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Retiree Health Plan Benefit Tabs™

This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Retiree Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.


Eligibility
 

Medicare participants enrolled in Kaiser Senior Advantage or Anthem Medicare have vision and dental benefits through the carrier.


Summary of Benefits
 

Summary of Benefits for Medicare Eligible Retirees (Enrolled in Medicare Parts A &: B)

  Kaiser Permanente Senior
Advantage HMO
Anthem Blue Cross Medicare
Preferred PPO

(In Network)
 

Diagnostic Services: No Charge

Preventative: $15 co-payment (2 routine cleanings every calendar year)

Please refer to the Evidence of Coverage or Description of Benefits and Copayments related to Fillings, Other Minor Services, Simple Extractions, Oral Surgery, Endodontics, Periodontics, Crowns

(See the DeltaCare Evidence of Coverage for additional details and coverages)

Routine Vision Services

$5 per visit

($150 allowance for eyeglasses or contact lenses every 24 months)

No Charge

($150 allowance for eyeglasses or contact lenses every 12 months)


General Information
 

Kaiser Permanente Dental Benefit is provided through Delta Dental

Anthem Blue Cross