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Summary Plan Description (SPD)
Amendment Number 2
To The
Southern California IBEW-NECA
Summary Plan Description
Dated June 1, 2004
Effective August 1, 2004, page 60 of the Self Funded Indemnity Plan is amended to aggregate the number of visits for Chiropractic Services and Physical Therapy - Out Patient as follows:
| Chiropractic Service Physical Therapy Outpatient |
Combined Total of 50 Visits, After Deductible |
Combined Total of 50 Visits, After Deductible
The headings entitled "Chiropractic Treatment" and "Physical Therapy" on page 75 of the Self Funded Indemnity Plan are deleted and restated as follows:
Chiropractic Treatment and Physical Therapy
For outpatient and non-hospital chiropractic care by a licensed chiropractor (D.C.) the Plan pays up to a maximum of 50 visits combined maximum with physical therapy per calendar year for necessary care not to exceed $35.00 per visit after deductible.
Charges for outpatient physical therapy, by a licensed physical therapist, the Plan pays up to a maximum of 50 visits combined maximum with chiropractic treatment visits per calendar year for necessary care not to exceed $35.00 per visit after the deductible. This benefit is only payable when physical therapy has been prescribed in writing by a medical doctor.
BY: Signature on File
Chairman
BY: Signature on File
Secretary