Retiree Health Plan -
Self Payment Rates Effective 10/1/12

REVISED

Date: August 1, 2012
To: Southern California IBEW-NECA Retiree Health Plan Participants (Kaiser Permanente, UnitedHealthcare, Medicare Supplement, and Premium Reimbursement Plans)
From: Southern California IBEW-NECA Administrative Trust Funds Office

Re: Retiree Health Plan – Self-Payment Rates Effective 10/1/12

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 determined that it is necessary to increase the self-pay rates from 15% of premium costs to 25% of premium costs for the period beginning October 1, 2012. The Board"„¢s decision is based 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 September 1, 2012 for an October 1, 2012 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 10/1/12 through 9/30/13)

Kaiser Permanente


EARLY RETIREE
(No Medicare Coverage)

MEDICARE ELIGIBLE
(Enrolled in Medicare Parts A & B)

One Early Retiree & One Medicare

Plan

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Kaiser HMO
Retiree Only $77 $142 Not Applicable Not Applicable
Retiree and Spouse $154 $284
Senior Advantage
Retiree Only

Not Applicable

$41 $68


Not Applicable


Retiree and Spouse

$82

$135

Retiree & Spouse




$118

$210

UnitedHealthcare


EARLY RETIREE

MEDICARE ELIGIBLE

One Early Retiree & One Medicare

Plan

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

UnitedHealthcare HMO
Retiree Only $91 $154

Not Applicable

Not Applicable

Retiree and Spouse

$188

$307

Secure Horizons
Retiree Only

Not Applicable

$54 $93

Not Applicable


Retiree and Spouse

$108

$187

Retiree & Spouse




$145

$247

Premium Reimbursement - The maximum dollar reimbursement is $405.96 for one retiree and $811.92 for retiree and spouse coverage.


EARLY RETIREE

MEDICARE ELIGIBLE

Plan

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Retiree Only $91 $154 $91 $154

Retiree and Spouse

$188

$307

$188

$307

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


EARLY RETIREE

MEDICARE ELIGIBLE

Plan

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Current
(through 9/30/12)

New
(10/1/12-9/30/13)

Retiree Only

Not Applicable

$69 $107

Retiree and Spouse

$138

$215

Recent Plan News