Date: August 2010

To: Southern California IBEW-NECA Retiree Health Plan Participants (Kaiser Permanente, PacifiCare, Medicare Supplement, and Premium Reimbursement Plans)

From: Southern California IBEW-NECA Administrative Trust Funds Office

Re: Retiree Health Plan - Self-Payment Rates Effective 10/1/10


This is your annual notification of changes to the self-payment rates for Retiree Health Plan ("RHP") coverage and a reminder of the RHP Annual Open Enrollment period.

The Board of Trustees of the Southern California IBEW-NECA Health Trust Fund has decided to maintain the 5% of premium costs for the period beginning October 1, 2010. The Board's decision to maintain the 5% self-payment rate is contingent upon the financial status of the Southern California IBEW-NECA Health Trust Fund. The Board of Trustees reserves the right to change the self-payment rates at any time. If there is a change to the self-payment rate, you will be notified at least 30 days before the effective date.

ANNUAL OPEN ENROLLMENT
Your enrollment in the Plan of your choice will continue as previously selected, unless you wish to make a change. If you are interested in changing health plans, you may obtain the form necessary to make a change by visiting our website at www.scibew-neca.org and clicking on "Forms" under the title "Retiree Health". No carrier changes will be made until the Administrative Trust Funds Office receives all required documents. Properly completed enrollment and/or election forms must be received by the Administrative Trust Funds Office on or before August 31, 2010 for an October 1, 2010 effective date.

If you have any questions, please contact the Administrative Trust Funds Office at (323) 221-5861 or toll-free at (800) 824-6935, and ask to speak with a Membership Services Department representative. Office hours are Monday through Friday from 9 a.m. to 5 p.m.


Southern California IBEW-NECA Retiree Health Plan
Monthly Pension Deduction/Self-Payment Amount (Effective 10/1/10 through 9/30/11)

Kaiser Permanente

EARLY RETIREE
(No Medicare Coverage)
MEDICARE ELIGIBLE
(Enrolled in Medicare Parts A & B)
One Early Retiree & One Medicare
Plan
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Kaiser HMO Retiree Only
$21
$24
Not Applicable
Not Applicable
Kaiser HMO Retiree and Spouse
$42
$48
Senior Advantage Retiree Only
Not Applicable
$12
$13
Not Applicable
Senior Advantage Retiree and Spouse
$24
$26
Retiree & Spouse



$33
$38

PacifiCare

EARLY RETIREE
MEDICARE ELIGIBLE
One Early Retiree & One Medicare
Plan
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
PacifiCare HMO Retiree Only
$26
$28
Not Applicable
Not Applicable
PacifiCare HMO Retiree and Spouse
$54
$57
Secure Horizons Retiree Only
Not Applicable
$15
$16
Not Applicable
Secure Horizons Retiree and Spouse
$29
$32
Retiree & Spouse



$36
$39

Premium Reimbursement - The maximum dollar reimbursement is $312.57 for one retiree and $655.44 for retiree and spouse coverage.

EARLY RETIREE
MEDICARE ELIGIBLE
Plan
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Retiree Only
$26
$28
$26
$28
Retiree and Spouse
$54
$57
$54
$57

Medicare Supplement - The maximum annual benefit is $2500 per person per year.

EARLY RETIREE
MEDICARE ELIGIBLE
Plan
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Current
(10/1/09-9/30/10)
New
(10/1/10-9/30/11)
Retiree Only
Not Applicable
$22
$22
Retiree and Spouse
$44
$44

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