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TABLE OF CONTENTS
INTRODUCTION........................................................................................................................ 1
ELIGIBILITY TO PARTICIPATE ........................................................................................... 1
CESSATION OF PARTICIPATION ........................................................................................ 3
ELECTIONS AND CONTRIBUTIONS.................................................................................... 4
BENEFITS .................................................................................................................................... 5
CLAIMS PROCEDURE ............................................................................................................. 9
PRIVACY OF HEALTH INFORMATION ............................................................................ 11
CONTINUATION COVERAGE RIGHTS UNDER COBRA .............................................. 11
CONTINUATION OF COVERAGE DURING MILITARY SERVICE ............................. 15
PLAN ADMINISTRATOR ....................................................................................................... 16
PLAN AMENDMENT OR TERMINATION ......................................................................... 16
ADDITIONAL INFORMATION ............................................................................................. 16
SUBROGATION........................................................................................................................ 18
RECOUPMENT ......................................................................................................................... 20
NO ASSIGNMENT OF BENEFITS ........................................................................................ 20
QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)....................................... 20
STATEMENT OF ERISA RIGHTS ........................................................................................ 21
APPENDIX A ............................................................................................................................. 23
APPENDIX B ............................................................................................................................. 24
APPENDIX D ............................................................................................................................. 28
APPENDIX V ............................................................................................................................. 29
DB1/ 115054502.5
