Page 160 - 2021 Medical Plan SPD

binding on all parties and subject to review by a legal authority only to the extent the decision was
arbitrary and capricious.

Source of Contributions and Funding under the Plan: The cost of coverage is paid through
contributions made by the Plan Sponsor and by the Participants. Benefits are provided from the general
assets of the Plan Sponsor.
Method of Calculating the Amount of Contribution: Employee-required contributions to the Plan
Sponsor are the employee's share of costs as determined by Plan Sponsor. From time to time, the Plan
Sponsor will determine the required employee contributions for reimbursement to the Plan Sponsor and
distribute a schedule of such required contributions to employees.

Qualified Medical Child Support Orders: The Plan's procedures for handling qualified medical child
support orders are available without charge upon request to the Plan Administrator.

Amendment or Termination of the Plan: Your employer, as the Plan Sponsor, has the right to amend or
terminate this Plan at any time. Note that the insurance contract, which is how benefits under the Plan are
provided, is not necessarily the same as the Plan. As a result, termination of the insurance contract does
not necessarily terminate the Plan.

26 Federal Notice