SOUTHERN CALIFORNIA IBEW-NECA HEALTH & WELFARE TRUST FUND

Important Notice to Participants
December 23, 2011

Dear Participant:

As most of you are aware, the cost of providing health benefits continues to rise. In order for the Trustees to maintain the health plan benefits, a change in the body scan benefits was made. The Trustees have elected to implement a 50% co-payment for the Body Scan benefit. Effective February 1, 2012, the co-payment for body scans received on or after February 1, 2012 will be 50% which is equivalent to $447.50. This benefit is not subject to the satisfaction of the annual deductible.The Body Scans are limited to one per eligible individual per calendar year.

All services must be rendered by Body Scan International. Claims from other providers will not be paid.

This Notice is a Summary of Material Modifications ("SMM") within the meaning of section 104 of the Employee Retirement Income Security Act of 1974.An SMM describes changes to the information provided in the most recent SPD. The SMM describes important changes to the Plan effective as of the date listed above.Please keep this SMM with your SPD for future reference.Please contact the Plan Office if you would like to request a copy of the Plan document, SPD or any SMM relating to the Plan.

Additional Benefits

Body Scan & Specialized Footwear
This Plan provides Participants with the following additional benefits:

Body Scan Benefit

The Body Scan Benefit is available to Participants, Eligible Spouses and Eligible Registered Domestic Partners under the Southern California IBEW-NECA Active Health Plan. The Body Scan Benefit is provided exclusively at this time through Body Scan International ("BSI").

Each Eligible Participant, Dependent Spouse and Registered Domestic Partner is entitled to one Body Scan Benefit per calendar year.The Body Scan Benefit is provided at a 50% copayment, or $447.50. BSI will submit your claim for the Body Scan Benefit directly to the appropriate claim administrator: Allied Administrators for HMO Participants; and Anthem Blue Cross for Participants in the Blue Cross PPO Plan.

To schedule an appointment for the Body Scan Benefit, Participants must call BSI at 877-BSI-5577.Please note that you must be eligible for coverage at the time of your body scan appointment to receive the Body Scan Benefit under the Active Health Plan.

BSI performs the Body Scan examination at its offices located at 2722 Walnut Avenue, Tustin, California 92780. In addition BSI will perform the Body Scan examination at its mobile units which will be parked from time to time at various locations in the Los Angeles Metropolitan Area.Please note that advance appointments are also required for Body Scan examinations at the mobile units and the same restrictions apply in terms of eligibility.

BSI also provides other services that are not part of the Plan's Body Scan Benefit. Please note that payment for those other services will be your responsibility since they are not covered under the Plan's Body Scan Benefit unless they are otherwise eligible expenses.

If you obtain a body scan through another provider (other than BSI), the Plan will not pay for any portion of the body scan examination.

If you have any questions regarding the Body Scan Benefit, please contact Body Scan International at (877) 274-5577 or (949) 717-4500. If you have questions about your eligibility for this benefit, please contact the Administrative Office at (800) 824-6935 or (323) 221-5861.

Specialized Footwear Benefit

The Active Health 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 members enrolled for medical benefits in the Active Health Plan.Members enrolled in the Kaiser HMO Plan may utilize this new benefit or they may choose to obtain orthotics through Kaiser.

Eligible Expenses

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.

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.

Maximum Annual Benefit

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

Submission of Claims

Claims for eligible expense reimbursement under this provision shall be submitted to Allied Administrators at:
Allied Administrators, Inc.
P.O. Box 2500
San Francisco, CA 94126

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 or Member and not to the provider.

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;
    • Socks or any supplies that are not custom-made or of which the equivalent can be purchased without prescription; or
    • Services provided to Participants that do not suffer from foot disfigurement as defined above under "Eligible Expenses."

Recent Plan News