Date: May 2010
To: Participants in the Southern California IBEW-NECA Active Health Plan
From: Southern California IBEW-NECA Trust Funds Administrative Office
Re: Plan Information
Enclosed are recently adopted amendments to the Southern California IBEW-NECA Active Health Plan ("Plan"), Summary Annual Report for Fiscal Year Ending June 30, 2009 (blue), Women's Health and Cancer Rights Act (pink) and Mental Health Parity Act (green). Please read the amendments in their entirety for a complete description. Please keep a copy of this notice with your Summary Plan Description.
If you have any questions about these amendments, please contact the Membership Services Department Monday through Friday between the hours of 9:00 a.m. and 5:00 p.m.
Amendment 42 – Initial Eligibility for Certain Employees of Certain New Contributing Employers
An explanation of this Amendment is not offered since the Amendment is self-explanatory
Amendment 43 – Clarification of Benefits under the Mandatory Generic Prescription Drug Plan
Beginning with prescriptions filled on or after September 23, 2009, the Mandatory Generic Prescription Drug Plan (a component of the Active Health Plan) will provide benefits at the stated copayments for quantities of prescription drugs of up to a 30-day supply or of up to a 100-day supply.
The current Summary Plan Description describes copayments that apply to a 30-day supply or to a 100-day supply. However physicians routinely write prescriptions for a supply of drugs that are not exactly the amount needed for 30 days or 100 days. Also, certain prescription drugs, such as insulin or Restasis® may be packaged by the manufacturer in such a way that the pharmacist is not able under the applicable dispensing guidelines to fill a prescription for exactly a 30-day or a 100-day supply.
In order to accommodate these variables, the attached amendment clarifies the intention of the Mandatory Generic Prescription Drug Plan to provide prescription drug benefits at the stated copayments for "up to a 30-day supply" or for "up to a 100-day" supply. For example, if a physician writes a prescription for a 100 days' supply of insulin, but the member's daily dosage is such that the pharmacist can dispense a supply for only 98 days (due to packaging limitations), then the pharmacist would fill the prescription by dispensing 98 days' worth of insulin and charge the member the applicable copayment for "up to a 100-day supply." Similarly if a physician wrote a prescription for a 10-day supply of ampicillin, the pharmacist would dispense the 10-day supply and charge the applicable copayment for "up to a 30-day supply."
Amendment 44 – Enhancement of Infertility Benefits Under the Self-Funded Anthem Blue Cross PPO Plan
Beginning January 1, 2010, the Active Health Plan will enhance the benefits for treatment of infertility (including in vitro fertilization procedures) for participants in the Self-Funded Hospital/Medical Indemnity Plan (with the Anthem Blue Cross PPO Option) from a lifetime maximum benefit per couple of $4,000 to a lifetime maximum benefit per couple of $5,000.
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