MASTER PLAN DOCUMENT AND PLAN DESCRIPTION OF …

MASTER PLAN DOCUMENT AND

PLAN DESCRIPTION OF

INTERNATIONAL ASSOCIATION OF HEAT & FROSTINSULATORS & ASBESTOS WORKERS – LOCAL 18

EMPLOYEE BENEFIT PLAN

Effective March 1, 2006

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I. SUMMARY OF MEDICAL/DENTAL/VISION BENEFITS......................................................... 1

A. SUMMARY OF LIMITING FACTORS..................................................................................................... 1B. SCHEDULE OF MEDICAL, DENTAL AND VISION BENEFITS................................................................. 2C. DESCRIPTION OF NETWORK PROVIDER MEDICAL COVERAGE........................................................... 6D. MAXIMUM MEDICAL BENEFITS ........................................................................................................ 6E. MEDICAL COSTS ............................................................................................................................... 6

1. Benefit Percentages..................................................................................................................... 62. Copayments ................................................................................................................................. 73. Deductible ................................................................................................................................... 74. Out-of-Pocket Maximums............................................................................................................ 7

F. DESCRIPTION OF MEDICAL BENEFITS................................................................................................ 81. Abortion....................................................................................................................................... 82. Acupuncture Treatment ............................................................................................................... 83. Allergy Injections and Surveys .................................................................................................... 84. Ambulance Service ...................................................................................................................... 85. Ambulatory Surgical Center........................................................................................................ 86. Birth Control ............................................................................................................................... 87. Birthing Centers .......................................................................................................................... 88. Chemical Dependency (Substance Abuse) .................................................................................. 89. Chemotherapy ............................................................................................................................. 910. Chiropractic Treatment............................................................................................................... 911. Dental Care for Accidental Injury............................................................................................... 912. Diagnostic Services ..................................................................................................................... 913. Emergency Room Treatment ..................................................................................................... 1014. Home Health Care Services ...................................................................................................... 1015. Hospice Care Expenses ............................................................................................................. 1016. Hospital Confinement................................................................................................................ 1117. Hospital Outpatient Treatment.................................................................................................. 1218. Infertility Treatment .................................................................................................................. 1219. Medical Supplies/Durable Medical Equipment......................................................................... 1220. Mental Health............................................................................................................................ 1321. Newborn Care Expenses ........................................................................................................... 1322. Nutritional Counseling .............................................................................................................. 1323. Oral Surgery.............................................................................................................................. 1324. Organ Transplants .................................................................................................................... 1425. Physical/Occupational Therapy ................................................................................................ 1426. Physician Services..................................................................................................................... 1527. Preadmission Testing ................................................................................................................ 1528. Pregnancy ................................................................................................................................. 1529. Prescription Drugs.................................................................................................................... 1630. Preventive Care......................................................................................................................... 1631. Private Duty Nursing ................................................................................................................ 1732. Radiation Therapy..................................................................................................................... 1733. Rehabilitation Facility............................................................................................................... 1734. Skilled Nursing Facility............................................................................................................. 1735. Smoking Cessation .................................................................................................................... 1736. Speech Therapy ......................................................................................................................... 1737. Sterilization ............................................................................................................................... 1838. Surgery ...................................................................................................................................... 1839. Temporomandibular Joint Dysfunction..................................................................................... 19

G. EXCLUSIONS FROM MEDICAL COVERAGE....................................................................................... 19H. DENTAL COVERAGE COSTS – BENEFIT PERCENTAGE ..................................................................... 24I. ALTERNATIVE DENTAL PROCEDURES ............................................................................................. 24

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J. PREDETERMINATION OF DENTAL CARE COSTS ............................................................................... 24K. SUMMARY OF DENTAL BENEFITS.................................................................................................... 24

1. Covered Preventive Services ..................................................................................................... 242. Covered Basic Services ............................................................................................................. 253. Covered Major Services ............................................................................................................ 264. Covered Orthodontia Services .................................................................................................. 27

L. EXCLUSIONS FROM DENTAL COVERAGE......................................................................................... 28M. VISION COVERAGE COSTS .............................................................................................................. 31N. SUMMARY OF VISION BENEFITS...................................................................................................... 31O. EXCLUSIONS FROM VISION COVERAGE .......................................................................................... 31

II. CARE MANAGEMENT.................................................................................................................. 34

A. PREAUTHORIZATION FOR HOSPITAL CONFINEMENT ....................................................................... 34B. MEDICAL CASE MANAGEMENT....................................................................................................... 35

III. ELIGIBILITY, ENROLLMENT AND EFFECTIVE DATES..................................................... 36

A. ELIGIBILITY .................................................................................................................................... 361. Employee ................................................................................................................................... 362. Employees of Employers Owned by Relatives........................................................................... 363. Employees with an Ownership Interest in an Employer ........................................................... 374. Non-Bargaining Unit Staff Employees of Incorporated Employers.......................................... 375. Employees in Newly Organized Groups and Newly Indentured Apprentices ........................... 386. Retiree ....................................................................................................................................... 407. Dependents ................................................................................................................................ 40

B. ENROLLMENT AND EFFECTIVE DATES ............................................................................................ 421. New Hire Enrollment................................................................................................................. 422. Special Enrollment .................................................................................................................... 443. Provisions of Certificates of Creditable Coverage.................................................................... 45

IV. RETIREE HEALTH BENEFITS.................................................................................................... 46

1. Eligibility ................................................................................................................................... 462. Family Security Benefits............................................................................................................ 473. Enrollment................................................................................................................................. 474. Payment for Retiree or Family Security Benefits ...................................................................... 485. Termination of Retiree Benefits................................................................................................. 486. Suspension of Retiree Medical Benefits .................................................................................... 497. Subsidy of Retiree Premiums - Retired Employees Separate Account (RESA) ......................... 49

V. EXTENSIONS OF COVERAGE .................................................................................................... 51

A. FMLA QUALIFIED LEAVE OF ABSENCE.......................................................................................... 51B. TOTAL DISABILITY EXTENSION OF COVERAGE ............................................................................... 51C. FAMILY SECURITY BENEFITS .......................................................................................................... 51D. SELF-PAYMENTS............................................................................................................................. 52E. COBRA CONTINUATION COVERAGE.............................................................................................. 54

VI. TERMINATION AND REINSTATEMENT OF COVERAGE................................................... 56

A. TERMINATION OF EMPLOYEE COVERAGE........................................................................................ 56B. TERMINATION OF DEPENDENT COVERAGE...................................................................................... 57C. REINSTATEMENT OF PARTICIPANT’S COVERAGE............................................................................. 57

1. COBRA Participants ................................................................................................................. 572. Reinstatement of Coverage Following a Military Leave........................................................... 573. Reinstatement of Coverage After Voluntary Termination of Employment ................................ 57

VII. CLAIMS........................................................................................................................................ 58

A. FILING............................................................................................................................................. 58

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B. APPEALING ..................................................................................................................................... 581. Explanation of Denial ............................................................................................................... 582. Request for Review .................................................................................................................... 593. Providing Additional Information ............................................................................................. 594. Decision on Review ................................................................................................................... 595. Explanation of Decision on Review........................................................................................... 596. Limitation .................................................................................................................................. 60

VIII. COORDINATION OF BENEFITS/THIRD PARTY LIABILITY ......................................... 61

A. ALLOWABLE EXPENSE .................................................................................................................... 61B. APPLICATION OF COORDINATION OF BENEFITS............................................................................... 61C. COORDINATION OF BENEFITS WITH MEDICARE............................................................................... 63D. RIGHT TO RECEIVE MEDICAL INFORMATION NECESSARY TO DETERMINE BENEFIT....................... 64E. PROTECTED HEALTH INFORMATION................................................................................................ 65

1. Disclosure of Summary Health Information ............................................................................. 652. Disclosure of Protected Health Information (PHI)................................................................... 653. Limitations of PHI Access and Compliance.............................................................................. 66

F. SUBROGATION/RIGHT OF REIMBURSEMENT.................................................................................... 66

IX. PLAN ADMINISTRATION ............................................................................................................ 69

A. PLAN ADMINISTRATOR ................................................................................................................... 69B. CLAIMS ADMINISTRATOR ............................................................................................................... 70C. PARTICIPANT .................................................................................................................................. 71

X. GENERAL PROVISIONS............................................................................................................... 74

A. LEGAL COMPLIANCE/CONFORMITY ................................................................................................ 74B. EFFECT OF PRIOR COVERAGE.......................................................................................................... 74C. SEVERABILITY ................................................................................................................................ 74D. HEADINGS....................................................................................................................................... 74E. WORD USAGE ................................................................................................................................. 74F. TITLES FOR REFERENCE .................................................................................................................. 74G. CLERICAL ERROR............................................................................................................................ 75H. MISSTATEMENTS............................................................................................................................. 75I. REFUND OF OVERPAYMENTS .......................................................................................................... 75J. WRITTEN AUTHORIZATION ............................................................................................................. 75

XI. DEFINITIONS.................................................................................................................................. 76

XII. IDENTIFICATION OF PLAN ................................................................................................... 84

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II.. SSUUMMMMAARRYY OOFF MMEEDDIICCAALL//DDEENNTTAALL//VVIISSIIOONN BBEENNEEFFIITTSS

A. Summary of Limiting Factors

This document serves as the Master Plan Document and as the Summary PlanDescription for this Plan. This document describes the conditions under which this Planwill pay for medical care. There may be circumstances when a Participant and hismedical provider determine that medical care which is not covered by this Plan isappropriate. All decisions regarding medical care are up to a Participant and his medicalprovider.

Several factors affect the Participant’s receipt of the benefits described in the Schedule ofBenefits which follows. The Participant must be properly enrolled and have coveragethat is effective and which is not limited by exclusions. The Participant’s benefits aresubject to coverage limits, claims limitations, satisfaction of Participant costs, andcoordination of benefits provisions. Benefits are listed and described first, subject to thelimitations described in detail in subsequent sections. Services are as specified;exclusions are examples only.

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B. Schedule of Medical, Dental and Vision Benefits

PLAN MAXIMUMS AND LIMITATIONS

Lifetime Maximum $500,000 per individual

Skilled Nursing Facility 45 days per Calendar Year

Treatment of Chemical Dependency $15,000 Lifetime(inpatient/outpatient combined)

Infertility Treatment $10,000 Lifetime(combined Family maximum)

Treatment of TemporomandibularJoint Syndrome

$1,000 Lifetime

Nicoderm/Habitrol Patches 1 course Lifetime

Preventive Care $500 per Calendar Year (1)

Wheelchair Rental up to 90 days per occurrence;or purchase of one every 5 years

CALENDAR YEAR DEDUCTIBLE

• Active Employees/Early Retirees(includes Dependents)

$250 per individual;$600 Family (cumulative)

• All Other Retirees (includes Dependents )

$150 per individual;$700 Family (cumulative)

(1) Please refer to Section F., Description of Medical Benefits, for an explanation ofcovered services. The services that are specified under “Preventive Care – OtherDiagnostic Services and Immunizations” will be subject to a $500 annual maximumbenefit.

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BENEFIT PERCENTAGES NETWORK NON-NETWORK

Hospital Expenses (inpatient/outpatient) 80%* 50%*

Physician Office Expenses 80%* 50%*

Second Surgical Opinions 80%* 50%*

Outpatient X-ray, Laboratory andDiagnostic Testing Expenses

80%* 50%*

Emergency Room Expenses(all related services)

• Life Threatening/Sudden & Serious Illness 80%* 80%*

• Non-Emergency Use $100 copayper visit, 80%* (2)

$100 copayper visit, 50%* (2)

Treatment of Mental Disorders 80%* 50%*

Treatment of Chemical Dependency 50%* 50%*

Urgent Care Facility/Physician Services 80%* 50%*

Skilled Nursing Facility Expenses 80%* 50%*

Hospice Care Expenses 80%* 50%*

Home Health Care Expenses 80%* 50%*

Private Duty Nursing Expenses 80%* 50%*

Surgical Expenses 80%* 50%*

Durable Medical Equipment/Supplies 80%* 50%*

Therapy Services(occupational, physical or speech)

80%* 50%*

(2) The emergency room copayment will be waived if the Participant is admitted directlyinto the Hospital from an emergency room visit.

*To the out-of-pocket limit, benefits thereafter will be payable at 100% for the remainderof that Calendar Year.

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BENEFIT PERCENTAGES (Continued) NETWORK NON-NETWORK

Preventive Care (1)

• Screening Tests

(Benefits are available for the Employee, spouseand Retirees only)

80%* 50%*

• Other Diagnostic Services andImmunizations

(Benefits are available for Active Employees andEarly Retirees only)

100% (1);deductible waived

100% (1);deductible waived

• Child Immunizations(Benefits are available for Dependent children upto age 8, enrolled under the Active Employeeand Early Retiree Plans only)

100% 100%

Prescription Drugs 80%* (3) (4) 80%* (3) (4)

All Other Covered Expenses 80%* 50%*

(1) Please refer to Section F., Description of Medical Benefits, for an explanation ofcovered services. The services that are specified under “Preventive Care – OtherDiagnostic Services and Immunizations” will be subject to a $500 annual maximumbenefit.

(3) A $750 per individual Calendar Year prescription drug deductible will be appliedinstead of the Calendar Year deductible for Medicare Primary Retiree Participants who areenrolled for Medicare Part D drug coverage.

(4) A $2250 per individual Calendar Year prescription drug deductible will be appliedinstead of the Calendar Year deductible for Retiree Participants who are eligible forMedicare Part D drug coverage, but who are not currently enrolled for such coverage.

* To the out-of-pocket limit, benefits thereafter will be payable at 100% for the remainderof that Calendar Year.

OUT-OF-POCKET MAXIMUM(excluding deductibles)

Per Individual $3,300 per Calendar Year

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DENTAL PLAN

BENEFIT MAXIMUM

Dental $750 per Calendar Year**

Orthodontia $1,500 Lifetime**

BENEFIT PERCENTAGES

Preventive Services 75%

Basic Services 75%

Major Services 75%

Orthodontia 75%

**Benefits paid for orthodontia treatment will also apply to the $750 Dental CalendarYear maximum.

VISION PLAN

SERVICES OR SUPPLIES MAXIMUM

Vision Benefit $175 per Calendar Year

Benefit Percentage 100% - all providers

Complete Visual Examination, including Refraction One per Calendar Year

Frames One frame per 24 months

Lenses, other than Contact Lenses, per pair One set per Calendar Year

Contact Lens,(including fitting, follow-up visits and contact lens)

One set per 24 months

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C. Description of Network Provider Medical Coverage

Network providers are Hospitals, Physicians or other providers who have agreed toprovide health care services to plan Participants at negotiated rates. Network providerlists will be furnished automatically and without charge to Employees. As specified inthis article, Network provider benefits are generally more generous than non-Networkprovider benefits. Network provider benefits will be payable to non-Network providersunder the following circumstances:

• Professional services rendered from an emergency room Physician, radiologist,anesthesiologist, or pathologist if such services are rendered in a Network facility.

• Treatment of a Medical Emergency.

• Services received by Participants who reside more than 25 miles from a NetworkMarket Area.

• Services received while traveling outside the Network servicing area.

D. Maximum Medical Benefits

Subject to the exclusions, conditions, and limitations stated in this document, the Planwill pay benefits to or on behalf of a Participant for covered medical expenses describedin this article up to the maximum amounts specified in the Schedule of Benefits.

The Plan will pay benefits for the Reasonable and Customary Charges for services andsupplies which are ordered by a Physician. However, Reasonable and Customarylimitations will not apply to Network PPO repriced claims. Services must be furnishedby an eligible provider and must be Medically Necessary.

The obligation of this Plan shall be fully satisfied by the payment of allowable expensesin accordance with the Schedule of Benefits. Benefits will be paid for the reimbursementof medical expenses incurred by the Participant if all provisions mentioned in thisdocument are satisfied. All payments made under this Plan for allowable charges will belimited to Reasonable and Customary or the applicable Network repriced amount.

E. Medical Costs

11.. BBEENNEEFFIITT PPEERRCCEENNTTAAGGEESS

After satisfaction of any applicable deductible, the Plan will provide the level of paymentindicated in the Schedule of Benefits. The Participant is responsible for the remainingpercentage.

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22.. CCOOPPAAYYMMEENNTTSS

A Participant may be assessed a $100 per-visit charge for emergency room visitsaccording to the Schedule of Benefits.

Note: The emergency room copayment will be waived if the Participant is admitteddirectly into the Hospital from an emergency room visit.

33.. DDEEDDUUCCTTIIBBLLEE

a) Level

Per Participant per Calendar Year: See Schedule of BenefitsPer Family per Calendar Year: See Schedule of Benefits

Note: Amounts applied to the Calendar Year deductible for Network providers will alsoapply to the Calendar Year deductible for non-Network providers and vice-versa.

b) Applicability

Carryover: Each Calendar Year, a new deductible must be satisfied. Any chargesincurred by an individual during the last three months of a year and applied toward suchindividual’s deductible for that year will be applied also toward such individual’sdeductible for the next year.

44.. OOUUTT--OOFF--PPOOCCKKEETT MMAAXXIIMMUUMMSS

The maximum amount a Participant must pay not including the Calendar Year deductibletoward eligible expenses. Expenses that are not covered do not apply to the out-of-pocket maximum, nor do penalties, the emergency room copayment, amounts over theReasonable and Customary limitation or the prescription drug deductible.

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F. Description of Medical Benefits

11.. AABBOORRTTIIOONN

Induced termination of a pregnancy for all covered females, by any acceptable means,only when Medically Necessary.

22.. AACCUUPPUUNNCCTTUURREE TTRREEAATTMMEENNTT

Benefits for acupuncture treatment when performed by a Physician will be availablewhen a medical diagnosis is made and the treatment and/or services being rendered arecovered expenses.

33.. AALLLLEERRGGYY IINNJJEECCTTIIOONNSS AANNDD SSUURRVVEEYYSS

Services and supplies related to the diagnosis and therapeutic treatment of allergies.

44.. AAMMBBUULLAANNCCEE SSEERRVVIICCEE

Professional ambulance service to the Hospital. In the event that a Sickness or Injuryrequires specialized emergency treatment not available at a local Hospital, transportationfor such treatment is covered when ordered by a Physician. The transportation within theUnited States and Canada must be by regularly scheduled airlines or railroad or by airambulance. The covered transportation is only from the city or town where the disabilityoccurred to the nearest Hospital qualified to render special treatment.

55.. AAMMBBUULLAATTOORRYY SSUURRGGIICCAALL CCEENNTTEERR

Facility charges for procedures performed in an Ambulatory Surgical Center andassociated services and supplies.

66.. BBIIRRTTHH CCOONNTTRROOLL

Benefits will be payable for expenses incurred by the Employee or spouse and will belimited to birth control pills, Intrauterine Devices (I.U.D.’s), Depo Provera injections,and charges incurred with the insertion or removal of Norplant subcutaneous birthcontrol.

Note: Benefits will be payable for expenses incurred by Dependent children only whenMedically Necessary.

77.. BBIIRRTTHHIINNGG CCEENNTTEERRSS

Facility charges for procedures performed in a Birthing Center and associated servicesand supplies.

88.. CCHHEEMMIICCAALL DDEEPPEENNDDEENNCCYY ((SSUUBBSSTTAANNCCEE AABBUUSSEE))Benefits will be payable subject to the maximum amount indicated in the Schedule ofBenefits for the following:

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a) InpatientSemiprivate room accommodations and Medically Necessary services and suppliesfurnished by the Hospital or facility for diagnosis or treatment of Chemical Dependency.

b) OutpatientMedical Expenses for Outpatient treatment of Chemical Dependency including thefollowing:

• Medically Necessary services and supplies provided by a Hospital or otherduly licensed facility on an Outpatient basis.

• Physician office visits or Physician visits on an Outpatient basis at a Hospitalor other licensed facility.

99.. CCHHEEMMOOTTHHEERRAAPPYY

A regimen comprised of a single agent or a combination of anti-cancer agents clinicallyrecognized for treatment of a specific type of cancer, including modifications andcombinations appropriate to the history of the cancer or according to protocol specifyingthe combination of drugs, doses, and schedules for administration of the drugs.

Drug Requirements

• Use that is included as an indication on the drug’s label as approved by theFDA or

• Use of an FDA-approved drug for an off-label purpose that is medicallyaccepted for an anti-cancer therapeutic regimen as evidenced by major drugcompendia, medical literature, and/or accepted standards of medical practice.

• Use of drugs to treat toxicities or side effects of the cancer treatment regimenwhen the drug is administered in relation to chemotherapy, including off-labeluses supported by medical literature.

1100.. CCHHIIRROOPPRRAACCTTIICC TTRREEAATTMMEENNTT

Diagnostic evaluations and treatments by manipulation and other modalities.

1111.. DDEENNTTAALL CCAARREE FFOORR AACCCCIIDDEENNTTAALL IINNJJUURRYY

Treatment of Accidental Injuries to the jaw, mouth, or sound natural tooth (a tooth whichis free of decay but may be restored by fillings, has a live root, and does not have a cap orcrown).

1122.. DDIIAAGGNNOOSSTTIICC SSEERRVVIICCEESS

Services performed for the express purpose of determining the cause of definitesymptoms experienced by the patient, not in connection with routine physicalexaminations except as specified in this Plan Document. Covered expenses include:

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• Pathology• Radiology• Physician’s Interpretation.

1133.. EEMMEERRGGEENNCCYY RROOOOMM TTRREEAATTMMEENNTT

Benefits will be payable as stated in the Schedule of Benefits for the following:

a) Life-Threatening/Sudden & Serious IllnessImmediate care required for a life-threatening Medical Emergency or Accidental bodilyInjury which untreated could result in death or serious bodily impairment.

b) Non-Emergency UseCare received for Sickness or Injury which does not qualify as life-threatening.

Note: The emergency room copay will not apply if the Participant is admitted directlyinto the Hospital from an emergency room visit.

1144.. HHOOMMEE HHEEAALLTTHH CCAARREE SSEERRVVIICCEESS

a) ServicesPart-time or intermittent nursing care provided or supervised by a Registered Nurse(R.N.) to the limit provided for Nursing Care; part-time or intermittent home health aideservices, primarily for the patient’s medical care; physical, occupational, speech, orrespiratory therapy by a licensed qualified therapist; nutrition counseling provided by orunder the supervision of a registered dietician; or medical supplies, laboratory services,drugs, and medications prescribed by a Physician.

b) RequirementsServices must be provided in the patient’s home under a written plan of the patient’sattending Physician’s stating the diagnosis, certifying that the Home Health Care is inlieu of Hospital Confinement, and further specifying the type and extent of treatment.

1155.. HHOOSSPPIICCEE CCAARREE EEXXPPEENNSSEESS

a) Services• Hospice room and board while the terminally ill person (diagnosed by the

attending Physician as having six months or less to live) is an inpatient in aHospice;

• Outpatient and other customary Hospice services provided by a Hospice orHospice team; and

• Counseling services provided by a member of the Hospice team.

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b) RequirementsThese services and supplies are eligible only if the Hospice operates as an integral part ofa Hospice Care Agency and the Hospice team includes at least a doctor and a registeredgraduate nurse. Each service or supply must be:

• Provided under a Hospice Care Agency program that meets standards set bythe Plan. If such a program is required by federal or state law to be licensed,certified, or registered, it must meet that requirement;

• Provided while the terminally ill person is in a Hospice Care Program; and• Ordered by the doctor directing the Hospice Care Program.

1166.. HHOOSSPPIITTAALL CCOONNFFIINNEEMMEENNTT

a) Room and BoardSemi-private room accommodations, including general nursing services. Room chargesmade by a Hospital having only private rooms will be paid as if the room were a semi-private room. Expenses for special care units, including general nursing services.Special care units include intensive care units, cardiac care units, respiratory care units,step down units, emergency care facilities, and other units considered by the Plan to bespecial care units.

If a private room is Medically Necessary for isolation purposes, the private room chargewill be considered as semiprivate.

b) Hospital Services and SuppliesBenefits will be payable for Medically Necessary services and supplies furnished duringa covered Hospital Confinement, including, but not limited to, the following:

• Meals and special diets• Operating and recovery rooms• Drugs and medicines required during a period of confinement• Oxygen and the use of equipment for its administration• Laboratory and pathological tissue examinations• Dressings and casts• Thyroid function studies• Blood transfusion services• X-ray and other radiological examinations• Electrocardiograms• Electroencephalograms• Physical therapy• Inhalation therapy• Use of heart-lung equipment• Kidney dialysis services• Anesthesia services

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• Use of anesthesia equipment• Radioactive materials and radiation therapy• Diagnostic services

1177.. HHOOSSPPIITTAALL OOUUTTPPAATTIIEENNTT TTRREEAATTMMEENNTT

Services rendered in an Outpatient department of a Hospital, including, but not limited to,the following:

• Allergy testing• Chemotherapy• Dialysis• Emergency Room Services• Laboratory Tests and X-Rays• Pre-Admission Testing• Radiation Therapy• Respiratory Therapy• Surgical Services

1188.. IINNFFEERRTTIILLIITTYY TTRREEAATTMMEENNTT

Benefits will be payable, subject to the maximum indicated in the Schedule of Benefits,for the diagnosis and treatment of infertility including but not limited to:

• Diagnostic procedures and related expenses (including X-ray and laboratoryexaminations) performed to determine the cause of infertility; and

• Assisted impregnation procedures.

1199.. MMEEDDIICCAALL SSUUPPPPLLIIEESS//DDUURRAABBLLEE MMEEDDIICCAALL EEQQUUIIPPMMEENNTT

Coverage includes, but is not limited to, the following:

• Rental or initial purchase (whichever is less expensive, subject to approval bythe Plan) of Durable Medical Equipment, including, but not limited to,respiration equipment, hospital beds, and wheelchairs. Replacement ofDurable Medical Equipment when Medically Necessary due to aphysiological change to the patient, due to normal wear and tear of an item orthe existing equipment is damaged and cannot be made serviceable.

• Wheelchair, subject to the maximum indicated in the Schedule of Benefits.• Blood and blood plasma (unless replaced by or for the patient).• Artificial limbs, eyes, and larynx (including fitting); heart pacemaker, surgical

dressings; cast; splints; trusses; braces; crutches.• Oxygen, lenses following cataract surgery, insulin and diabetic supplies.

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2200.. MMEENNTTAALL HHEEAALLTTHH

a) InpatientSemiprivate room accommodations and Medically Necessary services and suppliesfurnished by the Hospital or facility for diagnosis or treatment of Mental Disorders.

b) OutpatientMedical Expenses for Outpatient treatment of Mental Disorders including the following:

• Medically Necessary services and supplies provided by a Hospital or otherduly licensed facility on an Outpatient basis, including laboratory testing.

• Physician office visits or Physician visits on an Outpatient basis at a Hospitalor other licensed facility.

• Outpatient shock therapy.

2211.. NNEEWWBBOORRNN CCAARREE EEXXPPEENNSSEESS

Payment for covered Hospital and Physician expenses incurred by a well newborn childfor the initial Hospital confinement immediately following birth will be made on thesame basis as for any Sickness provided the Employee has properly enrolled hisDependents for Dependent benefits and Dependent benefits are effective.

When a newborn incurs charges as a result of Sickness, Injury or congenital abnormality,payment for covered expenses incurred for Hospital and Physician services duringHospital confinement immediately following birth will be made on the same basis as forany Sickness provided the Employee has properly enrolled his Dependents for Dependentbenefits and Dependent benefits are effective.

2222.. NNUUTTRRIITTIIOONNAALL CCOOUUNNSSEELLIINNGG

Nutritional counseling rendered by a licensed nutritionist (if licensing is required by thestate) or registered dietician. Benefits will be limited to the following conditions:

• Diabetes• Pre and post covered weight loss surgery• Post cardiac surgery

2233.. OORRAALL SSUURRGGEERRYY

Benefits are limited to osseous surgery (osteoplasty and ostectomy), to modify the bonysupport of the teeth, including flap entry and closure.

Note: The benefit listed above is in reference to dental services covered under theMedical Plan, for a complete listing of Dental Plan benefits, please refer to pages 24through 30.

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2244.. OORRGGAANN TTRRAANNSSPPLLAANNTTSS

a) ServicesCovered expenses related to non-experimental human organ transplants which areMedically Necessary. Covered procedures include, but are not limited to:

• Bone Marrow• Cornea• Heart• Heart/lung• Kidney• Liver• Lung• Pancreas

The Plan will also cover any other types of human organ transplants that becomeaccepted as non-experimental procedures, as determined by the Plan Administrator.Covered charges include acquisition cost and drugs, even if not otherwise covered underthis Plan.

Covered transplant-related expenses incurred by a living donor will be eligible if no othermedical coverage is available. In addition, donor expenses that are incurred for atransplant recipient who is a Participant covered under this Plan will be subject to theParticipant’s maximum payable under this Plan.

b) RequirementsTransplants: Any human solid organ or bone marrow/stem cell transplant provided that:

1) The condition is life-threatening; and2) Such transplant for that condition follows a written protocol that has been

reviewed and approved by an institutional review board, federal agency orother such organization recognized by medical specialists who haveappropriate expertise; and

3) The patient is a suitable candidate for the transplant approved by the Plan.

2255.. PPHHYYSSIICCAALL//OOCCCCUUPPAATTIIOONNAALL TTHHEERRAAPPYY

Medically Necessary services, as certified by a Physician, rendered by a certified orlicensed physical therapist or registered occupational therapist. Therapy rendered by alicensed therapist to restore the loss or impairment of motor functions resulting fromillness, disease or Injury. Coverage ends once maximum medical recovery has beenachieved and further treatment is primarily for maintenance purposes. Only therapydesigned to restore motor functions needed for activities of daily living (such as walking,eating, dressing, etc.) is covered.

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2266.. PPHHYYSSIICCIIAANN SSEERRVVIICCEESS

a) Hospital InpatientInpatient Services and Medically Necessary consultations by a Physician to a Hospitalinpatient.

b) Physician Home/Office VisitsServices and supplies provided by a Physician in a professional office or in the home ofthe Participant when Medically Necessary.

c) OtherReasonable and necessary services of a Physician. Covered services include, but are notlimited to, the following:

• Allergy Injections• Allergy Testing• Cardiac Rehabilitation• Chemotherapy• Dermatology Testing• Dialysis• Emergency Room Services• Infusion Therapy• Injections• Interpretation of Diagnostic Tests• Radiation Therapy• Respiratory Therapy

2277.. PPRREEAADDMMIISSSSIIOONN TTEESSTTIINNGG

Medically Necessary diagnostic testing received by a Participant within 7 days prior to aninpatient Hospital admission.

2288.. PPRREEGGNNAANNCCYY

This Plan shall not restrict benefits for any Hospital length of stay in connection withchildbirth for the mother or newborn child to less than 48 hours following a normalvaginal delivery, or less than 96 hours following a cesarean section. This Plan shall notrequire that a provider obtain authorization from the Plan or the insurance issuer forprescribing a length of stay not in excess of the above periods, and nothing is to preventthe mother’s or newborn’s attending health care provider and the mother from agreeing toan earlier discharge. Notwithstanding the above, compliance with this Plan’s policy ofprecertification for maternity care management shall be required.

Regular Plan benefits (as specified in the applicable sections of this document) arepayable for expenses incurred by only the Employee or spouse.

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Services required for the normal management of pregnancy, including any conditionusually associated with the management of a difficult pregnancy but not considered acomplication of pregnancy. Antepartum and postpartum care of the mother is included.

Services required for the treatment of complication of pregnancy, including any physicaleffect directly caused by pregnancy but considered to be an effect of a normal pregnancy,conditions related to ectopic pregnancy or conditions requiring cesarean section.

Care for Miscarriage.

2299.. PPRREESSCCRRIIPPTTIIOONN DDRRUUGGSS

Medications which require a written prescription.

If a Participant uses the Express Scripts Discount Drug Card, he will receive a discountedprice at the time of purchase. The Participant will then submit the prescription drugclaim for processing under the major medical portion of this Plan. Expenses will bepayable as indicated in the Schedule of Benefits.

Note: Vitamins, (except for pre-natal vitamins), dietary drugs, food and/or foodsupplements will not be covered with or without a prescription.

3300.. PPRREEVVEENNTTIIVVEE CCAARREE

Charges for the following services will be eligible for benefits as specified in theSchedule of Benefits:

a) Screening TestsBenefits will be payable for expenses incurred for the following specified screening testsperformed as part of a routine examination:

• PAP tests;• Prostate tests (PSA);• Mammograms, limited to 1 baseline mammography screening for covered

females age 35 to 39; and one mammography screening per Calendar Year forcovered females age 40 and over;

• Fecal occult blood test; and• Colonoscopies.

b) Other Diagnostic Services and ImmunizationsBenefits will be payable for the following services, subject to the annual maximumindicated in the Schedule of Benefits. Routine physical examinations, immunizations, flushots and any diagnostic tests, not including the tests which are specifically listed above.Routine physical examinations and flu shots are limited to once per Calendar Year.

17

c) Child ImmunizationsRoutine pediatric immunizations/inoculations and flu shots for Dependent children, up toage 8.

3311.. PPRRIIVVAATTEE DDUUTTYY NNUURRSSIINNGG

Services certified as Medically Necessary by a Physician and provided by a nurse. Thenursing services provided must require the special skill and training of a RegisteredNurse, Licensed Practical Nurse or professional nurse.

3322.. RRAADDIIAATTIIOONN TTHHEERRAAPPYY

Radiation therapy by X-ray, radon, radium and radioactive isotopes.

3333.. RREEHHAABBIILLIITTAATTIIOONN FFAACCIILLIITTYY

Facility charges for rehabilitation treatment performed in a Rehabilitation Facility andassociated services and supplies.

3344.. SSKKIILLLLEEDD NNUURRSSIINNGG FFAACCIILLIITTYY

Benefits will be payable up to the maximum indicated in the Schedule of Benefits for thefollowing:

a) ServicesServices and supplies (other than personal items and professional services) providedwhile the patient is under continuous medical care and requires 24-hour nursing care, androom and board.

b) RequirementsConfinement must be ordered by the Physician as Medically Necessary for convalescencefrom the illness or Injury that caused the Hospital Confinement. The confinement startswithin 30 days of a Hospital Confinement of 3 days. The attending Physician completesa treatment plan which includes a diagnosis, the proposed course of treatment and theprojected date of discharge from the facility.

Note: Skilled Nursing will be limited to 45 days per Calendar Year unless additionaldays are authorized by Case Management.

3355.. SSMMOOKKIINNGG CCEESSSSAATTIIOONN

Smoking deterrent patches for the treatment of nicotine addiction, limited to themaximum amount indicated in the Schedule of Benefits.

3366.. SSPPEEEECCHH TTHHEERRAAPPYY

Therapy rendered by a certified speech therapist/pathologist on the recommendation andevaluation of a Physician to restore already established speech loss due to an illness orInjury or to correct an impairment due to congenital defect for which corrective surgeryhas been performed.

18

3377.. SSTTEERRIILLIIZZAATTIIOONN

Procedures to bring about, but not reverse, sterilization, regardless of Medical Necessity.

3388.. SSUURRGGEERRYY

a) SurgeonCharges for multiple surgical procedures will be a covered expense subject to thefollowing provisions:

• If bilateral or multiple surgical procedures are performed by one surgeon,benefits will be determined based on the Reasonable and Customary Chargethat is allowed for the primary procedures. Then a portion of the Reasonableand Customary Charge will be allowed for each additional procedureperformed through the same incision; as well as for each additional procedureperformed through a separate incision. Any procedure that would be anintegral part of the primary procedure or is unrelated to the diagnosis will beconsidered “incidental” and no benefits will be provided for such procedures.

• If multiple unrelated surgical procedures are performed by two or moresurgeons on separate operative fields, benefits will be based on theReasonable and Customary Charge for each surgeon’s primary procedure. Iftwo or more surgeons perform a procedure that is normally performed by onesurgeon, benefits for all surgeons will not exceed the Reasonable andCustomary percentage allowed for that procedure; and

• If an assistant surgeon is required, the assistant surgeon’s covered charge willnot exceed 25% of the surgeon’s Reasonable and Customary allowance.

b) AnesthesiologistServices of a qualified anesthesiologist (not the services of an operating surgeon or asurgical assistant) in administering regional or general anesthesia in connection with acovered surgical service. Usual related care rendered in connection with theadministration of anesthesia is covered.

c) Cosmetic SurgeryRequired Coverage for Reconstructive Surgery Following Mastectomies: This Plan shallprovide, in a case of a Participant who is receiving benefits in connection with amastectomy and who elects breast reconstruction with such mastectomy, coverage for:

• reconstruction of the breast on which the mastectomy has been performed;• surgery and reconstruction of the other breast to produce a symmetrical

appearance; and• prostheses and physical complications for all stages of mastectomy, including

lymphedemas;

19

in a manner determined in consultation with the attending Physician and the patient.Such coverage may be subject to annual deductibles and benefit percentage provisions asmay be deemed appropriate and as are consistent with those established for other benefitsunder the Plan.

d) Dental SurgeryDental services for the treatment of a fractured jaw or an Injury to sound natural teeth.Benefits are payable for the services of a Physician, Dentist or dental surgeon, providedthe services are rendered for treatment of an Accidental Injury.

3399.. TTEEMMPPOORROOMMAANNDDIIBBUULLAARR JJOOIINNTT DDYYSSFFUUNNCCTTIIOONN

Benefits will be payable subject to the maximum amount indicated in the Schedule ofBenefits for covered services and supplies recognized as effective and appropriate by themedical or dental profession as necessary to treat TMJ, myofacial pain dysfunctionsyndromes and other associated disorders.

G. Exclusions From Medical Coverage

The following exclusions apply to this Plan except that if any exclusion is contrary to anylaw to which this Plan is subject, the provision is hereby automatically changed to meetthe law’s minimum requirement.

Abortion, except as specified on page 8.

Bereavement Counseling.

Charges which are not Medically Necessary.

Cosmetic or Reconstructive Surgery. Cosmetic or reconstructive surgery unless thesurgery is necessary for (a) repair or alleviation of damage resulting from an Accident;(b) because of infection or Sickness; or (c) because of congenital disease,developmental condition or anomaly of a covered Dependent child which has resulted ina functional defect. A treatment will be considered cosmetic for either of the followingreasons: (a) its primary purpose is to beautify or (b) there is no documentation of aclinically significant impairment, meaning decrease in function or change in physiologydue to illness, Injury or congenital abnormality. The term “cosmetic services” includesthose services which are described in IRS Code Section 213(d)(9).

Custodial Care. Charges for custodial care, domiciliary care, rest cures, services thatare primarily educational in nature (except as specified), or any maintenance-type carewhich is not reasonably expected to improve the patient’s condition (except Hospice Careas specified).

Dental Treatment. Any dental treatment or services, except specified services andMedically Necessary Hospital expenses.

20

Educational or vocational testing. Services for educational or vocational testing ortraining, except as specified.

Exercise programs. Exercise programs for treatment of any condition, except forPhysician-supervised cardiac rehabilitation, occupational or physical therapy covered bythis Plan.

Experimental or Investigative. For the purposes of determining eligible expenses underthe Plan, a treatment (other than off label drug use) will be considered to be experimentalor investigational if:

• The treatment is governed by the US Food and Drug Administration (FDA) and theFDA has not approved the treatment for the particular condition at the time thetreatment is provided; or

• The treatment is subject to ongoing phase I, II, or III clinical trials as defined by theNational Institute of Health, National Cancer Institute, or FDA; or

• There is documentation in published US peer-reviewed medical literature that statesthat further research, studies, or clinical trials are necessary to determine safety,toxicity or efficacy of the treatment.

Any expenses for experimental or investigational treatment, or any Hospital confinementor treatment that results from the experimental or investigational treatment will beexcluded from coverage by the Plan.

Eye care. Glasses, contact lenses, or eye examinations and/or surgical (radialkeratotomy, lasix or other eye surgery) or nonsurgical treatment of refractive error for thecorrection of vision or fitting of glasses, except as specified.

Felony participation. Charges for a Sickness or Injury sustained during thecommission, or attempted commission, of an assault or felony; or Injuries sustained whileengaging in an illegal occupation.

Foot care. Treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgiaor bunions (except open cutting operations), and treatment of corns, calluses or toenails(unless needed in treatment of a metabolic or peripheral-vascular disease).

Functional Therapy. Charges made for functional therapy for learning or vocationaldisabilities or for speech, hearing and/or occupational therapy, unless specificallycovered under another provision of this Plan.

Government coverage. Charges for services or supplies provided by the VeteransAdministration or in any Hospital or institution owned, operated, or maintained by theUnited States Government for a service-related Sickness or Injury.

21

Hair loss. Care and treatment for hair loss including wigs, cranial prostheses, hairtransplants or any drug that promises hair growth, whether or not prescribed by aPhysician, except for wigs after chemotherapy.

Hearing Aids and Exams. Charges for services or supplies in connection with hearingaids or exams for their fitting.

Hospital Employees. Professional services billed by a Physician or nurse who is anemployee of a Hospital or Skilled Nursing Facility and paid by the Hospital or facility forthe service.

Infertility Treatment. Any infertility treatment, testing or any procedure for which thepurpose is to enhance the possibility of reproduction, except as specified.

Marriage Counseling.

No charge. Care or treatment for which there would not have been a charge if nocoverage had been in force.

Non-emergency Hospital Admissions. Care and treatment billed by a Hospital for non-Medical Emergency admissions on a Friday or a Saturday. This does not apply if surgeryis performed within 24 hours of admission.

No Obligation to Pay. Charges incurred for which the Plan has no legal obligation topay.

No Physician Recommendation. Care, treatment, services or supplies notrecommended and approved by a Physician; or treatment, services or supplies when theParticipant is not under the regular care of a Physician. Regular care means ongoingmedical supervision or treatment which is appropriate care for the Injury or Sickness.

Obesity. Care and treatment relating to weight loss or dietary control, including the careand treatment of obesity whether or not it is, in any case a part of the treatment plan foranother Sickness. Medically Necessary charges for Morbid Obesity, including but notlimited to Physician office visits, behavior modification and required X-ray andlaboratory examinations will be covered.

Occupational. Care and treatment of an Injury or Sickness that is occupational—that is,arises from work for wage or profit including self-employment regardless of theavailability of Workers’ Compensation coverage.

Orthoptics/Vision Therapy.

22

Personal Comfort Items. Personal comfort items or other equipment, such as, but notlimited to, air conditioners, air-purification units, humidifiers, electric heating units,orthopedic mattresses, blood pressure instruments, scales, elastic bandages or stockings,nonprescription drugs and medicines, and first-aid supplies and nonhospital adjustablebeds.

Physician Visits. Charges made by a doctor for phone calls or interviews when thePhysician does not see the patient for treatment. This also includes charges for failure tokeep a scheduled visit or charges for completion of a claim form.

Pregnancy of Dependent Child.

Reasonable and Customary. The part of an expense for care and treatment of an Injuryor Sickness that is in excess of the Reasonable and Customary Charge.

Relationships. Professional services performed by a person who ordinarily resides in theParticipant’s home or is related to the Participant as a spouse, parent, child, brother orsister, whether the relationship is by blood or exists in law.

Replacement Braces. Replacement of braces of the leg, arm, back, neck or artificialarms or legs, unless there is sufficient change in the Participant’s physical condition tomake the original device no longer functional or the age of the brace makes it no longerfunctional.

Self-inflicted Injury. Any loss due to an intentionally self-inflicted Injury. (UnderHIPAA, benefits for injuries generally covered under a plan cannot be excluded merelybecause they were self-inflicted or were sustained in connection with a suicide orattempted suicide if the injuries resulted from a medical condition such as depression.)

Services Before or After Coverage. Care, treatment or supplies for which a charge wasincurred before a person was covered under this Plan or after coverage ceased under thisPlan.

Sex Changes. Care, services or treatment for non-congenital transsexualism, genderdysphoria or sexual reassignment or change. This exclusion includes medications,implants, hormone therapy, surgery, medical or psychiatric treatment.

Speech Therapy for remedial or educational purposes or for initial development ofnatural speech. This would apply to children who have not established a natural speechpattern for reasons that do not relate to a congenital defect. In these cases, speechtherapy would be considered educational in nature and not eligible for coverage. Speechtherapy would not meet coverage criteria for the following conditions: chronic voicestrain, congenital deafness, delayed speech, developmental or learning disorders,environmental or cultural speech habits, hoarseness, infantile articulation, lisping, mentalretardation, resonance, stuttering, and voice defects of pitch, loudness, and quality.

23

Sterilization Reversal.

Third, or subsequent, surgical opinions.

Travel or Accommodations. Charges for travel or accommodations, whether or notrecommended by a Physician, except for ambulance charges as defined as a coveredexpense.

Vitamins. Charges for vitamins, minerals, non-prescription food and/or foodsupplements, contraceptives, medications used for contraceptive purposes and non-prescription dietary drugs, except as specified on page 8.

War. Any loss that is due to a declared or undeclared act of war.

24

H. Dental Coverage Costs – Benefit Percentage

If a Participant receives any necessary Dental services or treatment specified in thisSection, the Plan, subject to all the provisions of this Plan Document will pay:

75% of Reasonable and Customary expenses for covered Preventive, Basic, Major andOrthodontia Services.

I. Alternative Dental Procedures

If two or more alternate procedures, services, or courses of treatment may satisfactorilycorrect a dental condition, the least expensive procedure will be considered for payment.Such determination will be made by the Claims Administrator based upon professionallyendorsed standards of dental care.

J. Predetermination of Dental Care Costs

If the expenses to be incurred for the performance of a Dental Service or series of DentalServices can reasonably be expected to be $100 or more, those expenses may be includedas Covered Dental Expenses, provided the Claim Administrator agrees, throughPretreatment Review prior to the performance of the service or services, to accept thoseexpenses as Covered Dental Expenses. If the Claims Administrator does not so agreethrough Pretreatment Review, or if a description of the procedures to be performed andan estimate of the Dentist’s charges are not submitted in advance, the amount of expensesincluded as Covered Dental Expenses will be determined by the Claim Administratortaking in to account alternate procedures, services, or courses of treatment based uponprofessionally endorsed standards of dental care.

The Participant is responsible for the total dentist’s bill irrespective of the amountpayable by the Plan.

K. Summary of Dental Benefits

Covered Dental Expenses include Reasonable and Customary necessary expensesincurred for the services and supplies listed below:

11.. CCOOVVEERREEDD PPRREEVVEENNTTIIVVEE SSEERRVVIICCEESS

Initial or periodic oral examinations, but not more than twice per Calendar Year.

Prophylaxis, including cleaning, routine scaling and polishing, but not more than twiceper Calendar Year.

Palliative emergency treatment and emergency oral examinations.

25

Consultations, limited to once per Calendar Year.

Sealants, but not more than once per tooth, every 5 years.

Fluoride treatment for Dependent children up to age 16, but not more than once perCalendar Year.

Space maintainers, only when used to preserve space caused by prematurely lost teeth.

Fillings (amalgam, composite, plastic and acrylic), limited to once per Calendar Year pertooth surface.

Dental X-rays as follows:

• full mouth or panorex X-rays, but not more than once during any 36consecutive months;

• bitewing X-rays, but not more than twice per Calendar Year;• other dental X-rays as deemed necessary.

22.. CCOOVVEERREEDD BBAASSIICC SSEERRVVIICCEESS

Sedative fillings.

Extractions (simple, erupted and impacted).

Endodontics (root canal therapy).

Denture adjustments.

Repair of crowns, bridges, removable dentures and inlays.

Recementation of crowns and/or bridges, limited to one per Calendar Year for any givencrown, bridge or due to an Injury.

Biopsies of oral tissue.

Pulp vitality tests.

Home visits by a Physician when Medically Necessary in order to render a coveredDental Service.

Oral surgery.

Apicoectomy.

Hemisection.

26

General anesthesia administered in connection with a covered dental service only ifadministered by an individual licensed to administer general anesthesia.

Intravenous sedation.

Nitrous oxide.

Injection of antibiotic drugs.

Study models.

Pin retention.

Pulp caps.

Occlusal adjustment.

Periodontics:

Occlusal equilibration, when no restoration is involved.

Gingivectomy and gingivoplasty.

Gingival curettage.

Scaling and root planing.

Surgical periodontic examination.

Mucogingivoplastic surgery.

Management of acute periodontal infection and oral lesions.

Perio-prophylaxis.

33.. CCOOVVEERREEDD MMAAJJOORR SSEERRVVIICCEESS

Inlays, onlays, or crowns, either restorative or as part of a bridge, including precisionattachments for dentures.

Temporary crowns.

Gold restorations.

Denture relining, limited to one per denture, per Calendar Year. (Immediate dentures arelimited to two, per two years, following placement.)

Post and cores.

27

Fixed bridge repairs.

Initial dentures, full and partial, and bridges, fixed and removable.

Replacement of or addition of teeth to an existing removable denture (full or partial) orfixed bridgework as follows:

1. Replacement or addition of teeth is made necessary by the extraction ofnatural teeth;

2. Replacement is necessary when an immediate temporary denture was insertedshortly following extraction of teeth and cannot be economically modified tothe final shape required;

3. The existing denture or bridgework was installed at least five years prior to itsreplacement and the existing denture or bridgework cannot be madeserviceable.

44.. CCOOVVEERREEDD OORRTTHHOODDOONNTTIIAA SSEERRVVIICCEESS

Benefits will be payable for all covered Participants for the following:

Installations of orthodontic appliances and all orthodontic treatments concerned with thereduction or elimination of an existing malocclusion and conditions resulting from thatmalocclusion through correction of abnormally positioned teeth.

Diagnostic services, including examination, study models, radiographs and all otherdiagnostic aids used to determine orthodontic needs only once in any five (5) year period,commencing with the date of the initial visit.

Active orthodontic treatment for thirty-six consecutive months or less. Retentiontreatment for eighteen consecutive months or less.

If active or retention orthodontia treatment began prior to the date of coverage, themaximum number of months for which benefits will be provided will be reduced by thenumber of months during which treatment was rendered prior to the date of coverage.Covered expenses will be the monthly fee which has been determined by the Physician atthe time the charges were incurred.

28

L. Exclusions From Dental Coverage


Appliance Replacement. Appliance replacement performed less than five years after aplacement or replacement, except as specified.

Broken Appointments. Charges for failure to keep a scheduled visit or charges forcompletion of a claim form.

Cosmetic Dentistry. Dental care which is provided solely for the purpose of improvingappearance, when form and function of the teeth are satisfactory and no pathologicalcondition exists.

Denture Adjustments. Denture adjustments, except as specified.

Education or Training.

Employer Sponsored Services. Services or supplies received from a dental or medicaldepartment maintained by or on behalf of an employer, a mutual benefit association,labor union, trustees, or similar person or group.

Experimental or Investigational. Any treatment unless it is both (1) generallyaccepted by the dental community in the United States, meaning that the clinical efficacy(including the anticipation of use outweighing harm) of the treatment has beendocumented in credible published dental literature which demonstrates that the results ofthe treatment have been measured for a five-year period or other period generallyregarded as valid; and (2) the treatment, as compared to accepted alternative treatmentsfor that condition, can reasonably be expected to: (a) result in similar or improvedsurvival, health or function, or (b) alleviate symptoms of or stabilize the condition.


Government Coverage. Any treatment or service which is compensated for or furnishedby the local, state or federal government (except where required by law).

Harmful habit appliances.

Lost or Stolen Bridges or Dentures. Charges for replacement of bridges or dentureslost, misplaced or stolen.

29

Medical Treatment. Services, supplies, or treatment covered under the Medical Plan.

No Charge. Care or treatment for which there would not have been a charge if nocoverage had been in force.


No Physician Recommendation. Care, treatment, services or supplies notrecommended and approved by a Physician; or treatment, services or supplies when theParticipant is not under the regular care of a Physician. Regular care means ongoingdental supervision or treatment which is appropriate care for the Injury or Sickness.

Not Necessary Service or Supply. Services or supplies which are not necessary.


Personal Comfort Items. Personal hygiene, comfort or convenience items.

Personalized Services. Personalizing dental service by added restorations to artificialteeth, implant dentures, use of magnets, or similar procedures.



Replacement of Crowns. Replacement of defective or lost crown until five years haveelapsed from the date of insertion.

Replacement of Dentures or Bridges. Replacement at any time of dentures or bridgeswhich can be made serviceable.

Replacement of Orthodontia Appliances. Replacement and/or repair of any applianceused during the course of orthodontia treatment.


30

Services Before Coverage. Charges incurred for dental services which were ordered orstarted before coverage began, including but not limited to the installation, manufactureor filling of dental restorations (fillings, inlays, crowns, bridgework and dentures).

Splinting. Splinting for periodontal purposes and/or other appliances or restorationswhose primary purpose is to stabilize periodontally involved teeth.

Sport Appliances. Expenses related to services or supplies of the type normallyintended for sport or home use.

Subsequent Orthodontia Treatment. Orthodontia treatment rendered within five yearsafter the completion of a course of orthodontia treatment.

Temporomandibular Joint Dysfunction Syndrome. Treatment of TemporomandibularJoint Dysfunction Syndrome (including all myofacial pain syndromes and otherassociated disorders).

Tooth Implants.

Vertical Dimensions. Appliances or restorations necessary to increase verticaldimensions and/or restore the occlusion.


31

M. Vision Coverage Costs

If a Participant receives any necessary Vision services upon the recommendation of anoptometrist or ophthalmologist, the Plan will pay 100%, limited to the amounts and/orfrequency as specified in the Schedule of Benefits.

The Participant is responsible for the remaining cost irrespective of the amount payableby the Plan.

N. Summary of Vision Benefits

If a Participant receives any necessary Vision services upon the recommendation of anoptometrist or ophthalmologist, the Plan will pay for complete vision examinations(including refraction), frames, lenses, and contact lenses as specified in the Schedule ofBenefits.

O. Exclusions From Vision Coverage


Broken Appointments. Charges for failure to keep a scheduled visit or charges forcompletion of a claim form.

Diagnostic Services. Diagnostic services and drugs or medications that are not part ofthe vision exam.

Education or Training.

Employer Sponsored Services. Services or supplies received from a dental or medicaldepartment maintained by or on behalf of an employer, a mutual benefit association,labor union, trustees, or similar person or group.

Experimental or Investigational. Any treatment unless it is both (1) generallyaccepted by the medical community in the United States, meaning that the clinicalefficacy (including the anticipation of use outweighing harm) of the treatment has beendocumented in credible published medical literature which demonstrates that the resultsof the treatment have been measured for a five-year period or other period generallyregarded as valid; and (2) the treatment, as compared to accepted alternative treatmentsfor that condition, can reasonably be expected to: (a) result in similar or improvedsurvival, health or function, or (b) alleviate symptoms of or stabilize the condition.


32

Frame or Lens Replacement. Broken, lost or stolen lenses or frames.

Government Coverage. Any treatment or service which is compensated for or furnishedby the local, state or federal government (except where required by law).

Medical Treatment. Medical or surgical treatment of the eyes.

No Charge. Care or treatment for which there would not have been a charge if nocoverage had been in force.


No Physician Recommendation. Any treatment or service not prescribed by aPhysician or optometrist.

Not Necessary Service or Supply. Services or supplies which are not necessary.

Not Specified. Any charge not specifically listed as a covered expense.


Orthoptics. Orthoptics, visual training or subnormal vision aids.

Personal Comfort Items. Personal hygiene, comfort or convenience items.



Safety Glasses. Safety glasses or goggles.


Services Before or After Coverage. Charges before coverage began or after coveragehas terminated.

33

Specialty lenses. Sunglasses whether plain or prescription, any tinted lenses,photosensitive lenses, ultraviolet coating, anti-reflective coating and scratch-resistantcoatings.


34

IIII.. CCAARREE MMAANNAAGGEEMMEENNTT

A. Preauthorization For Hospital Confinement

If a Participant requires Hospital confinement for an Injury or Sickness, Hospitaladmission authorization and length of stay approval may be obtained from the CareManagement Organization prior to a nonemergency admission. In the event of anemergency admission, authorization should be obtained within 48 hours or as soon asreasonably possible given the facts and circumstances of the emergency admission.Refer to the Plan identification card for the telephone number to call for PrecertificationReview.

If confinement extends beyond the approved length of stay, additional days should beauthorized by the Care Management Organization. The same requirements and reductionpenalties will apply to the additional days.

The Care Management Organization does not verify, authorize or guarantee payment ofbenefits. The Care Management Organization’s authorization means only necessity oftreatment. It is not a certification that benefits are payable.

35

B. Medical Case Management

Medical Case Management is a cost management program administered to provide atimely, coordinated referral to alternative care facilities to a Participant who suffers acatastrophic Sickness or Injury while covered under this Plan.

The following are examples of diagnoses that might constitute a catastrophic Sickness orInjury:

High Risk PregnancyNeonatal High Risk InfantCerebral Vascular Accident (CVA or Stroke)Multiple SclerosisAmyotrophic Lateral Sclerosis (ALS)Cancers/Tumor MalignancySevere Cardio/Pulmonary DiseaseLeukemiaMajor Head Trauma and Brain Injury Secondary to IllnessSpinal Cord InjuryAmputationMultiple FracturesSevere BurnsAIDSTransplantAny claim expected to exceed $25,000

When the case manager is notified of one of the above diagnoses (or any other diagnosisfor which Medical Case Management might be appropriate), the case manager willcontact the Participant to discuss current medical treatment and facilitate future medicalcare. The case manager will also consult with the attending Physician to develop awritten plan of treatment outlining all medical services and supplies to be utilized, as wellas the most appropriate treatment setting. The treatment plan may be modifiedintermittently as the Participant’s condition changes, with the mutual agreement of thecase manager, the patient, and the attending Physician.

All services and supplies authorized by the treatment plan will be considered coveredexpenses, whether or not they are otherwise covered under the Plan. The benefit level foralternative treatment settings may be the same as the Hospital benefit level, in theabsence of the Medical Case Management program. For all other services and supplies,the benefit level will be the same as the benefit for outpatient medical treatment, in theabsence of the program.

Any deviation from the treatment plan without the case manager’s prior approval willnegate the treatment plan, and all charges will be subject to the regular provisions of thisPlan.

36

IIIIII.. EELLIIGGIIBBIILLIITTYY,, EENNRROOLLLLMMEENNTT AANNDD EEFFFFEECCTTIIVVEE DDAATTEESS

A. Eligibility

The following are eligible:

11.. EEMMPPLLOOYYEEEE

An active full-time Employee who is directly employed in the regular business of andcompensated for services by the Employer and regularly works as follows:

• Individuals with 400 hours of Employer contributions per Work Quarter; or• Individuals with 800 hours of Employer contributions for the preceding two Work

Quarters.

To become initially eligible an Employee must have 800 hours reported and paid for himby the Employer in the two immediately preceding Work Quarters. An Employee mayself-pay the difference between the hours contributed and 800 hours required for initialeligibility if 500 or more hours are reported and paid for by the Employer. The initialperiod of eligibility is 5 months.

In addition, if an Employer has filed bankruptcy and has not contributed to the Fund onthe Employee’s behalf, an Employee may self-pay for the number of hours worked forthat Employer for which contributions were due in order to gain initial eligibility. AnEmployee must verify the number of hours worked through pay stubs or otherdocumentation and the self-payment must be received in the Fund Office no more than 30days after the Employee becomes aware that the necessary contributions have not beenmade on his behalf.

22.. EEMMPPLLOOYYEEEESS OOFF EEMMPPLLOOYYEERRSS OOWWNNEEDD BBYY RREELLAATTIIVVEESS

An Employer must contribute a minimum of 40 hours per week for a relative-Employee.In addition, the following provisions apply to Employees of a company owned byrelatives of the Employee:

• Any Employer owned by a spouse, child, parent, brother or sister of an Employee willcontribute on the actual hours worked by the Employee in employment for whichcontributions are required to be made to this Fund under a Collective BargainingAgreement or participation agreement.

• If the Employer contributes on less than 40 hours per week for the relative-Employee,the Employer must keep records for at least four years that document the total hoursworked by the relative-Employee for the Employer, the hours for which contributionsare required to be made to this Fund, and a description of the different types andamount of work performed by the relative-Employee (including both work for whichcontributions are required and any other work).

37

• If the Employer contributes on less than 40 hours per week for the relative-Employee,the Employer must agree to permit the Fund to conduct an audit of the Employer ifthe pattern or amount of hours reported gives the Fund reason to believe that theEmployer is not correctly contributing for the relative-Employee or is abusing theFund’s eligibility rules. The Employer will be obligated to pay the audit fee if thecontributions owned to the Fund are 5% or more of total contributions due for theperiod audited.

• If the Employer does not keep records which document the hours and workperformed by the relative-Employee, refuses to permit an audit by the Fund orprovides false information to the Fund, the Employer must contribute a minimum of40 hours per week for the relative-Employee. This requirement may be appliedretroactively.

• If the relative-Employee loses coverage, the relative-Employee must self-pay underthe rules regulating self-payments.

33.. EEMMPPLLOOYYEEEESS WWIITTHH AANN OOWWNNEERRSSHHIIPP IINNTTEERREESSTT IINN AANN EEMMPPLLOOYYEERR

The Employer must contribute on the Employee’s behalf on the basis of 40 hours perweek and must remain current in contributions for Employees covered by the CollectiveBargaining Agreement. Also, the following rules will apply to an Employee with someownership interest in an active, incorporated Employer if that Employer contributes onbehalf of Employees covered under a Collective Bargaining Agreement or participationagreement.

• In the case of an Employee with an ownership interest in the Employer who is notactively involved in the management of the Employer, who performs work coveredby the Collective Bargaining Agreement and who is paid by the hour, the Employer isnot required to sign a participation agreement covering that Employee and contributesto this Fund in accordance with the Collective Bargaining Agreement covering theEmployee.

• In the case of an Employee with an ownership interest in the Employer who isactively involved in the management of the Employer or who is salaried, in order forthat Employee to participate in this Fund, the Employer must sign a participationagreement, must contribute on the Employee’s behalf on the basis of 40 hours perweek and must remain current in his contributions for the Employees covered by theCollective Bargaining Agreement.

44.. NNOONN--BBAARRGGAAIINNIINNGG UUNNIITT SSTTAAFFFF EEMMPPLLOOYYEEEESS OOFF IINNCCOORRPPOORRAATTEEDD EEMMPPLLOOYYEERRSS

Employers must contribute at least 40 hours per week for the first 6 months of anEmployee’s participation. Employers must contribute on a minimum of 40 hours perweek for salaried Employees. In addition, the Fund will allow participation of non-bargaining unit staff of incorporated participating Employers. A summary of the rulesare as follows:

38

• The contribution rate paid must be the same rate as that of the contributing Employer(with the option of including Active and Retires Employees’ Separate Accounts(ARESA), if the local participates in ARESA).

• Initial eligibility will begin when other coverage terminates, or according to theNewly Organized Group & Newly Indentured Apprentice rules – whichever is later.

• Employers must contribute on all hours worked for hourly Employees; however atleast forty (40) hours per week must be contributed on all staff Employees for the firstsix months of an Employee’s participation. Employers must contribute on aminimum of forty (40) hours per week for salaried Employees.

• Employees will be eligible under the Newly Organized Group & Newly IndenturedApprentice Rules until they gain eligibility under the Fund.

• All full time staff Employees must participate, unless covered by other coverage.Those covered by other coverage may opt back into this Plan when the othercoverage terminates, upon proof of termination of the other coverage.

• The Fund reserves the right to terminate any Employer’s staff participation.

• The Employer must provide the Fund with a list of all Employees showing whichEmployees will and will not participate, and the reason for non-participation.

55.. EEMMPPLLOOYYEEEESS IINN NNEEWWLLYY OORRGGAANNIIZZEEDD GGRROOUUPPSS AANNDD NNEEWWLLYY IINNDDEENNTTUURREEDDAAPPPPRREENNTTIICCEESS

The Employee must work at least 135 hours per month and the Fund must receivecontributions for those hours. Each month that the Employee works 135 hours, eligibilitywill be provided for two months, those two months being the two months following themonth worked. Once the Employee meets the initial eligibility rules of the Plan, thisprovision will be replaced with the eligibility requirements as indicated previously inSection A.1 - Eligibility, Employee.

a) Which Employees Qualify for These Special Rules?The Fund has established special eligibility rules for “Employees in Newly OrganizedGroups and Newly Indentured Apprentices”. The Employees who qualify for thesespecial rules are individuals who are not Participants in the Plan, who may be currentemployees of a newly organized company who sign a Collective Bargaining Agreementwith a participating Local Union or newly organized employees represented by aparticipating Local Union who are then employed by an Employer already contributing tothe Fund. A Newly Indentured Apprentice will be an Employee who enrolls in anapprenticeship program maintained by the Local Union which participates in the Funds,who has contributions made on his behalf and who has never before been eligible forbenefits from the Fund. These special eligibility rules are not available for current

39

employees represented by the Union or other regular applicants for representation by theLocal Union.

b) To What Period Do These Special Rules Apply?The eligibility requirements that are applicable to Employees in Newly OrganizedGroups and Newly Indentured Apprentices are for a limited period before an Employeeestablishes eligibility under the regular eligibility provisions of the Plan.

Once an Employee in a Newly Organized Group and Newly Indentured Apprenticesmeets the regular eligibility provisions of the Plan as described in Section A.1 -Eligibility, Employee, these special provisions are no longer applicable. In addition, if anEmployee in a Newly Organized Group or a Newly Indentured Apprentice does not meetthe regular eligibility provisions within nine (9) months of employment or loseseligibility, these special rules are no longer applicable. In either circumstance, theEmployee can then become eligible for benefits only by meeting the regular eligibilityprovisions of the Plan as described Section A.1 - Eligibility, Employee.

c) Initial EligibilityEmployees in Newly Organized Groups or a Newly Indentured Apprentice becomeseligible for benefits following a Waiting Period of the first day of the month followingcompletion of at least 135 hours in the immediately preceding calendar month for whichthe Fund receives contributions. The contributions for the first month of coverage andthe names of new Employees covered under this provision must be received in the FundOffice prior to the first day of the first month of coverage.

d) Continuing EligibilityOnce an Employee has earned initial eligibility they will stay eligible under these specialrules as long as the Employee works at least 135 hours per month and the Fund receivescontributions for those hours. Each month the Employee works at least 135 hours permonth and the Fund receives contributions for those hours, eligibility will be provided fortwo months, those months being the two months following the month worked.

Once the Employee qualifies for coverage under the regular eligibility provisions of thePlan as described in Section A.1 - Eligibility, Employee, these special provisions will nolonger apply.

e) Losing EligibilityEmployees and their Dependents who are eligible under the Employees in NewlyOrganized Groups and Newly Indentured Apprentice provisions may lose eligibility if:

• Fewer than 135 hours of Employer contributions are received by the Fund for amonth on the Employee’s behalf,

• The Employee works for a non-participating employer in the insulation industrywithin the geographic jurisdiction of the International Association of Heat and Frost

40

Insulators and Asbestos Workers. (In this case, eligibility terminates immediatelyunless such work is pursuant to a written agreement which is provided to the Fund.)

• The Employee is inducted into the Armed Forces.

• There is a Plan Amendment that affects eligibility.

• The Local Union withdraws from the Fund.

f) Re-establishing Lost EligibilityIf for any reason, an Employee who is eligible for benefits under the Newly OrganizedGroups and Newly Indentured Apprentice provisions loses his eligibility, he may re-establish coverage only by meeting the regular eligibility provisions as described inSection A.1 - Eligibility, Employee.

The only exception to the above provision is for an Employee who loses eligibilitybecause of induction into the Armed Forces. In this case, the Fund office must benotified, in writing, and the Employee’s status will be frozen for the length of service orfour years, whichever is less. If the Employee returns within 90 days of discharge, hewill regain his status in the Fund.

g) Insufficient HoursIf an Employee who is eligible for benefits under the Newly Organized Groups andNewly Indentured Apprentice provisions loses his eligibility due to an insufficientnumber of hours worked, coverage may be continued through the COBRA provisions ofthe Plan.

h) Total DisabilityIf an Employee who is eligible for benefits under the Newly Organized Groups andNewly Indentured Apprentice provisions loses his eligibility due to Total Disability,coverage may be continued through the COBRA provisions of the Plan.

i) Continuing Eligibility for Dependents upon Death of anEmployee

If an Employee who is eligible for benefits under the Newly Organized Groups andNewly Indentured Apprentice provisions dies, coverage for his Dependents may becontinued through the COBRA provisions of the Plan.

66.. RREETTIIRREEEE

Retired Employees who are in receipt of a qualified pension, and their eligibleDependents, may continue to be covered under the Plan. Please refer to SECTION IV,Retiree Health Benefits, for additional information.

77.. DDEEPPEENNDDEENNTTSS

A Participant can be covered simultaneously as an Employee and a Dependent.

41

a) SpouseThe Employee’s spouse who is not legally divorced from the Employee or whosemarriage to the Employee has not been otherwise legally terminated.

b) ChildrenAn Employee’s unmarried child from birth until the date he attains age 19, provided thechild is principally dependent on the Employee for his support and maintenance. (Proofmay be required.)

An Employee’s unmarried child at least 19 years of age to the date he attains 24 years ofage provided the child is a full-time student in an accredited school and is principallydependent (named as an exemption on the Employee’s most current Federal Income TaxReturn) on the Employee for his support and maintenance. (Proof may be required.)

An Employee’s unmarried child who is already covered under the Plan and who is 19years of age or older and who, from the date his coverage would otherwise terminateunder the Plan, is both (a) incapable of self-sustaining employment by reason of mentalretardation or physical handicap and (b) principally dependent (named as an exemptionon the Employee’s most current Federal Income Tax Return) upon the Employee forsupport and maintenance. (Proof may be required.)

The Fund will have the right to require due proof of the continuation of the mentalretardation and/or physical handicap and will have the right and opportunity to examinethe child whenever the Fund may reasonably require it during such continuation. Aftertwo years have elapsed from the date the child attained the limiting age, only oneexamination will be required per year.

A “Child” is:

• An Employee’s natural born child or legally adopted child, provided the childis principally dependent on the Employee for his support and maintenance.(Proof may be required.) An adopted child shall be considered a “child” fromthe moment the child is placed in the custody of the parents for adoption; or

• An Employee’s stepchild who resides in the Employee’s household in aregular parent-child relationship and is principally dependent (named as anexemption on the Employee’s most current Federal Income Tax Return) onthe Employee for support and maintenance (Proof may be required); or

• Any child for whom the Employee has been granted legal guardianship by acourt of law, provided that the child resides in the Employee’s household in aregular parent-child relationship and qualifies as an exemption under theInternal Revenue Code. (Proof may be required.); or

42

• Any child for whom the Employee is required to provide health care coverageunder a Qualified Medical Child Support Order. Participants have the right toobtain applicable determination procedures free of charge from the PlanAdministrator.

If both parents of a child are covered for benefits, either but not both may cover the childas a Dependent.

B. Enrollment and Effective Dates

When an Employee enrolls his Dependents and authorizes any required contributions forDependent benefits, Dependent benefits will become effective as follows:

• If an Employee has eligible Dependents on the effective date of his coverageand he has enrolled and authorized contributions for Dependent benefits on orprior to the Employee’s effective date, then coverage for those Dependentswill be effective on the date the Employee’s coverage begins.

• If an Employee does not have eligible Dependents on the effective date of his

coverage and later acquires his first eligible Dependent(s), and if he enrollsthem within 31 days of the date of acquisition, then coverage for theDependent(s) will be effective on the date of acquisition.

If the Employee is already enrolled for Dependent benefits, any newly acquiredDependents, including newborns, must be enrolled within 31 days of acquisition.Coverage will be effective on the date of acquisition.

Benefits will not become effective for the Dependents of an Employee unless theEmployee is covered, or simultaneously becomes covered, for benefits. Under nocircumstances will coverage for an Employee’s Dependents occur prior to coverage forthe Employee.

11.. NNEEWW HHIIRREE EENNRROOLLLLMMEENNTT

An Employee hired on or after the effective date of this Plan becomes eligible forbenefits on the first day following a Waiting Period of 5 months of maintaining theminimum required hours.

Employees complete all enrollment paperwork when hired. Once the Employee meetsthe requirements of maintaining the minimum number of hours for 5 months, coveragewill automatically become effective on the date the Employee is eligible for coverageprovided the Employee has enrolled and authorized any required contributions on or priorto the date eligible by completing the American Administrative Group, Inc. EnrollmentForm.

Coverage will be automatic for everyone but exclusionary people.

43

a) How To Become Eligible For BenefitsThe Fund is designed to pay benefits based on a “Quarters System” that determineseligibility to receive benefits. The Fund has two different types of quarters that affectbenefits. They are:

• Work Quarters; and• Eligibility Quarters

During the Work Quarter the Employee establishes his eligibility for benefits in a latertime period. A Work Quarter is a period of three months for which contributions aremade to the Fund on his behalf. The hours for each Work Quarter are the hours workedin the payroll periods which ended in the Work Quarter for which the payments aremade. An Eligibility Quarter is the minimum period of time for which the Employee iseligible for benefits based on the contributions made in an earlier Work Quarter.

To summarize, an Employee earns rights to benefits during the Work Quarter. Theserights then entitle the Employee to benefits that are available to him in the EligibilityQuarters that follow.

WORK QUARTERS DETERMINE ELIGIBILITYFOR….

ELIGIBILITY QUARTERS

JanuaryFebruaryMarch

JuneJulyAugust

AprilMayJune

SeptemberOctoberNovember

JulyAugustSeptember

DecemberJanuaryFebruary

OctoberNovemberDecember

MarchAprilMay

b) Continuing EligibilityOnce an Employee has earned his initial eligibility he will continue to earn three-monthperiods of eligibility (Eligibility Quarters). An Employee will stay eligible as long as heworks at least 400 hours per Work Quarter and the Fund receives Employer contributionsfor those hours. If an Employee drops below 400 hours in a Work Quarter he can stillmaintain eligibility if at least 800 hours of Employer contributions have been made forthe Employee in the last two Work Quarters.

If for any reason an Employee looses his eligibility for benefits, they can get it backagain on the first day of an Eligibility Quarter following completion of any work quarterfor which the Employer reported and paid a minimum of 400 hours on behalf of theEmployee. However, if the Employee is not eligible for 4 consecutive Eligibility

44

Quarters, they must satisfy the requirements for initial eligibility to once again becomeeligible.

The only exception for continuing eligibility is if eligibility is lost due to induction intothe Armed Forces. In this case, the Employee should notify the Administrator in writingand eligibility status will be frozen for the length of service or four years, whichever isless. If an Employee returns to work for the Employer within 90 days of discharge, hewill regain status in the Fund.

Each Employee becomes eligible to cover his Dependents for benefits on the later of thefollowing dates:

• the date he is eligible for benefits, if he then has a Dependent (spouse and/orchild);

• the date he acquires his first eligible Dependent through marriage, birth,adoption, or placement for adoption.

If an Employee does not enroll himself or himself and his Dependents within 31 days ofthe date eligible, he will not be eligible to enroll in the Plan until one of the followingoccurs:

22.. SSPPEECCIIAALL EENNRROOLLLLMMEENNTT

If an Employee experiences a loss of other health coverage, including COBRAContinuation Coverage, the existence of which was the reason for declining coverageunder this Plan when first eligible to enroll, then the Employee may enroll for coveragewithin 31 days of the loss of such coverage. Loss of coverage means that COBRAContinuation Coverage has been exhausted or that coverage which was not under aCOBRA Continuation provision has been terminated as a result of loss of eligibility forthe coverage or termination of employer contributions towards such coverage. Coveragewill be effective on the date of the occurrence.

If an Employee declined coverage for his Dependents under this Plan when first eligibleto enroll because his Dependents had other health coverage, including COBRAContinuation Coverage, and they experience a loss of the other health coverage asdescribed above, the Employee may enroll for Dependent benefits within 31 days of theoccurrence. Coverage will be effective on the date of the occurrence.

If an Employee acquires a Dependent through marriage, he may enroll for coveragewithin 31 days of the marriage. Coverage will be effective on the date of the marriage.

If an Employee acquires a Dependent through birth, adoption or placement for adoption,the Employee may enroll for coverage within 31 days of the birth, adoption or placementfor adoption. Coverage will be effective on the date of the acquisition.

45

33.. PPRROOVVIISSIIOONNSS OOFF CCEERRTTIIFFIICCAATTEESS OOFF CCRREEDDIITTAABBLLEE CCOOVVEERRAAGGEE

The Plan shall issue a Certificate of Creditable Coverage, automatically and withoutcharge, under the following circumstances:

1. For an individual who is a Qualified Beneficiary entitled to elect COBRA coverage,the Certificate of Creditable Coverage shall be issued with the COBRA notice sentafter the Qualifying Event.

2. For an individual who loses coverage under the Plan, but is not entitled to COBRAcoverage, the Certificate of Creditable Coverage shall be issued as soon as reasonablypossible after coverage ceases.

3. For an individual who is a Qualified Beneficiary and has elected COBRA coverage,the Certificate of Creditable Coverage shall be issued within a reasonable time afterthe cessation of COBRA coverage or, if applicable, after the expiration of any graceperiod for the payment of COBRA premiums.

The Plan shall also issue a Certificate of Creditable Coverage at any time within twenty-four (24) months after coverage ceases, provided that the Plan receives a written requestfor the Certificate of Creditable Coverage by the former Plan Participant (or by anotherperson authorized by the former Plan Participant).

The Certificate of Creditable Coverage shall be in the form required by HIPAA.

Also upon written request, the Plan shall provide a copy of the Plan Document and otherinformation as outlined in the model form established by HIPAA to provide additionalinformation on categories of benefits for plans that use the Alternative Method ofcounting Creditable Coverage. The Plan shall charge the requesting entity or individual afee to cover the reasonable cost of providing this information.

46

IIVV.. RREETTIIRREEEE HHEEAALLTTHH BBEENNEEFFIITTSS

11.. EELLIIGGIIBBIILLIITTYY

An Employee may be considered eligible for coverage as a Retiree based on thefollowing:

a) Pension-Based EligibilityIf an Employee is receiving a pension other than a deferred pension or a disabilitypension from Local 18, he may continue his and his Dependents’ eligibility as a Retireeby making self-payments. The amount of the self-payment and the benefits provided toRetirees are set by the Trustees. The Retiree does not have to be available for work.

Eligibility for Retiree coverage will be subject to the following:

• If the Employee is receiving a disability pension from Local 18, he must bepermanently and totally disabled based on either his receipt of a Social SecurityDisability Award or has been found by the Board of Trustees to be permanentlydisabled because of an asbestos-related disease.

• To continue eligibility while retired, he must either:

1) be eligible under this Fund at the time of his retirement (and not employedin the insulation industry by a non-contributing employer during thisperiod unless such work is pursuant to a written agreement between aparticipating Local Union and himself, a copy of which is provided to theFund); or

2) have worked for the International Association of Heat and Frost Insulatorsand Asbestos Workers, the AFL-CIO, a Building Trades Council, or ifapproved by the Board of Trustees, a related organization whose purposeis to promote the unionized insulation industry from the time he was lasteligible under the Fund until retirement.

b) Eligibility for Retirees who have an Ownership Interestin an Employer

If the Retiree is an Employee with Ownership Interests in an Employer who was coveredby the Special Participation Agreement of Employees with Ownership Interests and wasactively working and participating in the Fund at the time of retirement, he may continuehis eligibility while retired if he meets the requirements stated above.

However, the Retiree may satisfy the pension requirement if he is receiving a pensionother than a deferred pension from the pension fund of a Local Union participating in thisFund, by receiving one from the National Asbestos Workers Pension Fund, from thepension plan of an Employer signatory to a Collective Bargaining Agreement or aretirement benefit from the Social Security Administration.

47

22.. FFAAMMIILLYY SSEECCUURRIITTYY BBEENNEEFFIITTSS

If the Employee should die while he is a Retiree and receiving benefits under this Plan,the eligibility of his Dependents who are covered by the Retiree Benefits at the time ofhis death will terminate on the last day of the quarter for which a payment has been madefor coverage for that Dependent.

However, coverage may be continued for a Retiree’s widow(er) provided all of thefollowing conditions are met:

• The Retiree’s widow(er) has been married to the Retiree for at least one yearimmediately prior to his death;

• There is no other group health benefits coverage on the widow(er) (exceptMedicare); and

• Applicable payments are made as determined by the Trustees.

If the widow(er) is not eligible to continue coverage because he or she had other grouphealth benefits coverage at the time of the Retiree’s death, he or she can elect to haveRetiree Benefits reinstated when the other coverage terminates, provided application forreinstatement is made within 60 days after termination of the other coverage.*

*Except as stated above, if a widow(er) does not select Retiree coverage at the time he orshe first becomes eligible, the widow(er) may not select it later.

In addition, coverage under this Plan may be continued for a Retiree’s Dependentchildren subject to the following:

• Dependent children of a deceased Retiree may continue to be entitled tobenefits if payments are made on their behalf for as long as they would havebeen eligible if the Retiree had not died; and

• If the Dependent children became Dependents of the Retiree as a result of amarriage of less than one year prior to the death of the Retiree, the benefits ofsuch Dependent children will terminate at the death of the Retiree.

33.. EENNRROOLLLLMMEENNTT

An application for Retiree Benefits must be filed with proper payment within 60 daysfollowing termination of eligibility as an Eligible Employee. If the application is beingfiled by the widow(er) of a deceased active Employee, the application must be filed withproper payment within 60 days following the date the deceased Employee’s activeeligibility would have terminated if he had stopped working on the date of his death. Anapplication is not accepted until approved by the Executive Committee of the Board ofTrustees.

If a Participant is receiving Retiree Benefits as a single person, he may add Dependentsupon his remarriage or within 60 days after the birth of his Dependent child, after the

48

placement of a Dependent child with him for adoption, or after termination of hisDependent(s) (or Widow(er)s) eligibility under another group health plan.

44.. PPAAYYMMEENNTT FFOORR RREETTIIRREEEE OORR FFAAMMIILLYY SSEECCUURRIITTYY BBEENNEEFFIITTSS

Retiree Benefits will be provided as described above to eligible Retirees and their eligibleDependents, and to qualified widow(er)s. The Trustees will determine benefits providedto Retirees, which will not necessarily be the same as those provided to EligibleEmployees, The self-payment rates for Retirees will be set by the Trustees from time totime. The Trustees may change the self-payment rates and change or discontinuebenefits for Retirees at any time

If a Retirees’ or widows’ payment is not received by the second of the month, there willbe a $100.00 late fee imposed, and due within a 15-calendar day lapse period. If paymentis not made at the end of 30 calendar days, coverage will end and there will be noreinstatement. If there is a second occurrence of a late payment, a quarterly pre-paymentwill be mandatory for reinstatement.

Payment to the Fund for Retiree Benefits must be made monthly or quarterly in advanceby:

• The Retiree; or• An eligible widow(er); and/or• Someone on behalf of eligible Dependent children.

55.. TTEERRMMIINNAATTIIOONN OOFF RREETTIIRREEEE BBEENNEEFFIITTSS

Coverage for Retiree Benefits will terminate if payment for benefits is not made on atimely basis.

If a Retiree returns to employment covered by the Fund, Employer contributions will bemade on his behalf under the terms of the applicable Collective Bargaining Agreement orparticipation agreement. Coverage as a Retiree will terminate when the Retiree becomeseligible as an Active Eligible Employee or when he is employed in the insulation industrywithin the geographical jurisdiction of the International Association of Heat and FrostInsulators and Asbestos Workers by a non-participating employer, unless such work ispursuant to a written agreement between a participating Local Union and the Retiree, anda copy of which is given to the Fund. If the Retiree gains eligibility as an Active EligibleEmployee he will receive benefits as an Active Eligible Employee and he will not berequired to make payments for Retiree benefits.

When the Employee stops working in employment covered by the Fund, he will continueas an Active Eligible Employee until his active eligibility terminates under the plan. Atthat time he may reinstate his coverage as a Retiree if he is receiving a pension from theNational Asbestos Workers Pension Fund, but he must do so immediately. TheEmployee may not make self-payments to continue active eligibility. However, ifRetiree Benefits terminate for any reason, except during periods in which activeeligibility is established, Retiree Benefits may not be reinstated at a later date.

49

66.. SSUUSSPPEENNSSIIOONN OOFF RREETTIIRREEEE MMEEDDIICCAALL BBEENNEEFFIITTSS

a) to Participate in a Medicare HMOQualified Retirees and Dependents who are eligible for Medicare may elect to suspendRetiree coverage through the Fund in order to participate in an HMO, which has acontract with the Health Care Financing Administration (HCFA) to provide Medicareservices. Suspended Retiree coverage can be reinstated in the future, should the Retireeor his Dependent decide to terminate the Medicare approved HMO coverage.

In order to qualify for future reinstatement of Retiree coverage through the Fund, theRetiree will be required to provide evidence that he or his Dependent are continuouslycovered with a Medicare approved HMO program during the full suspension period.

b) When the Retiree Has Other CoverageQualified Retirees, spouses, and/or Dependents who are covered by other coverage mayelect a one-time option to suspend Retiree coverage through the Fund in order toparticipate in the other coverage. Suspended Retiree, spouse, and/or Dependent coveragecan be reinstated in the future, should the Retiree, his spouse, and/or Dependent decide toterminate the other coverage.

The Retiree will be required to provide evidence the he, his spouse and/or Dependentwere continuously covered under the other coverage during the full suspension period.

77.. SSUUBBSSIIDDYY OOFF RREETTIIRREEEE PPRREEMMIIUUMMSS -- RREETTIIRREEDD EEMMPPLLOOYYEEEESS SSEEPPAARRAATTEE AACCCCOOUUNNTT((RREESSAA))

Local 18 has negotiated a separate contribution to pay for Retiree Benefits andSupplemental Medical Benefits. These contributions are accounted for separately. If aRetiree believes he is entitled to participate, he should contact the Union and EmployerTrustees representing his local area or Fund Office.

The following guidelines list eligibility requirements for subsidy of Retiree premiums.

1. The Employee must be eligible for Retiree benefits from this Fund.

2. The Employee must have pension eligibility from the local area, either inthe Local Union pension fund or the National Asbestos Workers PensionFund. An Employee with Ownership Interests in an Employer satisfiesthe requirements of this paragraph if the Employee:

a. Is covered by Special Participation Agreement forEmployees with Ownership Interests;

b. Has pension eligibility from the local area either in theLocal Union pension fund, the national Asbestos WorkersPension Fund, the pension plan of an Employer signatoryto the Collective Bargaining Agreement in the local area or

50

for a retirement benefit from the Social SecurityAdministration; and

c. Was actively working and participating in the Fundimmediately prior to retirement.

3. The Employee must have ten (10) years of participation in Local 18Jurisdiction in this Fund.

4. The Employee must have seven (7) years of eligibility in Local 18Jurisdiction in this Fund.

5. For those who have not participated in this Fund for ten (10) years, therequirements of Paragraphs 3 and 4 above can be met by an Employeewho has participated in this Fund and has been eligible for benefits inseventy percent (70%) of the years the individual has participated in thisFund.

6. Local Union with an RESA may include an Eligible Employee who istotally and permanently disabled and receiving a Social SecurityDisability Benefit even though that Employee does not meet therequirements of other RESA eligibility guidelines indicated herein.

7. Contributions must have been made on the Eligible Employee’s behalfinto the RESA for thirty-six (36) out of the sixty (60) months, immediatelypreceding the Employee’s pension effective date. If an Employee has notbeen participating in this account for at least sixty (60) months, thencontributions must have been made for such Eligible Employee for 3/5 ofthe entire period said Employee has been participating.

8. If an Employee meets the guidelines for the RESA based on hisemployment with Local 18 but he is not working out of Local 18Jurisdiction at the time of his retirement, he may still be eligible toparticipate in the Local 18 RESA Program when he retires. In order toqualify under this rule he must have worked for the InternationalAssociation of Heat and Frost Insulators and Asbestos Workers, the AFL-CIO, a Building Trades Council or, subject to approval by the Trustees, arelated organization whose purpose is to promote the unionized insulationindustry, from the time he was last eligible under this Fund untilretirement.

51

VV.. EEXXTTEENNSSIIOONNSS OOFF CCOOVVEERRAAGGEE

A. FMLA Qualified Leave of Absence

If an Employee takes a qualified leave of absence as recognized by the Family MedicalLeave Act of 1993 or similar state law, coverage for the Employee and any coveredEligible Dependents may be continued for the duration of the qualified leave up to twelveweeks under the Family Medical Leave Act. The Employer will be responsible formaking any required contributions to the Plan.

Note: An Employee’s eligibility for FMLA leave will be determined by his Employer.The Plan plays no role in that determination.

B. Total Disability Extension of Coverage

If a Covered Employee becomes totally disabled, coverage for the Employee and anycovered Eligible Dependents may be continued for a maximum of 24 months* (to runconcurrently with the Family Medical Leave Act of 1993 extension of coverage ifapplicable). The Employee will be responsible for making any required contributions tothe Plan.

*Thereafter, an Employee may be eligible for Self-Pay for an additional 12 months (SeeSection V. Extensions of Coverage, D. - Self-Payments).

C. Family Security Benefits

Any Dependent benefits which are in effect under this Plan at the time of the Employee’sdeath will be continued after such death while any required contributions for suchcoverage are continued.

Dependent benefits will not be continued beyond the last day of the quarter in which theEmployee’s eligibility would have normally terminated (assuming the Employee wasworking until the time of his death), except as specified below. The widow(er) andeligible Dependents may continue coverage beyond the above provided:

• The spouse has been married to the Employee for at least one year immediatelyprior to death.

• There is no other group health benefits available.• The widow(er) makes the required payments.

For the purposes of filing proof of loss and payment of claims, the Employee’s spouse, ifliving, will be considered as the Participant, otherwise the Dependent child (or his legalguardian) claiming benefits will be so considered.

52

This provision will not apply to a Dependent for whom a greater period of continuationof coverage is provided elsewhere in this Plan Document.

D. Self-Payments

If an Employee has less than 400 hours reported and paid to the Fund on his behalf by theEmployer for a Work Quarter (or less than 800 hours in the last two Work Quarters), hewill lose eligibility for benefits unless he makes personal (self) payments to the Fund tomaintain eligibility. Self-payment amounts required are based on the number of hoursthe Employee is short of the minimum required and also on the self-payment rate whichis periodically set by the Trustees.

An Employee will not receive credit for any hours for which they have worked unlesscontributions for those hours at the correct rate are received by the Fund office. AnEmployee will be required to self pay to continue eligibility and will receive a full refundwhen the delinquent Employer makes the contributions on the Employee’s behalf. Ifthere are any unreported hours and/or unpaid contributions that require the Employee tomake a self-payment, an Employee should immediately report this to the delinquentEmployer, the Fund Office, the Local Union Business Manager, the Local Union, and theEmployer Trustees for the area in which the Employee is working.

An Employee may make self-payments to continue eligibility as long as he isimmediately available for work as an Asbestos Worker for a participating Employer. Ifan Employee works for a non-union Employer in the insulation industry within thegeographical jurisdiction of the International Association of Heat and Frost Insulatorsand Asbestos Workers, the Employee’s eligibility will be terminated and he will not beable to make self-payments unless such work is pursuant to a written agreement betweenthe Local Union and the Employee, and a copy of which is provided to the Fund.

a) Self Payment NoticeDuring the months of February, May August and November of each year, thoseEmployees whose hours are not sufficient to continue eligibility will receive a self-payment notice. This report contains the name of the Employer(s) for which theEmployee worked, the months worked and the number of hours reported and contributedto the Fund on behalf of the Employee for the most recent Work Quarter. If theEmployee does not agree with the hours reported, the Employee should se the reverseside to indicate what the hours should be and return it to the Fund Office with hispayment. The amount due is stated on the center of the report. Before returning thenotice and the payment to the Fund Office, it must be signed by the Employee at thebottom. The self payment is due within 15 days from the date of the notice or medicalcoverage will be terminated.

b) Additional Information Regarding Self-PaymentsSelf-payments will allow an Employee to maintain his and his Dependents’ eligibility ifhe does not have enough Employer contribution hours. Self-payments are limited in

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nature and the following are specific rules that apply to self-payments, includinginformation on how self-payments are calculated:

• An Employee may make self-payments to preserve his eligibility only if he isimmediately available for full-time employment as an Asbestos Worker with aparticipating Employer in Local 18.

• Self-payments must be made on time – within 15 days of the date of the Self-PaymentNotice. The Fund Office mails these notices quarterly in February, May, August andNovember.

• If an Employee does not get a Self-Payment Notice by the 15th day of the first monthof the Eligibility Quarter, it is the Employee’s responsibility to contact the FundOffice by the end of the month or he will lose eligibility from the first day of theEligibility Quarter.

• An Employee may also make payment of contributions under the following condition,provided he is in compliance with the previously stated rules. In the event that theEmployee has not had at least 800 hours reported and paid for him by his Employerduring two consecutive Work Quarters, but he has had at least 500 hours during suchperiod, he may elect to pay the difference between hours worked reported and paidand 800 hours, at the contribution rate in effect, to become eligible the first day of thenext applicable five month benefit period for initial eligibility.

• After an Employee has made self-payments to the Fund for one year (fourconsecutive Quarters), where no hours are reported by an Employer signatory to theCollective Bargaining Agreement, the amount of self-payment will be based on 520hours per Work Quarter. The amount of the self-payment will continue to be basedupon 520 hours per Work Quarter and at the rate set by the Board of Trustees until400 hours of work have been performed in covered employment in one Work Quarterfor which the Fund has received contributions.

• The contribution rate on which a self-payment is calculated is the rate that is in effectfor Local 18 under this Plan on the last day of the Eligibility Quarter.

• A new retiree may self-pay for active or retiree coverage for the first self-paymentafter retirement.

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E. COBRA Continuation Coverage

Federal Legislation known as the Consolidated Omnibus Budget Reconciliation Act of1985 as amended (COBRA) requires that an Employee and/or Dependent (QualifiedBeneficiary) may elect to continue coverage up to the length of time specified below afterthe occurrence of any of the following events which would normally result in terminationof coverage under the Plan, provided they pay the full cost of Plan coverage, not toexceed 102% of the total cost or 150% of the total cost during the 11-month extension fordisability.

Each Qualified Beneficiary, including the Employee, spouse or any Dependent coveredunder the regular Plan, may make an independent election for Continuation Coverage.

Coverage may be continued up to 18 months for an Employee and/or Dependent whosequalifying event is the termination of employment (other than by reason of grossmisconduct) or the reduction of hours of an Employee. Continuation coverage may beextended from 18 months to 36 months for Dependent(s) who are qualified beneficiariesif during the 18-month period a second qualifying event occurs, such as the Employeedies, enrolls in Medicare, or divorces or legally separates from his spouse. Thisextension may also apply upon the loss of Dependent status by a Dependent child, butonly if the event would have caused the spouse or Dependent child to lose coverageunder the plan had the first qualifying event not occurred.

Continuation coverage may extend from 18 months to 29 months for an Employee and/orDependent who is or becomes totally disabled (as determined by the Social SecurityAdministration under Title 2 or Title 16) at any time during the first 60 days of COBRAcontinuation coverage, provided that such Employee and/or Dependent has given noticeof the disability within 60 days of the Social Security determination and requested theextended continuation period before the end of the first 18 months. If during thecontinuation coverage the qualified beneficiary is later determined by the SSA to be nolonger disabled, the individual must inform the Plan of this redetermination within 30days of the date it is made.

Coverage may be continued for up to 36 months for a Dependent in the qualifying eventof:

(a) The death of the Employee;(b) The divorce or legal separation of the Employee from his spouse;(c) The Employee’s becoming entitled to Medicare, and as a result the loss of

eligibility for coverage under the Plan by him and his Dependents;(d) The loss of Dependent status by a Dependent child under the terms of this

Plan.

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Coverage will be continued only for those Employees and/or Dependents who werecovered under the Plan on the day immediately preceding termination. However, if achild is born or placed for adoption with the Participant during the period of COBRAcontinuation coverage, such child is entitled to receive COBRA continuation coveragewith independent COBRA rights.

Coverage will not be continued beyond the earliest of the following dates:

(a) The date ending the period for which any required contribution has beenpaid;

(b) The date the Employee and/or Dependent first become entitled toMedicare, or first becomes covered under another group health planwithout being subject to that plan’s preexisting limitations;

(c) The date the Employer ceases to provide any group health plan.

Sometimes, filing a proceeding in bankruptcy under Title 11 of the United States Codecan be a qualifying event. If a proceeding in bankruptcy is filed with respect toInternational Association of Heat & Frost Insulators & Asbestos Workers – Local 18, andthat bankruptcy results in the loss of coverage of any retired Employee covered under thePlan, the retired Employee is a qualified beneficiary with respect to the bankruptcy. Theretired Employee’s spouse, surviving spouse, and Dependent children will also bequalified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.

If any provision of this section is contrary to the Consolidated Omnibus ReconciliationAct of 1985 (as amended), the provision is changed to comply with the law.

Note: All Plan Participants must notify the Plan in writing within sixty (60) days of

(a) Divorce or legal separation(b) Covered Dependent child ceasing to qualify as a Dependent(c) Acceptance of Medicare or coverage under another employer’s group

health plan (whether or not as an Employee), if that plan does not limitcoverage for Preexisting Conditions.

(d) Second qualifying event(e) Qualified Beneficiary’s disability or cessation of disability(f) Death of the Employee

Written notice must be provided to the Claims Administrator or the designated COBRAClaims Administrator, if applicable. The notice must include the name of the Employeewith identification number, Plan Name and Number, date and type of the qualifying eventand name(s) of the applicable Dependent(s).

FAILURE TO NOTIFY THE PLAN IN A TIMELY MANNER WILL RESULT INLOSS OF ELIGIBILITY FOR COBRA CONTINUATION COVERAGE.

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VVII.. TTEERRMMIINNAATTIIOONN AANNDD RREEIINNSSTTAATTEEMMEENNTT OOFF CCOOVVEERRAAGGEE

A. Termination of Employee Coverage

The coverage of any Employee covered under this Plan Document will cease on theearliest of the following dates except as provided under Continuation of Benefits (ifapplicable):

• The date this Plan Document terminates.• The date ending the period for which any required contributions have been

paid.• The first day of the next Eligibility Quarter following the date he is no longer

eligible for coverage under this Plan Document.• The date he elects in writing that termination of coverage occurs subject to the

provisions of Section 125 of the Tax Code and applicable regulations.• The date the Employee’s coverage terminates for one of the following

reasons:*

Fewer than 400 hours of Employer contributions are received by the Fund fora Work Quarter.

Fewer than 800 hours of Employer contributions are received by the Fund forthe preceding two Work Quarters on his behalf.

The Employee works for a non-participating Employer within the geographicjurisdiction of Local 18.

The Employee fails to make self-payments on time.

The Employee enters the Armed Forces.

There is a Plan Amendment that affects eligibility.

*Active Employees have a 3 month eligibility “cushion”. For example, if coverage termsin April, coverage is available through this quarter and the next quarter, if the Employeedoes not elect to self-pay. Eligibility Quarters begin on the following months:December, March, June, and September.

• A Retiree’s coverage terminates for one of the following reasons:

If payment is not made on a timely basis.

The date of death.

The date he elects in writing that termination of coverage occurs.

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This Plan will provide a Certificate of Creditable Coverage after the Employee’scoverage terminates under the Plan.

B. Termination of Dependent Coverage

Coverage with respect to each Dependent covered under this Plan Document will ceaseon the earliest of the following dates:

• The date benefits cease for the Employee.• The date such individual ceases to be a Dependent as defined in this Plan

Document.• The last day of the 6th month following the day the Dependent child leaves

high school or college.• The date the Dependent begins active duty in the Armed Forces of any

country for longer than two weeks.• The date for which written election of termination is received.• The date ending the period for which any required contributions have been

paid.

The Plan will provide a Certificate of Creditable Coverage after the Dependent’scoverage terminates under the Plan.

C. Reinstatement of Participant’s Coverage

11.. CCOOBBRRAA PPAARRTTIICCIIPPAANNTTSS

A Qualified Beneficiary who has elected COBRA continuation coverage will beconsidered to have had no lapse of coverage, provided the coverage is in effect on theday before the Employee returns to eligible employment.

22.. RREEIINNSSTTAATTEEMMEENNTT OOFF CCOOVVEERRAAGGEE FFOOLLLLOOWWIINNGG AA MMIILLIITTAARRYY LLEEAAVVEE

Upon return from a military leave of absence, provided the Employee qualifies under theVeteran’s Reemployment Rights Statute and provided that an enrollment form issubmitted, coverage for the Employee and Eligible Dependents will be reinstated on thereturn-to-work date. Under these conditions, the Employee and any Eligible Dependentswill not be subject to the Waiting Period. Any deductible or out-of-pocket maximumsatisfied prior to the leave of absence will be credited if reinstatement takes place duringthe same Calendar Year in which the expenses were incurred.

33.. RREEIINNSSTTAATTEEMMEENNTT OOFF CCOOVVEERRAAGGEE AAFFTTEERR VVOOLLUUNNTTAARRYY TTEERRMMIINNAATTIIOONN OOFFEEMMPPLLOOYYMMEENNTT

If an Employee terminates his employment with the Plan Sponsor and loses eligibility forbenefits, but is subsequently rehired by the Plan Sponsor, he can establish eligibilityagain on the first day of an Eligibility Quarter following completion of any Work Quarterfor which the Employer reported and paid a minimum of 400 hours on the Employee’sbehalf. If the Employee is not eligible for four consecutive Eligibility Quarters, theymust satisfy the requirements for Initial Eligibility to once again become eligible.

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VVIIII.. CCLLAAIIMMSS

A. Filing

Written notice of a claim must be given as soon as reasonably possible after theoccurrence or commencement of any loss covered by this Plan.

The Plan, upon receipt of a written notice of a claim, will furnish to the Participant formsfor filing proof of loss. If such forms are not furnished within 15 days after notice isgiven, the Participant will be considered to have complied with the requirement of thePlan with respect to proof of loss and written proof covering the occurrence, thecharacter, and the extent of the loss for which the claim is made.

In order to promptly process claims and to avoid errors in processing that could becaused by delays in filing, written proof of loss should be furnished to the Plan within 90days following the date of loss. Failure to furnish written proof within 90 days of losswill not invalidate or reduce any claim if it was not reasonably possible to give proofwithin such time, provided that such proof is furnished as soon as reasonably possible.Except for the circumstance of legal incapacity of the claimant, proof must be furnishedno later than 18 months from the date an expense was incurred or the claim will bebarred.

The Plan shall process a claim in accordance with its reasonable claims procedures, asrequired by ERISA, providing a written explanation of its claim decision within 30 daysof receipt of a claim. The Plan has a right to secure independent medical advice and torequire such other evidence as it deems necessary to decide the claim. The Plan maydetermine that an extension is necessary for reasons beyond the control of the Plan. If anextension is necessary, the Plan shall provide written notice to this effect before theexpiration of the initial 30-day period. If the reason for taking the extension is the failureof the claimant to provide information necessary to decide the claim, the Plan will notifythe claimant of this fact and will render a decision within 15 days of the date on whichthe claimant’s response is received by the Plan.

B. Appealing

11.. EEXXPPLLAANNAATTIIOONN OOFF DDEENNIIAALL

The written explanation of a claim denial shall set forth, in a manner calculated to beunderstood by the Participant, the following information:

• The reason(s) for denial.

• If the claim is denied because the Plan needs more information to make a decision, adescription of any additional information necessary for the Participant to perfect theclaim and explanation of why such information is necessary.

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• A statement that the claim and its denial shall be reviewed upon submission of awritten report.

• A statement that the Participant, the Participant’s attorney or other duly authorizedrepresentative shall have, as part of the review procedure, a reasonable opportunity toexamine pertinent Plan documents and records and to submit written comments onissues.

• A statement that failure to submit a written request for review within 180 days afterthe receipt of the written explanation of the claim denial shall make the Plan’sdecision final.

22.. RREEQQUUEESSTT FFOORR RREEVVIIEEWW

In order to appeal to the Plan for review of a denied claim, a Participant must provide anappeal or request for review in writing to the Plan within 180 days after the claim isdenied. A claim and its denial shall be reviewed if a written request for review is filedwithin 180 days after receipt of the written explanation of the claim denial by theParticipant. The Plan will decide an appeal in accordance with its reasonable claimsprocedures, as required by ERISA. A Participant who does not appeal on time and inwriting will lose the right to file a suit in state or federal court by failing to exhaustinternal administrative appeal rights if, as is generally the case, they are prerequisite tosuch a suit; in that event, the initial decision shall be the final decision of the Plan.

33.. PPRROOVVIIDDIINNGG AADDDDIITTIIOONNAALL IINNFFOORRMMAATTIIOONN

As part of the review procedure, the Participant or the Participant’s duly authorizedrepresentative shall have a reasonable opportunity to examine pertinent Plan documentsand records and to submit written comments on the issues.

44.. DDEECCIISSIIOONN OONN RREEVVIIEEWW

The Plan shall review the information and comments submitted by the Participant or theParticipant’s duly authorized representative. The Plan shall furnish the Participant with awritten explanation of the decision on review within 60 days following receipt of thewritten request for review.

55.. EEXXPPLLAANNAATTIIOONN OOFF DDEECCIISSIIOONN OONN RREEVVIIEEWW

The written explanation of the decision on review shall set forth, in a manner calculatedto be understood by the claimant, the following information:

• The specific reason(s) for the decision, including a response to the information andcomments, if any, submitted by the claimant and his duly authorized representative.

• Specific reference to pertinent Plan provisions and records, if any, on which thedecision is based.

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66.. LLIIMMIITTAATTIIOONN

• No action at law or in equity can be brought to recover on this Plan before exhaustingthe appeals procedure described above.

• No action at law or in equity can be brought to recover after the expiration of twoyears after the time when written proof of loss is required to be furnished to the Plan.

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VVIIIIII.. CCOOOORRDDIINNAATTIIOONN OOFF BBEENNEEFFIITTSS//TTHHIIRRDD PPAARRTTYY LLIIAABBIILLIITTYY

A. Allowable Expense

Allowable Expense means any Medically Necessary, Reasonable and Customary item ofexpense which is covered at least in part under one or more of the plans covering theperson for whom a claim is made. If a plan provides benefits in the form of servicesrather than cash payments, the reasonable cash value of each service rendered will beconsidered an Allowable Expense and a benefit paid.

B. Application of Coordination of Benefits

The benefits of another plan will be ignored in determining the benefits of this Plan if therules establishing the order of benefit determination stated below require that this Plandetermine its benefits before the other plan.

The benefits of a plan which does not contain a Coordination of Benefits provisionalways shall be determined before the benefits of the plan which does contain aCoordination of Benefits provision.

The plan that covers the person directly rather than as a Dependent, for example, as anEmployee, member, subscriber, or retiree (Plan A) is primary, and the plan that coversthe person as a Dependent (Plan B) is secondary.

Coverage through a Health Maintenance Organization (HMO) is primary for a DependentParticipant in this Plan who is also an HMO participant.

When the Participant is denied benefits by a Managed Care Organization, including anHMO, for voluntary treatment by a provider that does not participate in the ManagedCare Organization, the Participant will receive benefits under this Plan at a level that issecondary to the benefits the Managed Care Organization would have provided had theParticipant utilized a participating and/or network provider.

However, if the person covered directly is a Medicare beneficiary, and if Medicare issecondary to Plan B and if Medicare is primary to Plan A (for example, if the person is aretiree), then Plan B will pay before Plan A.

If a child is covered under more than one plan, the primary plan is the plan of the parentwhose birthday is earlier in the year if:

a) the parents are married;b) the parents are not legally separated (whether or not they have ever

been married); or

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c) a court decree awards joint custody without specifying that one parenthas the responsibility to provide health care coverage.

If both parents have the same birthday, the plan that has covered either of the parentslonger is primary.

If the specific terms of a court decree state that one of the parents is responsible for thechild’s health care expenses or health care coverage and the plan of that parent has actualknowledge of those terms, that plan is primary. If the parent with financial responsibilityhas no coverage for the child’s health care services or expenses, but that parent’s spousedoes, the spouse’s plan is primary. This subparagraph shall not apply with respect to anyclaim determination period during which benefits are paid or provided before the entityhas actual knowledge.

If the parents are not married or are legally separated (whether or not they ever weremarried) or are divorced, and there is no court decree allocating responsibility for thechild’s health care services or expenses, the order of benefit determination among theplans of the parents and parents’ spouses (if any) is:

a) the plan of the custodial parent;b) the plan of the spouse of the custodial parent;c) the plan of the noncustodial parent;d) the plan of the spouse of the noncustodial parent.

The following rules apply unless the other plan does not have the same rule and as aresult the plans do not agree on the order of benefits:

The plan that covers a person as an Employee who is either laid off or retired (or as thatEmployee’s Dependent) is primary and a plan that covers a person as a Dependent of aninactive spouse is secondary. Coverage provided an individual as a retired worker and asa Dependent of that individual’s spouse as an active worker will be determined aspreviously stated above.

If a person whose coverage is provided under a right of continuation pursuant to federalor state law is also covered under another plan, the plan covering the person as anEmployee, member, subscriber, or retiree (or as that person’s Dependent) is primary andthe continuation coverage is secondary.

If the preceding rules do not determine the order of benefits, the primary plan is the onethat covered the person for the longer period of time, measured from the person’s firstdate of coverage. If that date is not readily available for a group plan, the date the personfirst became a member of the group shall be used as the date from which to determine thelength of time the person’s coverage under the present plan has been in force. Todetermine the length of time a person has been covered under a plan, two plans shall betreated as one if:

63

a) the covered person was eligible under the second within 24 hours afterthe first ended; and

b) the start of a new plan does not include a change in the amount orscope of a plan’s benefits or a change in the entity that pays, providesor administers the plan’s benefits, or a change from one type of plan toanother (single- to multi-employer, for example).

If none of the preceding rules determines the primary plan, the Allowable Expenses shallbe shared equally by the two plans.

Note: If both the husband and wife are covered Employees, the deductible will be waivedfor expenses when calculating benefits for each Participant under the primary coverage,but the deductible will apply when calculating coordination of benefits with thesecondary coverage. In addition, the waiver of deductible in connection with aparticular claim does not mean that the deductible requirement is satisfied for theCalendar Year.

C. Coordination of Benefits with Medicare

Medicare is the program of medical care benefits provided under Title XVIII of theSocial Security Act of 1965 as amended.

Individuals who have earned the required number of quarters for Social Security benefitswithin the specified timeframe are eligible for Medicare Part A at no cost. Ineligibleindividuals age 65 and over may purchase Medicare Part A by making application andpaying the full cost. Participation in Medicare Part B is available to all individuals whopay the full cost of coverage. A new voluntary prescription drug benefit (Part D) to theMedicare program is available to “Part D individuals,” which Medicare defines asindividuals who have coverage under Medicare Part A or Part B and who live in theservice area of a Part D plan.

Federal legislation requires that active Employees age 65 and over be given the option toelect either the Employer’s plan or Medicare as primary coverage. If the affectedEmployee elects this Plan as his primary coverage, the regular benefits of this Plan willapply. If an Employee elects Medicare as his primary coverage, no benefits will beavailable under this Plan.

Federal legislation also requires that an active Employee’s spouse who is age 65 or overbe given the option to elect the Employer’s plan or Medicare as his primary coverage. Ifthe affected spouse elects the benefits of this Plan as his primary coverage, the regularbenefits of this Plan will apply. If the spouse elects Medicare as his primary coverage, nobenefits will be available under this Plan.

The Plan is the primary payer and Medicare is the secondary payer for services thatwould have been covered by Medicare in each of the following situations:

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an Employee or Dependent spouse of an Employee covered under this Planbecause of current employment who is entitled to Medicare benefits because ofhis age;

an Employee or Dependent covered under this Plan as a result of currentemployment who is entitled to Medicare benefits because of total disability;

an Employee or Dependent who is entitled to Medicare because of end stage renaldisease until the end of the Medicare secondary coordination period.

Benefits for Participants who are eligible for Medicare benefits will be paid according tothe Health Care Financing Administration rules and regulations coordinating Medicarewith group health plans. This Plan will pay secondary in all instances allowed by HCFAand the Medicare Secondary Payer provisions of the Social Security Act , includingprovisions of 42 U.S.C. § 1395y(b)(1)(A).

When Medicare is the primary payer and an Employee or Dependent entitled to Medicareincurs Hospital, surgical or other charges covered under Medicare and other chargeswhich are not covered under Medicare, this Plan’s benefits will cover charges incurred tothe extent that they are not covered under Medicare. All of the Coordination of Benefitsprovisions will apply, including the provision that states that a Managed Care Participantwill receive benefits under this Plan at a level that is secondary to the benefits of theManaged Care Option (for example, Medicare Plus Choice) would have provided had theParticipant utilized a participating and/or network provider. Furthermore, this Plan shallnot provide coverage for costs that may be counted towards meeting a Participant’sMedicare Savings Account Policy deductible.

Medicare will pay primary, secondary or last to the extent stated in federal law. WhenMedicare is the primary payer, this Plan will base its payment upon benefits that wouldhave been paid by Medicare under Parts A and B regardless of whether or not the personwas enrolled in both of these parts. Enrollment in Part D is voluntary.

D. Right To Receive Medical Information Necessary ToDetermine Benefit

By accepting coverage under this Plan, the Participant agrees to supply information aboutmedical conditions and records or other coverage he and his spouse or Dependent(s) havewhen this Plan asks for it. If this Plan makes a payment and later finds out that it shouldnot have been primary, the Participant must return the excess amount paid to this Plan.All private health information will be kept confidential and will be used on a need onlybasis.

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E. Protected Health Information

11.. DDIISSCCLLOOSSUURREE OOFF SSUUMMMMAARRYY HHEEAALLTTHH IINNFFOORRMMAATTIIOONN

This Plan shall disclose to the Plan Sponsor summary health information (informationthat does not and could not be used to identify an individual) if the Plan Sponsor requestssuch information for the purpose of:

• obtaining premium bids from health plans for providing health insurance coverageunder this Plan or for similar purposes; or

• modifying, amending, or terminating this Plan.

22.. DDIISSCCLLOOSSUURREE OOFF PPRROOTTEECCTTEEDD HHEEAALLTTHH IINNFFOORRMMAATTIIOONN ((PPHHII))The Plan will disclose PHI (information that identifies or could identify an individual) tothe Plan Sponsor only in accordance with HIPAA Privacy laws. The Plan will use PHI tothe extent and in accordance with the uses and disclosures permitted by the HealthInsurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the Planwill use and disclose PHI for purposes related to health care treatment, payment forhealth care, and health care operations.

The Plan Sponsor hereby acknowledges and agrees to the following provisions in thisdocument:

a. Not to use or further disclose PHI other than as permitted or required by the plandocument or as required by law; and to ensure that the separation between the Planand Plan Sponsor required under the privacy rules is supported by reasonable andappropriate security measures;

b. To ensure that any agents, including a subcontractor, to whom the Plan Sponsorprovides PHI received from the Plan agree to the same restrictions and conditions thatapply to the Plan Sponsor with respect to such PHI; and to implement administrative,physical and technical safeguards that reasonably and appropriately protect theconfidentiality, integrity and availability of the electronic PHI that it creates, receives,maintains or transmits on behalf of the Plan;

c. Not to use or disclose PHI for employment-related actions and decisions or inconnection with any other benefit or employee benefit plan of the Plan Sponsorunless authorized by an individual;

d. To report to the Plan any security incident or any PHI use or disclosure that itbecomes aware is inconsistent with the uses or disclosures for which provision ismade;

e. To make available protected health information in accordance with 45 CFR§164.524;

66

f. To make available protected health information for amendment and incorporate anyamendments to protected health information in accordance with 45 CFR §164.526;

g. To make available the information required to provide an accounting of disclosures inaccordance with 45 CFR §164.528;

h. To make its internal practices, books, and records relating to the use and disclosure ofPHI received from the Plan available to the Department of Health and HumanServices upon request;

i. If feasible, to return or destroy all PHI received from the Plan and retain no copies ofsuch information when no longer needed for the purpose for which disclosure wasmade, except that, if such return or destruction is not feasible, limit further its usesand disclosures of the PHI to those purposes that make the return or destruction of theinformation infeasible; and

33.. LLIIMMIITTAATTIIOONNSS OOFF PPHHII AACCCCEESSSS AANNDD CCOOMMPPLLIIAANNCCEE

Access to PHI information may be given only to the Plan Sponsor and staff of the PlanSponsor who receive protected health information relating to payment under, health careoperations of, or other matters pertaining to the Plan in the ordinary course of business incarrying out Plan administration functions that the Plan Sponsor performs for the Plan.The access and use of PHI by the Plan Sponsor and staff described above is limited topurposes of the administration functions that the Plan Sponsor performs for the Plan. Ifthe Plan Sponsor and said staff do not comply with this Plan document, the Plan Sponsorshall provide a mechanism for resolving issues of noncompliance, including disciplinarysanctions.

F. Subrogation/Right of Reimbursement

Expenses which result from an Injury or Sickness due to the act of a third party are notcovered by this Plan. These expenses are excluded, but if the Plan chooses to advanceexpenses, the Plan will have a first priority lien against any amounts received by theParticipant from any source, regardless of whether the Participant is made whole by thesettlement or judgment. The Participant agrees to cooperate with the Plan and to take noaction to prejudice the Plan’s full recovery.

If a Participant files a claim under this Plan for medical and/or dental expenses incurredas a result of an Injury or Sickness due to the act of a third party, the Plan Administratorshall have the right to enforce either the Subrogation or the Right of Reimbursementprovision below.

The Participant must execute any subrogation/right of reimbursement agreement requiredby the Plan Administrator prior to receipt of any benefits payable under this Plan.Neither the Subrogation nor the Right of Reimbursement provisions and/or agreement

67

may be modified by the Participant unless specifically authorized in writing by the PlanAdministrator.

The Participant must furnish the Plan Administrator any and all information that the PlanAdministrator may reasonably require to protect the Plan’s right of subrogation and/orreimbursement, and shall do nothing to prejudice that right.

If a judgement or settlement is received by or on behalf of an eligible individual, theEligible Employee and the eligible individual shall repay to the Plan the lesser of the fullamount of benefits paid by the Plan, or the amount of any recovery, whether or not thesource of the recovery was legally responsible for the payment of those expenses. If suchrepayment is not made to the Plan, the Plan shall have the right, in addition to any otherlegal rights it may have, to reduce further benefits or claims made by the EligibleEmployee and any covered Dependent, until the full amount of the repayment has beenreceived by the Plan.

a) Subrogation• Recovery will be from any source making payment to the full extent of payments

made by the Plan, regardless of whether or not the Participant has been made wholeor fully compensated for his/her illness/Injury.

• The Plan Administrator will be subrogated to any legal claim the Participant mayhave and is entitled to assert a lien against the third party.

• Notice of a lien is sufficient to establish the Plan’s lien against the third party.

• Any recovery by the Plan Administrator will be limited to the amount of anypayments made under the Plan for medical expenses resulting from the negligent orintentional act and the cost of prosecuting the claim including attorneys’ fees andcollection fees. The Plan will not be responsible for the fees or costs of attorneysretained by the Participant, and that same shall not be deducted from the Plan’srecovery, unless the Plan agrees to such an arrangement in writing.

For purposes of this provision, subrogation means the Plan Administrator has the right toact in place of the Participant to make a lawful claim or demand against the third party.

CONFLICTING STATUTES: Although the Plan Administrator may choose to enforceeither the Subrogation or right of Reimbursement provision, if the Subrogation provisionconflicts with the laws of the State or the governing jurisdiction, and the application ofsuch laws to the Plan is not preempted by the Employee Retirement Income Security Actof 1974 (ERISA), then the Subrogation provision shall not be enforced, and the Right ofReimbursement provision will apply.

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b) Right of Reimbursement• The Participant will reimburse this Plan from any money received from the

Participant’s insurer, a third party, or the third party’s insurer; first party coverage,including Um/UIM, MedPay/PIP.

• Reimbursement will be up to the amount of benefits paid by this Plan;

• The Plan will not be responsible for the fees or costs of attorneys retained by theParticipant and the same shall not be deducted from the Plan’s recovery unless thePlan agrees to such an arrangement in writing.

The reimbursement agreement will be binding upon the Participant whether the paymentreceived from the third party or its insurer results from:

• A legal judgment or• An arbitration award or• A compromise settlement or• Any other arrangement.

The reimbursement agreement will be binding on any recovery made by the Participant,even if the settlement does not include medical expenses.

It is not necessary that the medical expenses be itemized in the third party payment orthat the third party and/or its insurer admit liability.

Also the Plan is under no obligation to recover such reimbursement on behalf of theParticipant.

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IIXX.. PPLLAANN AADDMMIINNIISSTTRRAATTIIOONN

A. Plan Administrator

Any duly authorized officer of the Plan Administrator may exercise any authority orresponsibility allocated or reserved to the Plan Administrator under this Plan.

The Plan Administrator shall have the right to hire all persons providing services to thePlan and to appoint a Claims Administrator to receive, initially review, and processclaims for benefits.

The Plan Administrator shall have the authority and responsibility to call and attend themeetings at which this Plan’s funding policy and method are reestablished and reviewed.

The Plan Administrator shall have the discretionary authority and responsibility toconstrue and interpret terms of this Plan; to make factual determinations, including allquestions of eligibility; to establish the policies, interpretations, practices, and proceduresof this Plan; to adopt and implement procedures, including Care Management, in its solediscretion; to decide whether care or treatment is Medically Necessary and whether acharge meets Reasonable and Customary criteria; and to render final decisions on reviewof claims as described in this Plan Document. All interpretations under the Plan, and alldeterminations of fact made in good faith by the Plan Administrator will be final andbinding on the Participants and beneficiaries and all other interested parties. Benefitsunder this Plan will be paid only if the Plan Administrator decides in its discretion thatthe applicant is entitled to them.

Furthermore, the Plan Administrator shall have the right to determine the amount,manner, and time of payment of any benefits under this Plan and to change contributionrates for Participants at any time and from time to time, and to the extent permitted byterms of any collective bargaining agreement.

The Plan Administrator has a duty to maintain records and to file reports required by law.This duty shall include complying with applicable reporting or disclosure requirements.

The Plan Administrator shall forward applications to the Claims Administrator and notifythe Claims Administrator in writing of changes with respect to Participants and otherfacts necessary for determining Plan coverages and for processing claims for Planbenefits.

The Plan Administrator or any duly authorized representative of the Plan Administratorwill have the right to examine any claim for benefits under this Plan, whether assigned orunassigned. The Plan Administrator will, at the Plan’s expense, have the right to havethe person whose Sickness or Injury is the basis for a claim examined as often asreasonably required during the time a claim is pending under the Plan. The Plan

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Administrator will not discriminate in treatment of individuals in similar situations, andthe Claims Administrator is not obligated to inquire into the circumstances.

For purposes of determining the applicability of the coordination of benefits andsubrogation provisions of this Plan or any provision with a similar purpose that is inanother plan and for purposes of implementing those provisions, the Plan Administratoror Claims Administrator may release necessary information to, or obtain necessaryinformation from, any other organization or individual.

The Plan Administrator shall have the unlimited right to amend this Plan in any and allrespects at any time, and from time to time, without prior notice to any Participant orEligible Dependent. Any such amendment shall be by a written resolution of themajority of the Board of Trustees and shall become effective as of the date specified inthe enabling resolution. Any such amendment shall be binding upon all Participants(including those Participants on continuation coverage). However, the responsibilities ofthe named fiduciaries and their delegates shall not be increased or changed byamendment without their written consent.

An amendment to the Plan may be retroactively effective but shall not adversely affectthe rights of a Participant under this Plan for covered medical expenses provided after theeffective date of the amendment but before the amendment is adopted.

The Plan shall furnish a summary of a material reduction in covered services or benefitsto Participants within 60 days after the change has been adopted by the Plan.

Notwithstanding that the Plan is established with the intention that it be maintainedindefinitely, the Plan Administrator reserves the unlimited right to terminate or merge thePlan at any time without prior written notice to any Participant. Such termination shallbe evidenced by a resolution of the majority of the Board of Trustees. The date of themerger or termination will be the date specified in the enabling resolution. Terminationof the Plan shall apply to all Participants (including those on continuation coverage).Additionally, the Plan Administrator reserves the right to determine from time to time thelevel of contribution required from Participants for Plan coverage.

The Plan Administrator shall perform all other responsibilities allocated to the PlanAdministrator in the instrument appointing the Plan Administrator.

B. Claims Administrator

The Claims Administrator shall have the authority and responsibility to administer thePlan’s claims procedures, to process claims for benefits in accordance with Planprovisions, and to file claims with the insurance companies, if any, who issue stop lossinsurance policies to the Plan.

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The Plan Administrator must furnish the Claims Administrator all information the ClaimsAdministrator reasonably requires as to matters pertaining to this Plan. All materialwhich may have a bearing on coverage or contributions will be open for inspection by theClaims Administrator at all reasonable times during the continuance of this Plan and untilthe final determination of all rights and obligations under this Plan.

C. Participant

A Participant of this Plan is entitled to certain rights and protection under the EmployeeRetirement Income Security Act of 1974 (ERISA). ERISA provides that all PlanParticipants shall be entitled to:

Receive Information About Plan and Benefits

Examine, without charge, at the Plan Administrator’s office and at otherspecified locations, such as worksites and union halls, all documentsgoverning the Plan, including insurance contracts and collectivebargaining agreements, and a copy of the latest annual report (Form 5500Series) filed by the Plan with the U.S. Department of Labor and availableat the Public Disclosure Room of the Employee Benefits SecurityAdministration.

Obtain, upon written request to the Plan Administrator, copies ofdocuments governing the operation of the Plan, including insurancecontracts and collective bargaining agreements, and copies of the latestannual report (Form 5500 Series) and updated summary plan description.The Plan Administrator may make a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report. The PlanAdministrator is required by law to furnish each Participant with a copy ofthis summary annual report.

Continue Group Health Plan Coverage

The Employee and qualified beneficiaries may continue health carecoverage if there is a loss of coverage under the Plan as a result of aqualifying event. COBRA participants may have to pay for such coverage.Review this summary plan description and the documents governing thePlan on the rules governing your COBRA continuation coverage rights.

Reduction or elimination of exclusionary periods of coverage forPreexisting Conditions under a group health plan, if there is creditablecoverage from another plan. Participants should be provided a certificateof creditable coverage, free of charge, from their group health plan orhealth insurance issuer when they lose coverage under the plan, when they

72

become entitled to elect COBRA continuation coverage, when COBRAcontinuation coverage ceases, if requested before losing coverage, or ifrequested up to 24 months after losing coverage. Without evidence ofcreditable coverage, Participants may be subject to a PreexistingCondition exclusion for 12 months (18 months for Late Enrollees) afterthe enrollment date for coverage.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for Plan Participants, ERISA imposes dutiesupon the people who are responsible for the operation of the Employeebenefit plan. The people who operate the Plan, called “fiduciaries” of thePlan, have a duty to do so prudently and in the interest of the Employeeand other Plan Participants and beneficiaries. No one, including theEmployer, a union, or other person, may fire you or otherwisediscriminate against you in any way to prevent you from obtaining abenefit or exercising your rights under ERISA.

Enforcement of Rights

If a claim for a benefit is denied or ignored, in whole or in part,Participants have a right to know why this was done, to obtain copies ofdocuments relating to the decision without charge, and to appeal anydenial, all within certain time schedules.

Under ERISA, there are steps that may be taken to enforce the aboverights. For instance, if a copy of plan documents or the latest annualreport from the Plan is requested and not received within 30 days, a suitmay be filed in a Federal court. In such a case, the court may require thePlan Administrator to provide the materials and pay up to $110 a day untilthe materials are received, unless the materials were not sent because ofreasons beyond the control of the Plan Administrator. If there is a claimfor benefits which is denied or ignored, in whole or in part, a suit may befiled in a state or Federal court. In addition, if there is disagreement withthe Plan's decision or lack thereof concerning the qualified status of amedical child support order, a suit may be filed in Federal court. If itshould happen that Plan fiduciaries misuse the Plan’s money, or if you arediscriminated against for asserting your rights, you may seek assistancefrom the U.S. Department of Labor, or you may file suit in a Federal court.The court will decide who should pay court costs and legal fees. If thesuit is successful, the court may order the person sued to pay these costsand fees. If you lose, the court may order you to pay these costs and fees;for example, if it finds your claim is frivolous.

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Assistance with Your Questions

If there are any questions about this Plan, contact the Plan Administrator.If there are any questions about this statement or about your rights underERISA, or if you need assistance in obtaining documents from the PlanAdministrator, you should contact the nearest office of the EmployeeBenefits Security Administration, U.S. Department of Labor, listed in yourtelephone directory or the Division of Technical Assistance and Inquiries,Employee Benefits Security Administration, U.S. Department of Labor,200 Constitution Avenue, N.W., Washington, D.C. 20210. You may alsoobtain certain publications about your rights and responsibilities underERISA by calling the publications hotline of the Employee BenefitsSecurity Administration.

The Participants in this Plan have the sole right to select their own providers of healthcare. The Plan will not choose a provider for any Participant, or have any liability forany acts, omissions, or conduct of any provider. The Plan’s only obligation is to makepayments according to the terms of this Plan Document. The payments that the Planmakes are not an attempt to fix the value of any services or supplies provided to aParticipant.

A Participant will have the right to assign the payment of any benefits for which he iseligible under this Plan to any eligible provider of services. If a provider makes arepresentation to the Claims Administrator that a person covered under this Plan hasmade an assignment of benefit payments to the provider, the Claims Administrator willmake payment to the provider based on that representation.

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XX.. GGEENNEERRAALL PPRROOVVIISSIIOONNSS

A. Legal Compliance/Conformity

This Plan shall be interpreted, construed, and administered in accordance with applicablestate or local laws of the Employer’s principal place of business to the extent such lawsare not preempted by federal law. If any provision of the Plan Document or Employer’sPlan is contrary to any law to which it is subject, the provision is hereby automaticallychanged to meet the law’s minimum requirement.

B. Effect of Prior Coverage

Coverage for any Participant under this Plan Document replaces any prior coverage ineffect for that Participant provided by the Employer under any immediately prior plandocument or policy.

C. Severability

In the event that any provision of this Plan shall be held to be illegal or invalid for anyreason by a court of competent jurisdiction, such illegality or invalidity shall not affectthe remaining provisions of the Plan and the Plan shall be construed and enforced as ifsuch illegal or invalid provision had never been contained in the Plan.

D. Headings

Headings are for reference and not for interpretation or construction.

E. Word Usage

Whenever words are used in this document in the singular or masculine form, they shallwhere appropriate be construed so as to include the plural, feminine, or neuter form.

F. Titles for Reference

The titles used within this document are for reference purposes only. In the event of adiscrepancy between a title and the content of a section, the content of a section shallcontrol.

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G. Clerical Error

No clerical errors made by the Plan Administrator; or the Claims Administrator inkeeping records pertaining to this coverage or delays in making entries in such recordswill invalidate coverage otherwise validly in force or continue coverage otherwise validlyterminated. Upon discovery of any error, an equitable adjustment of any benefits paidwill be made.

H. Misstatements

If any relevant fact as to an individual to whom the coverage relates is found to havebeen misstated, an equitable adjustment of contributions will be made. If themisstatement affects the existence or amount of coverage, the true facts will be used indetermining whether coverage is in force under this Plan and its amount.

I. Refund of Overpayments

If the Plan pays benefits for expenses incurred on account of a Covered Participant, thatCovered Participant, or any other person or organization that was paid, must provide arefund to the Plan if either of the following apply:

• All or some of the expenses were not paid by the Covered Participant or did notlegally have to be paid by the Covered Participant.

• All or some of the payment the Plan made exceeded the benefits under the Plan.

The refund shall equal the amount the Plan made in excess of the amount it should havepaid under the terms of the Plan. If the refund is due from another person ororganization, the Covered Participant agrees to help the Plan obtain the refund whenrequested.

If the Covered Participant, or any other person or organization that was paid, does notpromptly refund the full amount, the Plan may reduce the amount of any future benefitsthat are payable under the Plan. The reductions will equal the amount of the requiredrefund. The Plan may have other rights in addition to the right to reduce future benefits.

J. Written Authorization

If an Employee is not present, the Employee’s spouse or Business Manager cannot getspecific information from the Fund Office about the Participant unless a writtenauthorization is first submitted to the Fund Office. After written authorization isreceived, the Fund Office is permitted to disclose necessary information about theParticipant to whomever has been so designated.

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XXII.. DDEEFFIINNIITTIIOONNSS

Accident and Accidental means an unforeseen or unexplained sudden occurrence bychance, without intent or volition.

Ambulatory Surgical Center is a licensed facility that is used mainly for performingoutpatient surgery, has a staff of Physicians, has continuous Physician and nursing careby Registered Nurses (R.N.s) and does not provide for overnight stays.

Appliance means a device used to replace missing parts, to provide function or fortherapeutic use. The term includes dental prostheses, splints, orthodontic appliances andobturators.

Birthing Center means any freestanding or Hospital-based facility which provides an “athome” atmosphere for the delivery of babies. This facility must be licensed and operatedin accordance with the laws pertaining to Birthing Centers in the jurisdiction where thefacility is located.

The Birthing Center must provide facilities for obstetrical delivery and short-termrecovery after delivery; provide care under the full-time supervision of a Physician andeither a Registered Nurse (R.N.) or a Licensed Nurse-midwife; and have a writtenagreement with a Hospital in the same locality for immediate acceptance of patients whodevelop complications or require pre- or post-delivery confinement.

Calendar Year means a twelve-month period beginning on the first day of January andending on the last day of the following December.

Chemical Dependency is the condition caused by regular excessive compulsive drinkingof alcohol and/or physical habitual dependence on drugs that results in a chronic disorderaffecting physical health and/or personal or social functioning. This does not includedependence on tobacco and ordinary caffeine-containing drinks.

Claims Administrator means American Administrative Group, Inc.

COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, asamended.

Cosmetic Dentistry means dentally unnecessary procedures.

Covered Charge means any expense that is eligible for benefits and not otherwiseexcluded under this Plan.

Custodial Care is care (including room and board needed to provide that care) that isgiven principally for personal hygiene or for assistance in daily activities and can,according to generally accepted medical standards, be performed by persons who have no

77

medical training. Examples of Custodial Care are help in walking and getting out of bed;assistance in bathing, dressing, feeding; or supervision over medication which couldnormally be self-administered.

Dental Service means a professional dental service which is included in the list of dentalservices under Covered Dental Expenses and is rendered by a Dentist in the necessarytreatment of Accidental Injury, dental disease or defect. It shall also mean:

1. the scaling and cleaning of teeth by a licensed dental hygienist or dentalassistant if performed under the supervision and direction of a Dentist and acharge is made for such service by the Dentist.

2. laboratory services for preparation of dental restoration and dental prostheticdevices if the Dentist includes the cost of such services or devices in thecharges for these services.

Dentist is a person who is properly trained and licensed to practice dentistry and who ispracticing within the scope of such license.

Durable Medical Equipment means equipment that (a) can withstand repeated use, (b)is primarily and customarily used to serve a medical purpose, (c) generally is not usefulto a person in the absence of an illness or Injury and (d) is appropriate for use in thehome.

Eligible Dependent means an individual who meets the requirements for such status asstated in the eligibility section of this document.

Eligible Employee means a person who is employed by an Employer on whom sufficienthours are contributed to gain or maintain eligibility, as specified in the Eligibility sectionof this Plan. The term also means a retiree as specified in the Eligibility section of thisPlan.

Employer is the Employers who are signatory to a collective bargaining agreement withthe Union which requires contributions to the Fund.

Enrollment Date is the first day of coverage or, if there is a Waiting Period, the first dayof the Waiting Period.

Endodontics means the branch of dentistry concerned with the treatment of teeth havingdamaged pulp; root canal therapy.

ERISA is the Employee Retirement Income Security Act of 1974, as amended.

Family means an Employee and his Dependents. Under any benefit section, a “coveredFamily member,” as of any given time, is a Family member for whom coverage is then inforce under the section.

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Fund means the Local 18 Heat and Frost Insulators Medical Trust Fund.

Generic Drug means a Prescription Drug that has the equivalency of the brand namedrug with the same use and metabolic disintegration. This Plan will consider as aGeneric Drug any Food and Drug Administration approved generical pharmaceuticaldispensed according to the professional standards of a licensed pharmacist and clearlydesignated by the pharmacist as being generic.

Home Health Care Agency is an organization the main function of which is to provideHome Health Care services and supplies and which is federally certified as a HomeHealth Care Agency and licensed by the state in which it is located, if licensing isrequired.

Hospice Care Agency is an organization the main function of which is to provideHospice Care services and supplies and which is licensed by the state in which it islocated, if licensing is required.

Hospital is an institution which is engaged primarily in providing medical care andtreatment of sick and injured persons on an inpatient basis at the patient’s expense andwhich fully meets these tests: it is accredited as a Hospital by the Joint Commission onAccreditation of Healthcare Organizations; it is approved by Medicare as a Hospital; itmaintains diagnostic and therapeutic facilities on the premises for surgical and medicaldiagnosis and treatment of sick and injured persons by or under the supervision ofRegistered Nurses (R.N.s); and it is operated continuously with organized facilities foroperative surgery on the premises.

The definition of “Hospital” shall be expanded to include the following:

A facility operating legally as a Rehabilitation Facility for rehabilitative care.

A facility operating legally as a psychiatric Hospital or residential treatment facility formental health and licensed as such by the state in which the facility operates.

A facility operating primarily for the treatment of Chemical Dependency if it meets thesetests: maintains permanent and full-time facilities for bed care and full time confinementof at least 15 resident patients; has a Physician in regular attendance; continuouslyprovides 24-hour a day nursing service by a Registered Nurse (R.N.); has a full-timepsychiatrist or psychologist on the staff; and is primarily engaged in providing diagnosticand therapeutic services and facilities for treatment of Chemical Dependency.

Hospital Confinement. Any confinement in a Hospital for which a charge is made forroom and board.

Incurred Charge means the charge for a service or supply is considered to be incurredon the date it is furnished except:

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1. Expenses for fixed bridgework, crowns, inlays or restorations shall be deemedincurred on the first day of preparation of the tooth or teeth involved providedthe person remains continuously covered during the course of treatment.

2. Expenses for full or partial dentures shall be deemed incurred on the date thefinal impression is taken provided the person remains continuously coveredduring the course of treatment.

3. Expenses for relining or rebasing of an existing partial or complete dentureshall be deemed incurred on the first day of preparation of the reline or rebaseof such denture provided the person remains continuously covered during thecourse of treatment.

4. Expenses or charges for endodontic services shall be deemed incurred on thedate the specific root canal procedure commenced provided the personremains continuously covered during the course of treatment.

5. Expenses or charges for orthodontic services shall be deemed incurred on thedate the initial active appliance was installed.

Injury means an Accidental physical Injury to the body caused by unexpected externalmeans.

Intensive Care Unit is defined as a separate, clearly designated service area that ismaintained within a Hospital solely for the care and treatment of patients who arecritically ill. This also includes what is referred to as a “coronary care unit” or an “acutecare unit.” It has facilities for special nursing care not available in regular rooms andwards of the Hospital; special life saving equipment which is immediately available at alltimes; at least two beds for the accommodation of the critically ill; and at least oneRegistered Nurse (R.N.) in continuous and constant attendance 24 hours per day.

Legal Guardian means a person recognized by a court of law as having the duty oftaking care of the person and managing the property and rights of a minor child.

Licensed Practical Nurse or Licensed Vocational Nurse means an individual who islicensed to perform nursing service by the state in which the person performs suchservice and who is performing within the scope of that license.

Lifetime, used in this Plan in the context of benefit maximums and limitations, refers tothe “lifetime” of coverage under this Plan, not to the term of an individual’s life.

Medical Emergency means a sudden onset of a condition with acute symptoms requiringimmediate medical care and includes such conditions as heart attacks, cardiovascularaccidents, poisonings, loss of consciousness or respiration, convulsions or other suchacute medical conditions.

Medically Necessary care and treatment is recommended or approved by a Physician orDentist; is consistent with the patient’s condition or accepted standards of good medicaland dental practice; is medically proven to be effective treatment of the condition; is notperformed mainly for the convenience of the patient or provider of medical and dental

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services; is not conducted for research purposes; and is the most appropriate level ofservices which can be safely provided to the patient.

Medicare is the Health Insurance For the Aged and Disabled program under Title XVIIIof the Social Security Act as amended.

Mental Disorder means any disease or condition, regardless of whether the cause isorganic, that is classified as a Mental Disorder in the current edition of InternationalClassification of Diseases, published by the U.S. Department of Health and HumanServices.

Morbid Obesity is defined as being 100% or 100 pounds over a Participant’s ideal bodyweight.

Necessary Service or Supply with regard to Dental services or supplies means a serviceor supply broadly accepted by the dental profession as essential to the care or treatmentof the teeth and/or surrounding tissues and structures.

No-Fault Auto Insurance is the basic reparations provision of a law providing forpayments without determining fault in connection with automobile accidents.

Oral Surgery means the branch of dentistry concerned with surgical procedures in andabout the mouth and jaws.

Orthodontics means the branch of dentistry concerned with the detection, preventionand correction of abnormalities in the positioning of the teeth in the relationship to thejaws. Commonly, straightening teeth.

Outpatient Care is treatment including services, supplies and medicines provided andused at a Hospital under the direction of a Physician to a person not admitted as aregistered bed patient; or services rendered in a Physician’s office, laboratory or X-rayfacility, an Ambulatory Surgical Center or the patient’s home.

Palliative means an alleviating measure. To relieve.

Participant is a person covered under this Plan or the legal representative or guardian ofa minor or incompetent person covered under this Plan.

Periodontics means the science of examination, diagnosis and treatment of diseasesaffecting the periodontium.

Periodontium means collectively the tissues which surround and support the tooth: thegingiva, the cementum, the periodontal membrane, and the alveolar or supporting bone.

Physician means a Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Doctor ofDental Surgery (D.D.S.), Doctor of Medical Dentistry (D.M.D.), Doctor of Podiatry

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(D.P.M.), Doctor of Chiropractic (D.C.), Audiologist, Certified Nurse Anesthetist,Certified Nurse Midwife (C.N.M.), Chiropodist (D.S.C.), Nurse Practitioner (N.P.),Occupational Therapist, Optometrist (O.D.), Physician Assistant (P.A.), Physiotherapist,Psychiatrist, Psychologist (Ph.D.), Registered Physical Therapist, Social Workers whohave been referred by a psychiatrist or psychologist (L.C.S.W.), Speech LanguagePathologist. In addition, the above providers must be licensed and regulated by a state orfederal agency and must be acting within the scope of his or her license.

Plan means International Association of Heat & Frost Insulators & Asbestos Workers –Local 18 Employee Benefit Plan, which is a benefit plan for certain Employees coveredunder the collective bargaining agreement of Local 18 and is described in this document.

Plan Sponsor is Board of Trustees, Local 18 Heat and Frost Insulators Medical Trust.

Plan Year is the twelve-month period beginning on either the effective date of the Planor on the day following the end of the first Plan Year which is a short Plan Year.

Pregnancy is childbirth and conditions associated with Pregnancy, includingcomplications.

Reasonable and Customary Charge is a charge which is not higher than the usualcharge made by the provider of the care or supply and does not exceed the usual chargemade by most providers of like service in the same area. This test will consider thenature and severity of the condition being treated. It will also consider medicalcomplications or unusual circumstances that require more time, skill or experience.

The Plan will base Plan benefits on the actual charge billed if it is less than theReasonable and Customary Charge.

Reasonable and Customary limitations will not apply to Network PPO repriced claims.

Registered Nurse means a professional person who is licensed to perform nursingservice by the state in which the person performs such service and who is performingwithin the scope of that license.

Rehabilitation Facility means an inpatient medical facility that is licensed as a Hospitalor freestanding Rehabilitation Facility, where licensure is required, or it may be CARFaccredited. Physicians and Registered Nurses are on staff and available. This type offacility provides physical, occupational and speech therapy by licensed therapists andalso have available a program of structured cognitive therapy. Social work and dischargeplanning are provided, to include planning for care and equipment needs after discharge.

Sickness is a person’s illness, disease or Pregnancy (including complications).

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Skilled Nursing Facility is a facility that fully meets all of these tests:

It is licensed to provide professional nursing services on an inpatient basis to personsconvalescing from Injury or Sickness. The service must be rendered by a RegisteredNurse (R.N.) or by a Licensed Practical Nurse (L.P.N.) under the direction of aRegistered Nurse. Services to help restore patients to self-care in essential daily livingactivities must be provided.

Its services are provided for compensation and under the full-time supervision of aPhysician or with Physician services available at all times under an establishedagreement.

It provides twenty-four hour per day nursing services by licensed nurses, under thedirection of a full-time Registered Nurse (R.N.).

It has established methods and written procedures for the dispensing and administrationof drugs.

It maintains a complete medical record on each patient.

It has an effective utilization review plan.

It is not, other than incidentally, a place for the provision of rest, custodial care, oreducation or for care required by reason of age, drug addiction, alcoholism, mentalretardation or mental disorders.

It is approved and licensed by Medicare.

This term also applies to charges incurred in a facility referring to itself as an extendedcare facility, convalescent nursing home or any other similar nomenclature.

Spinal Manipulation/Chiropractic Care means skeletal adjustments, manipulation orother treatment in connection with the detection and correction by manual or mechanicalmeans of structural imbalance or subluxation in the human body. Such treatment is doneby a Physician to remove nerve interference resulting from, or related to, distortion,misalignment or subluxation of, or in, the vertebral column.

Surgical Procedure shall include but not be limited to one or more of the followingtypes of medical procedures performed by a Physician:

• Incision, excision or electrocauterization and shave biopsy of any part of the body.• Manipulative reduction or treatment of a fracture or dislocation, including application

of a cast or traction.• Laser beam photocoagulation.• Suturing of a wound, surgical debridement and dressing of burns; acne surgery.• Diagnostic and therapeutic endoscopic procedures.

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• Surgical injection treatments of aspirations.• Cardiac catheterizations and other arterial or venous catheterizations.• Maternity procedures.• Transplantation of organ(s).

Total Disability as it applies to an Employee means the Employee is unable, as a resultof Sickness or Injury, to perform the normal duties of his occupation and is notperforming work of any kind for wage or profit. As it applies to a Dependent, it meansthat the Dependent, as a result of Sickness or Injury, is unable to perform the normalduties appropriate to a person in good health of the same sex and age.

Union means International Association of Heat & Frost Insulators & Asbestos WorkersLocal 18.

Urgent Care Facility shall mean a facility other than a free clinic providing medical careand treatment of Sick or Injured persons on an Outpatient basis. In addition, it must meetall of the following tests:

It is accredited by the Joint Commission on Accreditation of Hospitals or is approved bythe federal government to participate in federal and state programs.

It maintains on-premise diagnostic and therapeutic facilities for surgical and medicaldiagnosis and treatment by or under the supervision of duly qualified Physicians.

It is operated continuously with organized facilities for operative surgery on thepremises.

It is staffed with continuous Physician services and registered professional nursingservices whenever a patient attends the facility.

It does not provide services or other accommodations for patients to stay overnight.

Waiting Period shall mean any period of time imposed by the Plan between the first dayof employment and the first day of eligibility for coverage under the Plan.

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XXIIII.. IIDDEENNTTIIFFIICCAATTIIOONN OOFF PPLLAANN

PLAN: International Association of Heat & Frost Insulators &Asbestos Workers – Local 18 Employee Benefit Plan

PLAN SPONSOR:

Board of TrusteesLocal 18 Heat and Frost Insulators Medical Trust Fund3302 South East StreetIndianapolis, Indiana 46227

The Fund is administered by a Board of Trustees, each of whom is a fiduciary tothe Fund and the Plan. The following are Trustees:

Tony MagnaPat MeredithScott CollierNick RogeroJim PetridesDave McCoy

PLAN SPONSOR TAX ID NO.: 52-6038498

PLAN NO.: 501

CLAIMS ADMINISTRATOR:

American Administrative Group, Inc.P.O. Box 5227Lisle, Illinois 605321-888-478-2860

AMERICAN ADMINISTRATIVE GROUP, INC. CLIENT NO.: 477

TYPE OF BENEFITS PROVIDED: See Schedule of Benefits

TYPE OF PLAN ADMINISTRATION:

Medical benefits are provided from a Trust Fund which is funded by Employercontributions and earnings thereon. Life, accidental death and disability benefitsare provided pursuant to an insurance contract with Fort Dearborn Life InsuranceCompany.

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PLAN ADMINISTRATOR/AGENT FORLEGAL PROCESS/NAMED FIDUCIARY:

International Association of Heat & Frost Insulators &Asbestos Workers – Local 183302 South East StreetIndianapolis, Indiana 46227

CONTRIBUTIONS TO PLAN:

The plan is funded by contributions which are paid by Employers pursuant to theterms of collective bargaining agreements with the Union. Information as towhether a particular Employer is a sponsor may be obtained by Participants andbeneficiaries upon request to the Plan Administrator.

FISCAL YEAR END: Last day of February

Documents

MASTER PLAN DOCUMENT AND PLAN DESCRIPTION OF …