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IBEW Local 11-LA NECA Active Health Plan
Summary Plan Description (SPD)


AMENDMENT NO. 39
TO THE
SOUTHERN CALIFORNIA IBEW-NECA ACTIVE HEALTH PLAN

Effective for the death of a dependent spouse or domestic partner and/or a child occurring on and after January 1, 2009, the dependent life insurance benefits are amended as shown on page 148 attached which replaces in its entirety page 148 of the Summary Plan Description for the Southern California IBEW-NECA Active Health Plan effective June 1, 2004.

Approved and adopted by the Board of Trustees meeting held on December 4, 2008.

BOARD OF TRUSTEES
SOUTHERN CALIFORNIA IBEW-NECA
HEALTH TRUST FUND

BY: Signature on File
Chairman

BY: Signature on File
Secretary

 

Metropolitan Life Insurance Company
Life Insurance & Accidental Death & Dismemberment Benefits

Schedule of Benefits

The amounts shown below are the maximum amounts payable as subsequently explained.

Employee Only

Life Insurance effective June 1, 2005... $50,000
Accidental Death, Dismemberment Insurance effective October 1, 2006... $50,000

The Accidental Death or Dismemberment Insurance of each Employee will automatically terminate on the date eligibility ceases and may not be converted to an individual policy.

Life Insurance for Dependents

Spouse and domestic partner effective January 1, 2009... $1,500
Children to age 21, or if full-time student to age 25, effective January 1, 2009... $   750

The Dependent Effective Date Proviso shall apply if a child is then confined to a hospital.

Certificate of Coverage

This booklet explains a plan of insurance under the Policy shown below. The Plan is subject to all of the terms and limits of the Policy and any amendments thereto which apply.

A Certificate of Insurance may be requested from the Administrative Office.

Group Policyholder

Trustees of the Southern California IBEW-NECA Health Trust Fund
Group Policy Number: A4328-G1
President
Metropolitan Life Insurance Company
New York, NY (herein called the Company)

Life Insurance

Insuring Clause for Life Insurance

If the insured individual dies from any cause, while insured for life insurance under this Policy, the amount of insurance, as provided by the Policy, will be payable to the beneficiary when the Company receives due proof of death in writing at its home office. A certified copy of the death certificate must be provided to the Administrative Office.