Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)

Amendment No. 3
To the Summary Plan Description of the Southern California IBEW-NECA Health Trust Fund Restated As Of September 1, 2017

This Amendment to the Southern California IBEW-NECA Health Trust Fund Active 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 an increase to the frame and lens allowances under the in-network Vision Service Plan (VSP) benefits. The VSP allowance was increased from $120 on frames to $150 for in-network providers and from $120 to $130 on elective contact lenses for in-network providers.

  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, Article 10, Vision Benefits, section 10.2 of the SPD, the Co-Payments and Schedule of Benefits is amended as follows:


    10.2 Co-Payments and Schedule of Benefits
    Anthem Blue Cross and UnitedHealthcare Plan Participants
    Benefit Frequency
    (Based on service year)
    Co-payment Coverage from
    a VSP doctor
    Out-of-Network
    Reimbursement
    Exam 12 months $5 Covered in full after the co-payment. 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 co-payment. 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 allowance 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
    Vision Benefit Co-pay/ Allowance
    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 $100 Allowance*
    An eyeglass frame 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.
  3. All other terms and conditions of the Summary Plan Description and Plan, shall remain in full force and effect.

Executed this 17th day of July 2018 at Commerce, California.

BY: Signature on File
Chairman

BY: Signature on File
Secretary