Retiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)
10.5 Your Rights Under ERISA
As a Participant in the Southern California IBEW-NECA Health Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Participants will be entitled to:
10.5.1 Receive Information About Your Plan and Benefits
- Examine, without charge, at the Administrative Office and at other specified locations, such as work locations and union halls, all documents governing the Plan, including Summary Plan Descriptions, Collective Bargaining Agreements, and a copy of the latest annual report (Form 5500 series).
- Obtain, upon written request to the Administrative Office, copies of documents governing the operation of the Plan, including Collective Bargaining Agreements, and copies of the latest annual report (Form 5500 series) and an updated Summary Plan Description. The Plan Administrator may make a reasonable charge for the copies.
- Receive a summary of the Plan's annual financial report. The Board of Trustees are required by law to furnish each Participant with a copy of this summary annual report.
10.5.2 Continue Group Health Plan Coverage
- Continue health coverage for yourself or your Spouse if there is a loss of coverage under the Plan as a result of a "Qualifying Event." You or your Spouse may have to pay for such coverage. Review this Summary Plan Description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights.
10.5.3 Prudent Actions by Plan Fiduciaries
- In addition to creating rights for Participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to do so prudently and in the interest of you and other Participants and beneficiaries.
- No one, including your Employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a health benefit or exercising your rights under ERISA.
10.5.4 Enforce Your Rights
- If your claim for a health benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.
- Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator.
- If you have a claim for benefits that is denied or ignored in whole or in part, and you have exhausted the claim review and appeal procedures available to you under the plan, you may file suit in a state or federal court. In addition, if you disagree with the plan's decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court. If it should happen that plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
10.5.5 Assistance with Your Questions
- If you have any questions about your plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest Office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory, or:
Division of Technical Assistance and Inquiries
Employee Benefits Security Administration
U.S. Department of Labor
200 Constitution Avenue, N.W., Suite N-5623
Washington D.C, 20210
The nearest office of the Employee Benefits Security Administration is located at:
Los Angeles Regional Office
1055 E. Colorado Blvd, Suite 200
Pasadena, CA 91106
You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.