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

Amendment No. 2
To the Summary Plan Description of the Southern California IBEW-NECA Health Trust Fund Retiree Health Plan

This Amendment to the Southern California IBEW-NECA Health Trust Fund Retiree Health Plan Summary Plan Description (“SPD”) is made by the Board of Trustees of the Southern California IBEW-NECA Health Trust Fund (“Board of Trustees”) with reference to the following facts and circumstances:

  1. The Board of Trustees wishes to amend the SPD to reflect the addition of the same orthotic benefit currently offered to Active participants.
  2. The Board of Trustees has reserved to themselves the ability to amend the SPD from time to time.

NOW THEREFORE, effective January 1, 2019, Section 6.4, Specialized Footwear is added to Article 6: Additional Benefits as follows:

6.4 Specialized Footwear Benefit
The Plan provides benefits for specialized footwear, sometimes known as “orthotics.” The annual benefit of $400 may be used to defray the costs of consulting with a certified orthotist or other provider certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics and the cost of fabricating and fitting the specialized footwear. Specialized footwear includes orthopedic shoes and custom-made, rigid plastic or polypropylene inserts for the shoe. This benefit is available to all eligible retirees and spouses enrolled for medical benefits under the Plan.

Eligible expenses subject to reimbursement shall include expenses for the professional services provided by an orthotist, prosthetist, pedorthist or other provider certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics when professional services are in connection with the treatment of foot disfigurement. For purposes of this benefit, foot disfigurement means foot disfigurement resulting from cerebral palsy, arthritis, polio, spinal bifida, diabetes, accidental injury or abnormal condition.

6.4.1 Specialized Footwear

 Eligible services for specialized footwear shall include the cost of fabricating custom-made rigid (plastic or polypropylene) foot orthotics (shoe inserts) and/or custom-made standard orthopedic shoes.

6.4.2 Maximum Annual Benefit

The maximum annual benefit payable per eligible individual for eligible expenses incurred for the procurement of specialized footwear shall be $400.

6.4.3 Submission of Claims

Claims for eligible expense reimbursement under this provision shall be submitted to Coast Benefits, Inc. at:

Coast Benefits, Inc.
3444 Camino del Rio North, Suite 101
San Diego, CA 92108

Claims must include the name and address of the provider, the date services are rendered, the diagnosis or condition being treated, and an itemized listing of services rendered. Reimbursement shall be made directly to the Participant and not to the provider.

6.4.4 Exclusions

No benefits shall be provided under the terms of this provision for:

  • Dress shoes;
  • Casual shoes (e.g., tennis shoes or deck shoes);
  • Shoe inserts (except as provided above);
  • Foot pads;
  • Foot orthotics that are fabricated from soft plastic, cork or leather;
    1. Socks or any supplies that are not custom-made or of which the equivalent can be purchased without prescription; or
    2. Services provided to Participants that do not suffer from foot disfigurement as defined above under “Eligible Expenses.

All other terms and conditions of the Plan shall remain in full force and effect.

Executed this 30th day of January 2019, at Commerce, California.

BY: Signature on File
Chairman

BY: Signature on File
Secretary