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Summary Plan Description (SPD)
Amendment Number 23 to
The Southern California IBEW-NECA Health Plan
Effective for claims incurred on and after December 1, 2006, the Self-Funded IBEW-NECA Dental Plan is amended as follows:
The section entitled "Trust Dental Plan - Summary of Benefits for Active Employees" as contained on page 96 of the Active Participants’ Summary Plan Description dated June 1, 2004 has the following codes added at the end of the subsection entitled "Diagnostic Treatment":
| 00472 | Accession of tissue, gross examination, preparation and transmission of written report | $115 |
| 00473 | Accession of tissue, gross & microscopic examination, preparation and transmission of written report |
$115 |
| 00474 | Accession of tissue, gross & microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of report. | $115 |
Approved and adopted at the Board Meeting held on this 15th day of May, 2007 at City of Commerce, California.
BY: Signature on File
Chairman
BY: Signature on File
Secretary