- Active Health
- Retiree Health
- DB Pension
- DC Pension
- SUB 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:
NOW THEREFORE, effective March 1, 2019, Article 8, Benefits for Disabled Retirees who commenced retirement prior to April 1, 2017, sub-section 8.4, Vision Co-Payments and Schedule of Benefits, is amended as follows:
8.4 Vision Co-Payments and Schedule of Benefits:
|UnitedHealthcare Plan Participants|
|Benefit||Frequency (Based on service year)||Copayment||Coverage from a VSP Doctor||Out-of-Network Reimbursement|
|Exam||12 months||$5||Covered in full after the copayment.||Up to $45 allowance|
|Prescription Eyewear - If you choose contact lenses you will be eligible for frame 12 months from the date the contact lenses were obtained.|
|Lenses||12 months||$10 (lenses and/or frame)||Single vision, lined bifocal and lined trifocal lenses are covered in full after the copayment.||Single vision up to $45 allowance.
Lined bifocal up to $65 allowance.
Lined trifocal up to $85 allowance
|Frame - As Provided by VSP||24 months||$10 (lenses and/or frame)||Covered up to $150
|Up to $47 allowance|
|Contact Lenses*||12 months||Covered in full for medically necessary allowance, $130 allowance for Elective Contact lenses||Up to $210 allowance for medically necessary and $105 for Elective Contact lenses|
*Your allowance applies to the cost of your contact lens exam and your contact lenses. You'll receive a 15 percent savings off the cost of your contact lens exam from a VSP doctor. Your contact lens exam is in addition to your routine eye exam to check for eye health risks associated with improper wearing or fitting of contacts. You may get regular glasses (frames and lenses) twelve months after you get contact lenses.
|Kaiser Vision Plan|
|Eye refraction exams to determine the need for vision correction and to provide a prescription for eyeglasses||$5 per visit|
|Regular plastic eyeglass lenses every 24 months||$150 Allowance*|
|An eyeglass frames every 24 months|
|Medically necessary contact lenses||No charge|
*An allowance is the total expenses of an item that is covered. If the cost of the item you select exceeds the allowance, you must pay the difference.
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
BY: Signature on File