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.

Health Reimbursement Arrangement

ATTENTION IBEW Local 11 - Inside Wireman, Intelligent Transportation and Railroad Participants, Inspectors and 9th Sound and Communication District
 

If required under the terms of a Collective Bargaining Agreement or certain other agreements, an Employer may make pre-tax contributions on behalf of a Participant to this Plan for funding a Health Reimbursement Arrangement (HRA). Amounts contributed to an HRA Account, if any, may be used to reimburse a Participant tax-free for certain medical expenses which are not covered by this Plan or any other health plan. If a Participant's spouse and/or children are eligible under the terms of this Plan, their reimbursable medical expenses qualify for tax-free reimbursement from the HRA Account. All HRA contributions are Fund assets. Participants are not vested in any contributions made on their behalf, and an HRA Account may only be used in accordance with the terms of the Plan.

Claims for HRA qualified reimbursable expenses may be submitted to the Southern California IBEW-NECA Health Trust Fund in care of the Third Party Administrator.

Eligibility
 

If an Employer makes an HRA contribution to the Plan on behalf of a Participant, the Participant is entitled to use these contributions, subject to the terms of the Plan once he/she becomes eligible to participate in the Plan. The Participant's HRA benefit is called an HRA Account. An HRA Account may be used to reimburse eligible expenses incurred by the Participant, his/her eligible spouse and his/her eligible dependents as defined under the Plan.

Benefit Amount
 

The amount of the HRA benefit in any Calendar Year is determined by the number of hours the Participant works in Covered Employment, multiplied by the rate set forth in the Collective Bargaining Agreement (CBA) or other agreement. If the HRA Account is not used in any one Calendar Year, it may be carried over year-to-year until depleted. It is expected that this benefit will be provided as long as the CBA or other agreement provides for a contribution for such a benefit and, once an HRA Account is established, as long as a Participant has a balance remaining in his/her HRA Account (subject to the forfeiture rules listed below). The Trustees, however, retain the right to change the rules pertaining to this benefit or terminate this benefit as they deem appropriate.

COBRA Continuation Coverage
 

If a Participant loses coverage under the Active Plan for any reason other than Non-Covered Electrical Employment the Participant may use his/her account to pay the cost of his/her COBRA coverage under the Active Plan and that of his/her eligible dependents.

If a Participant eligible under the Active Plan dies, his/her eligible dependents may use the deceased Participant's HRA Account to pay the cost of their COBRA coverage under the Active Plan. A surviving Spouse shall always have primary control over the HRA Account. If there is no Surviving Spouse, eligible dependents shall have pro rata rights to the HRA Account for COBRA purposes and nothing prevents a surviving eligible dependent to waive their interest in favor of other surviving eligible dependents for purposes of COBRA continuation coverage under the Active Plan.

Reimbursable Expenses
 

An HRA Account may be used to reimburse eligible health care expenses incurred by the Participant or his/her spouse or his/her eligible dependents which would otherwise be only partially covered or excluded from coverage by the Plan and any other health plan. Reimbursable expenses are those that constitute medical care under Section 213 of the Internal Revenue Code. An HRA Account may be used to reimburse the Participant for Plan deductibles, co-payments, and other non-covered expenses for medical, prescription drug, dental, vision and psychiatric services. An HRA Account may also be used to pay for self-pay premiums, COBRA premiums, other medical plan coverage, Medicare supplemental coverage, and long-term care insurance premiums.

To be eligible for reimbursement, the Participant must be eligible for Health Plan coverage under the rules of the Plan.

Claims Procedures
 

No reimbursement of submitted claims will be made from a Participant HRA Account unless aggregate eligible claims submitted provide for reimbursement of at least $25.00. Individual claims may be aggregated to meet the $25.00 minimum. An HRA Reimbursement Claim Form must be submitted to a named Third Party Administrator that not only processes the claims received but also handles all non-eligibility based appeals related to specific claims. No claims are ever to be submitted to the Administrative Trust Funds Office other than disputes as to eligibility. Claim forms will be available from the Administrative Trust Funds Office or the Trust Funds website at www.scibew-neca.org and will require the Participant's certification that the expenses were not reimbursed, and are not reimbursable, by this or any other plan. Along with the HRA Reimbursement Claim Form, supporting documentation must be provided describing the expenses and proving that the Participant (or eligible spouse or other eligible dependents) paid the expenses. Supporting documentation may include the following:

  • An itemized bill describing the services provided, the person to whom the services were provided, the date of service, and the charged amount.
  • An Explanation of Benefits (EOB)
  • A receipt showing proof of payment
Third Party Administrator
 

Coast Benefits, Inc.
SC IBEW-NECA Claims Administrator
3444 Camino del Rio North, Suite 101
San Diego, CA 92108
Toll Free Telephone: 1-844-739-7956
Toll Free Fax: 1-877-501-1015
Participant HRA Portal: https://scibewneca.lh1ondemand.com/

Important Information