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.

Important Note
 

Continuation coverage applies to participants who lose coverage due to unemployment in the industry or due to disability. Continuation coverage can also apply to dependents, based on several circumstances.

Temporary Disability/Workers Compensation Coverage
 

If you become disabled while working on covered employment as an Employee, and you meet the other applicable provisions, you can receive 40 hours of credit towards eligibility for each week that you remain disabled, up to a total of 26 weeks. The following rules apply:

  1. You must have been eligible for Plan benefits in the month in which the occupational injury occurred, and had contributions paid to this Plan on your behalf by an Employer.
  2. You must give written notice of your disability to the Administrative Office, within 30 days from the date you cease to be eligible under the Plan.
  3. You must provide proof, satisfactory to the Board of Trustees, certifying your disability, and the time period of disability.
  4. You must provide proof that you are receiving Workers Compensation benefits, or will be entitled to Workers Compensation benefits.
 

Certain participants may be eligible for Family Medical Leave in accordance with Federal law. However, it is the employer's obligation to continue health contributions to the Plan during any period of Family Medical Leave. This continuation coverage can be triggered by the birth/adoption of a child, for your own serious health condition, having to care for a spouse, child or parent with a serious health condition, to care for a military family member (spouse, child or parent) with a serious injury or illness, or due to a "qualifying exigency."

Military Leave
 

If you are an Active Member and are called to active duty, you may qualify for continuation coverage for a limited period of time under the Uniformed Services Employment and Reemployment Rights Act of 1994 ("USERRA") similar to the COBRA coverage described below. In addition to the legally mandated USERRA coverage, current plan rules provide the extension of USERRA coverage for up to 5 years at no cost to the participant, and the hour bank will be frozen as of the date that active duty begins.

COBRA in General
 

A law known as COBRA allows a participant and/or family to self-pay for continued coverage under a set of defined "Qualifying Events". Participants must apply and make monthly self-payments in strict compliance with the rules in order to be covered under the COBRA provision. Medical, prescription, dental, and vision benefits only can be continued under COBRA.

Note: An employee will not be eligible for COBRA coverage if the employee's loss of coverage under this Plan is as a result of work in Non-Covered Electrical Employment.

Election and Payment Rules
 

You or your dependents must notify the Plan if coverage is terminated because of a divorce, legal separation, or a child's losing dependent status within 60 days of the event. Once a qualifying event has occurred and the Plan is notified, you will be sent a COBRA information package. You have 60 days from the date this package is sent to notify the Plan that you want to elect COBRA coverage. You must remit your first monthly payment (and payment for each month since the qualifying event) within 45 days after you first elect COBRA coverage.

Qualifying Events and Maximum Continuation Period
 
Qualifying Event Who Can be Covered Maximum Continuation Period
Loss of benefits caused by reduction in work Employee and dependents 18 months after loss of benefits*
Loss of benefits caused by termination of employment except for gross misconduct Employee and dependents 18 months after loss of benefits*
Loss of benefits caused by death of participant Dependents 36 months after Qualifying Event
Loss of benefits caused by divorce Dependents 36 months after Qualifying Event
Loss of benefits caused by child losing dependent status Dependent child 36 months after Qualifying Event
Entitlement to Medicare within 18 months before Qualifying Event #1 or #2 above Dependents Later of: (1) 36 mo. from Medicare entitlement, or (2) 18 months from date of loss of coverage due to original Qualifying Event

* COBRA can be extended to 29 months if the covered person is disabled prior to or in the first 60 days of COBRA coverage. COBRA can also be extended if enrolled in Kaiser or UnitedHealthcare under Cal-COBRA.

COBRA Rates
(1/1/19-12/31/19)
 
  Blue Cross UnitedHealthcare Kaiser
Trust Funds Subsidized COBRA (medical/RX)
First three consecutive months
$50 $50 $50

Trust Funds Subsidized CORE Plus
(Medical/Rx/Vision/Dental/MAP)
United Concordia (PPO) $187 $187 $168
CIGNA (DHMO) $129 $129 $111
Delta Dental (DHMO) $114 $114 $96
United Concordia (DHMO) $120 $120 $101

Trust Funds COBRA (non-subsidized)
CORE (Medical/RX) Rates
$1,655 $1,650 $1,280

Trust Funds COBRA non-subsidized CORE  
(Medical/Rx/Vision/Dental/MAP)
United Concordia (PPO) $1,791 $1,786 $1,398
CIGNA (DHMO) $1,733 $1,728 $1,341
Delta (DHMO) $1,718 $1,713 $1,326
United Concordia (DHMO) $1,723 $1,719 $1,331