Southern California IBEW-NECA Active Health Plan  

Amendment # 33
To the Mandatory Generic Prescription Drug Plan
As Set Forth in the
Active Health Plan Summary Plan Description

Dated June 1, 2004

The subsection of the “Mandatory Generic Prescription Drug Plan” entitled “Limitations” as set forth on page 86 of the Active Health Plan Summary Plan Description is hereby amended to read as follows, and this change is effective for prescriptions filled on and after July 1, 2008:

Limitations:
The following items are a covered benefit subject to the limitations as stated below:

• Drugs to treat erectile dysfunction (including but not limited to Viagra, Cialis and Levitra) – coverage will be for prescriptions limited to a maximum of eight (8) pills for a 30-day supply for males (excluded for females). The participant will be responsible for a copayment equal to fifty percent (50%) of the total retail cost of the prescription.
• Smoking deterrents when prescribed in writing, by a physician, subject to the following limitations: up to 90 days supply per year; lifetime maximum benefit, 180 days supply. This limitation applies to smoking deterrents received from both retail and mail pharmacy outlets. It is recommended you discuss a treatment plan with your physician. There are many products to assist you in smoking Cessation. These include the following:
  • Nicotine Patches
  • Nicotine Gum
  • Nicotine Nasal Spray (Rx Required)
  • Nicotine Inhalers (Rx Required)
  • Nicotine Lozenges
  • Zyban (Bupropion) (Rx Required)
• Morning after pills & kits (i.e., Preven, Plan B)- (limited to 2 total per person per 365 days)

APPROVED AND ADOPTED at the Board of Trustees’ meeting held on June 17, 2008.

BY: Signature on File
Chairman

BY: Signature on File
Secretary