Hospital Precertification Required. 2 | No Charge | $250 co-payment |
| Emergency Services | 10% co-payment 1 | 10% co-payment. 2 | $5 co-payment. Co-payment waived if admitted. | $250 co-payment. Co-payment waived if admitted. |
| Preexisting Conditions | Not Applicable. All conditions are covered provided they are a covered benefit. | |||
| Benefits Available While Hospitalized as an Inpatient | ||||
| Alcohol, Drug or Other Substance Abuse Detoxification | 10% co-payment 1 | 30% co-payment 2 | No Charge | No Charge |
| Mental Health Services (As required by law, coverage includes treatment for Severe Mental Illness (SMI) of adults and children and the treatment of Serious Emotional Disturbance (SED). | 10% co-payment 1 | 30% co-payment 2 | No Charge | No Charge |
| Newborn Care | 10% co-payment 1 | 30% co-payment 2 | No Charge | No Charge |
| Physician Care | 10% co-payment 11 | 30% co-payment 2 | No Charge | No Charge |
| Reconstructive Surgery | 10% co-payment 1 | 30%co-payment 2 | No Charge | No Charge |
| Rehabilitative Care (including physical, occupational and speech therapy) | 10% co-payment. Must obtain prior approval. 1 | 30% co-payment. Up to $35 max benefit per visit. Must obtain prior approval. 2 | No Charge | No Charge |
| Skilled Nursing | 10% co-payment. 1 | 30% co-payment. 2 | No Charge | No Charge |
| Voluntary Termination of Pregnancy (Medical, Medication and surgical) | 10% co-payment. 1 | 30% co-payment. 2 | $5 Co-payment | $75 co-payment |
| Benefits Available on an Outpatient Basis | ||||
| Ambulance | 10% co-payment 1 | 10% co-payment 2 | No Charge | No Charge |
| Durable Medical Equipment | 10% co-payment. 1 | 30% co-payment. 2 | No Charge | No Charge |
| Durable Medical Equipment for the Treatment of Pediatric Asthma (includes nebulizer, peak flow meters, face masks and tubing for Medically Necessary Treatment of Pediatric Asthma of dependent children under the age of 19) | 10% co-payment. 1 | 30% co-payment. 2 | No Charge | No Charge |
| Immunizations (For Children Under two (2) years of age, refer to well-baby care) | No Charge | 30% co-payment 2 | $5 Office Visit Co-payment | No Charge |
| Laboratory Services (When available through or authorized by PCP) | 10% co-payment. 1 | 30% co-payment. 2 | No Charge | No Charge |
| Mental Health Services (As required by law, coverage includes treatment for Severe Mental Illness (SMI) of adults and children and the treatment of Serious Emotional Disturbance (SED). | 10% co-payment 1 | 30% co-payment 2 | $5 Office Visit Co-payment | $25 Office Visit Co-payment |
| Oral Surgery Services | 10% co-payment 1 | 10% co-payment 2 | No Charge | No Charge |
| Outpatient Medical Rehabilitation Therapy at Participating Free Standing or Outpatient Surgery Facility | 10% co-payment 1 | 30% co-payment 2 | $5 Office Visit Co-payment | $25 Office Visit Co-payment |
| Outpatient Surgery at Participating Free Standing or Outpatient Surgery Facility | 10% co-payment. 1 | 30% co-payment. 2 | No Charge | No Charge |
| Physician Office Visits (Physician, laboratory, radiology and related services as recommended by the American Academy of Pediatrics (AAP). Advisory Committee on Immunization Practices (ACIP) and U.S. Preventive Services Task Force and authorized through PCP for children). | 10% co-payment 1 | 30% co-payment 2 | $5 Office Visit Co-payment | $5 Office Visit Co-payment |
| Well-Baby Care (Preventive health service, including immunizations as recommended by the American Academy of Pediatrics (AA), Advisory Committee on Immunization Practices (ACIP) and U.S. Preventive Care Task Force and authorized through PCP for children). | 0% co-payment 1 | 30% co-payment 2 | No Charge | No Charge |
| Well-Woman Care (includes PAP smear (By PCP or an OB/GYN in PMG and a referral by the PMG for screening mammography as recommended by the U.S. Preventive Services Task Force). | 0% co-payment 1 | 30% co-payment 2 | No Charge | No Charge |
|
||||
| Prescription Drugs Available on an Outpatient Basis: The Mandatory Generic Prescription Drug Plan is designed to help you meet the cost of prescription drugs prescribed by your doctor, for you or your eligible dependents, for the treatment of illness or injury. You must use a generic drug substitute whenever it is available. If you or your doctor requests a brand-name drug instead of a generic equivalent, you will be charged the difference in cost between the brand-name drug and the generic, in addition to the co-payment applicable to the quantity and type of drug prescribed. The co-payments, which vary depending on the type of drug prescribed and the quantity dispensed, are detailed below: |
||||
| Generic | $10 up to a 30-day supply | $10* up to a 30-day supply 1 | $0 up to a 100-day supply | $10 up to a 30-day supply |
|---|---|---|---|---|
| Brand-Name | $20 up to a 30-day supply | $20* up to a 30-day supply 1 | $10 up to a 30-day supply | $20 up to a 30-day supply |
| Mail Order (Maintenance Drugs) – up to a 90-day supply | ||||
| Generic | $20 up to a 90-day supply | N/A | $0 up to a 100-day supply | $20 up to a 90-day supply |
| Brand-Name | $40 up to a 90-day supply | N/A | $20 up to a 100-day supply | $40 up to a 90-day supply |
|
||||
- All references in the SPD appearing at Article 4, Eligibility and General Plan Provisions, Article 17, Disclosure Information, and elsewhere in the SPD are amended to replace the eligibility requirement of "100 hours" to "120 hours", and the Hours Bank Reserve not to exceed from "600 hours" to "720 hours".
- Article 4, subsection 4.2, Example 2 is amended by providing clarification to the example provided as follows:
Example 2: You work 28.75 hours in January, February, March and April and the employer(s) reported and paid the contributions in February, March, April and May. By the end of May, you have worked 120 hours and the contributions have been received on your behalf, and you will be eligible for coverage August 1st.
All other terms and conditions of the Summary Plan Description and Plan, shall remain in full force and effect.
Executed this 20th day of October 2022 at Pasadena, California.
BY: Signature on File
Chairman
BY: Signature on File
Secretary