Retiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)

3.3 Enrolling in Coverage

Retiree Health Plan coverage is not automatic. Applying for Retiree Health Plan coverage is a separate process from applying for pension benefits.

The Health Hours Estimation/Retiree Health Plan application is generally mailed upon notification of your application for retirement benefits under the Southern California IBEW-NECA Pension Plan.

After you return the Health Hours Estimation/Retiree Health Plan application to the Administrative Office, if you are eligible to receive Retiree Health Plan benefits, the Administrative Office will send you a Retiree Health Plan enrollment packet. If you do not respond to the enrollment packet, the Administrative Office will send you a certified reminder letter. If you elect not to participate in the Retiree Health Plan, then you should make an affirmative declaration by checking the box declining coverage. If your enrollment forms are not received by the Administrative Office within 30 days of the date the certified reminder letter is mailed, you will permanently lose the right to elect Retiree Health Plan coverage. The presumption will be that you declined participation in the Retiree Health Plan.

You must ensure that your enrollment paperwork is received by the Administrative Office by the applicable deadline listed above. The Plan is not responsible for any delays in sending the application to the Administrative Office.

Once a valid and complete enrollment package is received by the Administrative Office, your Retiree Health Plan benefits will begin on the first day of the following month. Coverage for your Eligible Spouse will begin on the same date.

For example, if a valid and complete enrollment package is received on January 15, coverage for you and your Eligible Spouse may begin on February 1.

3.3.1 30-Day Application Deadline

The deadline for the Retiree Health Plan enrollment is 30 days after the latest of the following:

  1. First meeting the eligibility requirements for Retiree Health Plan coverage;
  2. Receiving pension benefits from the Southern California IBEW-NECA Pension Plan;
  3. Exhausting all Hours Bank Reserve coverage under the Active Plan;
  4. Exhausting all COBRA coverage under the Active Plan; and
  5. Special enrollment rights under HIPAA (See Article 3.3.2 HIPAA Special Enrollment Rights).

If you do not enroll in the Retiree Health Plan coverage by the applicable deadline listed above, you will permanently lose the right to elect Retiree Health Plan coverage. (See 3.3: Enrolling in Coverage.)

3.3.2 HIPAA Special Enrollment Rights

The only exception to the 30-day initial enrollment deadline detailed in Article 3.3.1: 30-Day Application Deadline is when you and/or your Spouse delay Retiree Health Plan coverage because you and/or your Spouse have other health coverage. This is a Special Enrollment right required under the Health Insurance Portability and Accountability Act (HIPAA) and is only applicable during you and your Spouse's initial enrollment for Retiree Health Plan coverage.
You must advise the Administrative Office in writing that you are delaying enrollment in the Retiree Health Plan because you are covered under other health coverage. This written notice must be received by the Administrative Office prior to the end of the 30-day application deadline detailed in (Article 3.3.1: 30-Day Application Deadline), or you will lose your HIPAA Special Enrollment rights.
When the other health coverage ends, you must enroll in Retiree Health Plan coverage within 30 days of the loss of the other health coverage. At that time, you must submit written proof of the other coverage, its duration and the date the coverage ended. If you do not enroll within 30 days, you will lose your HIPAA Special Enrollment rights and the ability to elect Retiree Health Plan coverage.

3.3.3 Self-Pay Premium

Upon request, the Administrative Office can provide you with a chart indicating the amount of the monthly Retiree Health Plan self-pay premium for each option under the Retiree Health Plan.
There are two ways to pay the monthly self-pay premium:

  1. A deduction from your monthly Southern California IBEW-NECA Pension Plan benefit (the Administrative Office will provide you with an authorization form to complete and sign); or
  2. A monthly payment made directly to the Southern California IBEW-NECA Health Plan.

Your monthly self-pay premium must be received by the 15th of the previous month (i.e. your premium payment for January is due by December 15th). Coverage will not be granted until your self-pay premium for the month is received.

The amount of the monthly self-pay premium is typically adjusted annually effective January 1st. You will be notified at least 60 days in advance of any premium change or generally with Open Enrollment (generally held during the months of November and December with plan changes effective January 1st). The amount of the self-payment is based on you paying a portion of the HMO premium or Plan benefit cost.
The Board of Trustees reserves the right to change the monthly self-pay premium at any time.