2024 Medicare Part D Notice of Creditable Coverage — This notice is to inform you that your current prescription drug benefit program through the Southern California IBEW-NECA Health Trust Fund provides "creditable coverage," as defined below. It also includes answers to questions you may have regarding your current prescription drug program and how it relates to Medicare Part D coverage.
2022 Medicare Part D Notice of Creditable Coverage — This notice is to inform you that your current prescription drug benefit program through the Southern California IBEW-NECA Health Trust Fund provides "creditable coverage," as defined below. It also includes answers to questions you may have regarding your current prescription drug program and how it relates to Medicare Part D coverage.
2021 Medicare Part D Notice of Creditable Coverage — Important Notice from Southern California IBEW-NECA Health Trust Fund About Your Prescription Drug Coverage and Medicare
HIPAA Privacy Notice — The Southern California IBEW-NECA Health Plan may use the
limited quantity of private health information available, that is,
information that constitutes protected health information as defined in
the Privacy Rule of the Administrative Simplification provision of the
Health Insurance Portability and Accountability Act of 1996
("HIPAA"), for purposes of making or obtaining payment for your care
and conducting health care operations.
Retiree Health Plan Beneficiary Benefit Form (Retiree Only) — Use this form to designate the beneficiary(ies).
Change of Address — Use this form to change your address. Be sure to fill it out completely and return it to the Trust Office. (English Version)
Forma Para Solicitar Cambio De Dirección (En Español) — Use esta forma para hacer un cambio de dirección postal. Asegúrese de completar todos los espacios en la forma, y de enviar la misma a la oficina del Trust Funds.
HIPAA Participant Authorization Form — Use this form to instruct the Fund Office to communicate with you at an alternate address regarding your eligibility, carrier changes, etc.