Amendment Number 5 to
The Southern California IBEW-NECA
Summary Plan Description
For Active Employees
Dated June 1, 2004
Effective March 1, 2005, the following language is deleted from the Indemnity Plan General Plan Exclusions:
Item N, Check-up Exams
All remaining General Plan Exclusions following existing Item M are re-lettered accordingly, beginning with "Custodial Care".
On page 74, the following section is added following the section entitled Preventative Care (Dependents Age 7 to Age 16):
Annual Physical Examination Benefit (Age 16 and Older)
- A physician's services for routine physical examinations, limited to no more frequently than once every twelve months.
- A maximum annual benefit allowance not to exceed $250 for physician's services. The Plan will pay the lesser of the physician's charges or $250.
- Annual examinations received from a Prudent Buyer Participating provider will not be subject to the Plan deductible or co-insurance.
- Annual examinations received from a Non-participating Provider will be subject to the annual deductible and co-insurance factor.
Approved and adopted at the meeting of the Board of Trustees of the Southern California IBEW-NECA Health Trust Fund held on May 24, 2005.
BY: Signature on File
Chairman
BY: Signature on File Secretary
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