Page 64 - 2023 Down East Wood Ducks - Benefits Guide.docx_Neat

Medical coverage added on special enrollment must take effect no later than the first day of
the month after the enrollment, except for coverage added in connection with a birth,
adoption or placement for adoption, which will take effect retroactive to the date of the birth,
adoption or placement.

BENEFITS

Special Note. Benefits under the Plan are solely provided through a contract of insurance
between the Board and an insurer. The rights of each participant, beneficiary, or other person
claiming benefits under the Plan are defined and limited by the insurance policy that is in
force at any particular time for the provision of such benefits. A claimant may enforce rights
under that policy directly against the insurer after exhausting administrative remedies in the
section of this booklet entitled CLAIMS PROCEDURE. The Board also retains the right, as
policyholder, to take action in its discretion to enforce the policy of insurance on behalf of
participants and beneficiaries.

Medical Coverage

This section briefly summarizes the medical benefits available under the Plan and describes
some important rules regarding your annual election under the Plan. For a more complete
description of the benefits available under your medical option(s), please refer to the separate
descriptive booklet(s) that you have received from the Board, your Employer, insurance
companies, and other organizations with which the Board has contracted to provide benefits.

Your Employer provides the medical option(s) listed on Appendix A. You are responsible
for making decisions regarding the coverage option you choose (if more than one option is
available to you) and your selection of physicians and other medical providers. You may use
any source of care for health treatment and health coverage that you select. Neither the Board
nor your Employer will have any obligation for the cost or legal liability for the outcome of
such care, or your decision not to seek or obtain care, other than liability under the Plan for
the payment of covered expenses. You also have the option to waive the medical option(s)
offered by your Employer.

In addition, you and your physician are responsible for choosing the course of treatment for
(or for choosing not to treat) any illness, injury or other medical condition. The Board and/or
your Employer are not in any way responsible for the outcome of any medical treatment or
health care (or lack of such treatment or care).

.
You should refer to the benefit booklet(s) distributed to you to answer specific coverage
questions and to help you decide which options (if more than one option is available to you)
are right for you and your family. Benefit booklet(s) are also available from your Employer.

Wellness Programs. From time to time the Plan may offer wellness programs designed to
promote the health and wellbeing of all employees. These wellness programs may provide
financial incentives to engage in activities that encourage healthy lifestyle changes, provide
you with information about your current health condition by undergoing health screenings or

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