Active Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.

 

When you initially become eligible for coverage (and once every 12 months after any election) you are allowed to select between 3 plans for medical benefits and between 4 plans for dental benefits. Failure to complete the enrollment process in a timely manner will cause your Hours Bank Reserve to be charged as if you are enrolled, but you will have no actual coverage.

Your Choices
Medical
Dental
  • Anthem Blue Cross (PPO)
  • UnitedHealthcare (HMO)
  • Kaiser Permanente (HMO)
  • United Concordia PPO
  • DeltaCare USA (DHMO)
  • United Concordia (DHMO)
  • CIGNA Dental (DHMO)
MedExpert
 

Provides advocacy and assistance services to all participants and their family members.

Anthem Blue Cross PPO (Prudent Buyer)
 

The Board of Trustees have contracted with Anthem Blue Cross of California for the purpose of making the extensive Anthem Blue Cross PPO network available to you. The doctors and hospitals (providers) have agreed to substantial reductions from their regular fees when the preferred providers are used.

UnitedHealthcare
 

UnitedHealthcare is a network model Health Maintenance Organization (HMO). It contracts with doctors who are in private practice or are part of established Medical Groups.

You choose a participating Medical Group and from that Medical Group you must select a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary.

Generally, covered benefits are provided to you at no cost or for a fixed copayment for most outpatient services.

Kaiser Permanente
 

Kaiser is a hospital model HMO that owns its own medical clinics and hospitals, and employs its own doctors. Under the Kaiser Plan, you can choose your own physician, and are encouraged to do so. You must live within the list of Kaiser ZIP codes to be eligible to enroll in the Kaiser Plan. You can use any Kaiser facility at any time. There are specialist doctors within Kaiser. Generally, covered benefits are provided to you for a fixed copayment or at no cost.

Dental Choices
 

Whether you select Kaiser, UnitedHealthcare, or Anthem Blue Cross as your medical Plan, you have the option to enroll in one of the Dental Plans as part of your covered benefits.

You get a choice of one of the following dental plans:

  • United Concordia PPO
  • CIGNA Dental Plan (DHMO)
  • DeltaCare USA Dental Plan (DHMO)
  • United Concordia Dental Plan (DHMO)

The Trust offers four dental plans from which to choose: a dental PPO plan and three Dental Health Maintenance Organizations (DHMO) plans. The dental PPO plan is provided by United Concordia/Concordia Advantage Plus. The three DHMO plans are CIGNA, DeltaCare USA, United Concordia.

 

Participants in the Anthem Blue Cross (PPO) and UnitedHealthcare (HMO) have vision coverage through Vision Service Plan. Kaiser Permanente (HMO) participants have vision coverage through Kaiser. Safety prescription glasses are covered through Vision Service Plan for all three medical plans.

Prescription
 

All eligible participants have prescription drug coverage through the mandatory generic prescription drug plan managed by Citizens Rx.

 

Member Assistance Program (MAP): covers all eligible participants and members of their household.