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Table of Contents

1. YOUR HEALTH and BENEFIT PLAN A EFFECTIVE PLAN YEAR 2014
2. CLASSES ELIGIBLE FOR COVERAGE
3. CLASSES NOT ELIGIBLE FOR COVERAGE
4. ELIGIBILITY FOR BENEFITS
5. CONTINUATION OF ELIGIBILITY
6. SELF-PAYMENT
7. CREDIT
8. METHOD OF PAYMENT
9. PLAN A COVERAGE/B CONTRIBUTIONS
10. NOT AVAILABLE FOR WORK
11. QUALIFICATIONS FOR RETIREE COVERAGE
12. RETIRED PENSIONERS – MAINTENANCE OF COVERAGE
13. RETIREE’S RETURNING TO COVERED EMPLOYMENT
14. TERMINATION OF COVERAGE
15. DEFINITIONS
16. GENERAL EXCLUSIONS
17. SCHEDULE OF BENEFITS
18. HOSPITAL COVERAGE
19. SPECIAL CONDITIONS
20. MEDICAL BENEFITS
21. PRESCRIPTION DRUG PROGRAM
22. PRESCRIPTIONS BY MAIL
23. PRESCRIPTION DRUG COVERAGE AND MEDICARE
24. EMPLOYEE ASSISTANCE PROGRAM
25. ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
26. DEATH BENEFITS (Stage 2)
27. DENTAL BENEFITS (Stage 2)
28. SCHEDULE OF COVERED DENTAL PROCEDURES
29. EXTENSION OF BENEFITS
30. PREFERRED PROVIDER ORGANIZATION DENTAL PLAN (P.P.O.)
31. VISION CARE BENEFIT FOR PARTICIPANTS (Stage 2)
32. EXCLUSIONS – VISION
33. HEARING CARE BENEFIT FOR PARTICIPANTS (Stage 2)
34. MEDICAL REIMBURSEMENT ACCOUNT
35. GENERAL PROVISIONS
36. MEDICARE
37. RIGHT OF RECOVERY
38. EXCLUSION OF BENEFITS RECOVERABLE UNDER THIRD-PARTY ACTIONS
39. NONASSIGNABILITY AND SPENDTHRIFT CLAUSE
40. CLAIM FILING INSTRUCTIONS
41. IMPORTANT NOTICE TO ELIGIBLE PARTICIPANTS ON CONTINUATION OF COVERAGE LAW (COBRA)
42. SUPPLEMENTAL UNEMPLOYMENT BENEFIT PROGRAM
43. SHORT TERM DISABILITY (LOSS OF TIME)
44. YOUR RIGHTS UNDER ERISA
45. SUMMARY PLAN DESCRIPTION
46. STATEMENT OF PRIVACY PRACTICES
47. STATEMENT OF ERISA RIGHTS
48. COMMUNICATIONS
49. PLAN INTERPRETATIONS AND DETERMINATION
50. CAUTION