Page 32 - PWH 2018 Plan Documents

Program with respect to deductibles, copayments or other cost-sharing provisions and limitations, except
that such terms may not impose greater limits or cost sharing on any length of stay required under Section
10.1 above than for any preceding portion of such stay.

Mental Health Parity Act

If a Health Benefit Program is subject to ERISA § 712, then the terms of this Section shall apply.

A Health Benefit Program that provides both medical and surgical benefits and mental health benefits shall
not impose any lifetime or annual limits on mental health benefits that violate the requirements of ERISA
§ 712.

Women’s Health and Cancer Rights Act

If a Health Benefit Program is subject to ERISA § 713 and provides medical and surgical benefits with
respect to a mastectomy, then this Section shall apply. Such Health Benefit Program shall, with respect to
a Participant who is receiving benefits in connection with a mastectomy, and who elects breast
reconstruction in connection with such mastectomy, provide coverage for the following (subject to
applicable deductibles, copayments and other Health Benefit Program limitations):

(1) reconstruction of the breast on which the mastectomy has been performed;

(2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and

(3) prostheses and physical complications for all stages of mastectomy, including
lymphedemas;

in a manner determined in consultation with the attending physician and the patient.

Subrogation and Recovery

If a Participant incurs covered expenses or receives benefits under a Benefit Program with respect to an
injury or illness for which a third party (or its insurer) may be liable, the Plan retains all rights of
subrogation, recovery and reimbursement as set out more specifically in the Governing Documents for
each Benefit Program.

Coordination of Benefits

Coordination of Benefits. When a Participant is covered by this Plan and another plan, the plans
will coordinate benefits when a claim is received. The terms of this Section 14 shall apply, except to the
extent specifically provided otherwise in the Governing Documents of a Health Benefit Program.

The plan that pays first according to the rules will pay as if there were no other plan involved. If this Plan is
secondary or subsequent, it will pay the amount it would have otherwise paid, minus whatever the primary
plan paid, so that benefits are not duplicated. The total reimbursement will never be more than the amount
that would have been paid if this Plan had been the primary plan.

Benefit Plan. This provision will coordinate the health benefits of a benefit plan. The term benefit
plan means this Plan or any one of the following plans:

(1) Group or group-type plans, including franchise or blanket benefit plans.