CONTINUATION OF COVERAGE (SELF-PAY) AS REQUIRED BY THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA):

 You and your eligible Dependent(s) have the right to continue your medical coverage (as well as dental and vision coverage) under this Plan on a self-pay basis, as described under the section titled CONTINUATION PERIOD, if insurance would otherwise terminate due to a Qualifying Event.  This provision does not apply to Accidental Death and Dismemberment insurance.

 Qualifying Event means one of the following occurrences which would otherwise terminate your or your Dependent's insurance in the absence of this provision:

a. termination of your employment;

b. your work hours are reduced;

c. your retirement;

d. your death;

e. your entitlement to Medicare;

f. your divorce;

g. termination or substantial reduction of your coverage as a retiree within one year before or after the Employer files bankruptcy proceedings under Title 11 of the United States Bankruptcy Code; or

h. with respect to your Dependent child, his ceasing to satisfy the Plan's definition of an eligible Dependent.

ELIGIBILITY RULES

(Continued)

Election Period

 You and/or your Dependent(s) may elect to continue coverage within 60 days of the later of:

a. the date you and/or your Dependent(s) would otherwise lose coverage due to the Qualifying Event; or

b. the date you and/or your Dependent(s) are notified of your right to elect the continuation coverage.

 It is your or your Dependent's responsibility to notify the Plan Administrator of any of the following Qualifying Events: your divorce or legal separation; or your Dependent child ceases to be an eligible Dependent.  You and/or your Dependent(s) must provide such notification within 60 days after the later of:

a. the date of the Qualifying Event; or

b. the date your Dependent would otherwise lose coverage due to the Qualifying Event.

Such election must be in writing, on a form provided by the Plan Administrator.  Elected benefits will be continued provided:

a. the election form is duly completed and returned to the Plan Administrator within the 60-day period noted above; and

b. the required premium is paid to the Plan Administrator.  You must make your payment with 60 days after your election.  Although no payment is required for 45 days after your election, no claims can be processed until payment is actually received for the period from the end of group coverage through the month in which the claim was incurred.

Core and Non-core Coverage

 You may choose either core coverage or non-core coverage at the time of your election.  Core coverage includes medical coverage only.  Non-core coverage includes medical, dental, and vision coverage.  Once you elect either core or non-core coverage, you may not change that coverage for the duration of your COBRA coverage.

 ELIGIBILITY RULES

(Continued)

Continuation Period

 Coverage may continue, on a self-pay basis, after your bank of hours is exhausted as follows:

a. Coverage for you and/or your Dependent(s) may be continued for up to 18 months, if coverage terminated due to the Person's:

 1. termination of employment;

 2. reduced work hours, except in the case of a bankruptcy proceeding under Title 11 of the United States Bankruptcy Code with respect to the Employer; or

 3. retirement.

The 18-month period of continuation may be extended an additional 11 months if at the time of the qualifying event described in a. 1 or a. 2., you or your dependent are determined to be disabled by the Social Security Administration.  The premium for these additional 11 months can be substantially higher.

 

Proof of disability must be provided to the Plan Administrator within 60 days of the date the Social Security Administration makes the determination.  This extended period of continuation coverage applies only to the person who has been determined to be disabled by the Social Security Administration.

b. Coverage for your Dependent may be continued for up to 36 months, if coverage terminated due to:

 1. your death;

 2. divorce or legal separation; or

 ELIGIBILITY RULES

(Continued)

 3. with respect to your Dependent child, his ceasing to satisfy the Plan's definition of an eligible Dependent.

If the Qualifying Event is your entitlement to Medicare, coverage for your Dependent may be continued for up to 36 months from the date you became entitled to Medicare.

c. If an Employer files a bankruptcy proceeding under Title 11 of the United States Bankruptcy Code:

 1. coverage for you as a Retired Person may be continued for life;

 2. coverage for the widow(er) of a Retiree who dies before filing of the bankruptcy proceeding may be continued for life;

 3. coverage for the widow(er) and Dependent child(ren) of a Retiree who dies after the filing of the bankruptcy proceeding may be continued for an additional 36 months.

 If your Dependent's coverage is continued for reasons listed under item a. of this section, and, during the initial Continuation Period, a Qualifying Event occurs which entitles the Dependent to continue coverage under item b. of this section, your Dependent may elect to continue coverage up to a combined maximum of 36 months.

 You and/or your Dependent(s) who elect to continue coverage, shall be solely responsible for the payment of the premium for such continued coverage.  If an election is made after the Qualifying Event, premium payment for continuation coverage during the period preceding the election must

 ELIGIBILITY RULES

(Continued)

be made within 60 days of the date of the election.  Thereafter, the premium may be paid in monthly installments.

Termination of Coverage

 The continued coverage will cease on the first of the following dates:

a. the date your premium payment is due but not recieved--once COBRA coverage is terminated for non-payment of premiums it cannot be reinstated;

b. the date the Plan terminates;

c. the date a required premium is due and unpaid after any applicable grace period;

d. the date you and/or your Dependent(s) become insured under another group health plan.   This may not apply if you or your Dependent have a pre-existing condition which is excluded or limited under the new plan.  Contact the Plan Administrator for additional information when you and/or your Dependents become insured under another group plan;

e. the date you and/or your Dependent(s) become entitled to Medicare.  This does not apply in situations where the Qualifying Event is the Employer's bankruptcy proceeding under Title 11 of the United States Bankruptcy Code; or

f. the date of a retired Person's death, in situations where the Qualifying Event is the Employer's Title 11 bankruptcy proceedings; or

g. the date the applicable period of continuation is exhausted; or

h. the first day of the month which begins 30 days after you or your Dependent(s) receive a final determination from Social Security that you or your Dependent(s) are no longer disabled,

(Continued)

in situations where the Qualifying Event was termination of employment or reduction in hours and where COBRA coverage was being continued for an additional 11 months.

Conversion

 If you and/or your Dependent(s) choose not to elect continuation under this provision, you will retain the right to elect whatever individual conversion coverage is offered by the Company.  In this case, you and/or your Dependent(s) only have 31 days from the date coverage would have otherwise terminated to request conversion.

 Conversion to individual coverage is also available to you and/or your Dependent(s) at the end of the Continuation Period.

 Conversion coverage may cost more and provide lesser coverage than the group policy.

Contact the Plan Administrator as soon as possible when a Qualifying Event has occurred for additional information about your and your Dependent's right for Continuation.

SCHEDULE OF BENEFITS

Life insurance, (member only) )Insurance amount  $2,000

Accidental death & dismemberment, (member only)

 Principal Sum $2,000

Comprehensive Major Medical Expense Benefits

 Lifetime maximum $500,000

   Limited to $100,000 for the treatment of

Insurance Co. hospital preadmission review is not utilized.

MultiPhasic Physical Examination (member & spouse)

 Maximum per plan year  $100

  This benefit is provided directly by the Trust Fund and is not insured.

DEFINITIONS

These are some of the terms used in your booklet. Some other terms are described where they are used. PLEASE READ THEM CAREFULLY.

It can help you to better understand what your benefits are.

1.  "Company" means The  Insurance Company.

2.  "Complications of pregnancy" means:

 (a) conditions that require hospital confinements (when the pregnancy is not terminated), whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy, or which are caused by pregnancy; and

 (b) nonelective Caesarean section; ectopic pregnancy which is terminated; and spontaneous termination of pregnancy which occurs during a period of gestation in which a viable birth is not possible.

3. "Covered Charges" means the Reasonable and Customary charges which are incurred for the medically necessary treatment of conditions that are covered under this Plan.

4. "Extended Care Facility" means an institution which:

 (a) is regularly engaged in providing skilled nursing care for sick and injured persons under 24hours supervision of a Physician or a graduate Registered Nurse (R.N.);

 (b)  has available at all times the services of a Physician who is a staff member of a general hospital;

 (c)  has on duty 24 hours a day a graduate Registered Nurse (R.N.), Licensed Vocational Nurse (L.V.N.) or skilled practical nurse;

 (d)  has a graduate Registered Nurse (R.N.) on duty at least 8 hours per day;

 (e)  maintains a daily medical record for each patient; and

 (f)  complies with all licensing and other legal requirements.

"Extended Care Facility does not mean any institution, or part thereof (other than incidentally), which is a place for rest, a place for custodial care, a place for the aged, a place for drug addicts, a place for alcoholics, a hotel, or a similar institution."

5.  "Home health care" means the continued care and treatment of an insured person who is under the direct care and supervision of a physician but only if (i) continued hospitalization would have been required if home health care were not provided, (ii) the home health treatment plan is established and approved by a physician within 14 days after an inpatient hospital  confinement has ended and such treatment plan is for the same or related condition for which the insured person was hospitalized, and (iii) home health care commences within 14 days after the hospital confinement has ended.

6. "Home health agency" means a public or private agency or organization licensed by the State Department of Health Services in accordance with the provisions of Chapter 8 (commencing with Section 1725) of Division 2 of the Health and Safety Code.

 (c) has bylaws in effect with respect to its staff of Physicians; and

 (d) has a requirement that every patient be under the care of a Physician; and

 (e) provides 24hour nursing service rendered or supervised by a registered professional nurse; and

 (f) has in effect a hospital utilization review plan; and

 (g) is licensed pursuant to any state or agency of the state responsible for licensing hospitals; and

 (h) has accreditation under one of the programs of the Joint Commission on Accreditation of Hospitals.

"Hospital" does NOT mean any institution, or part thereof, which is used principally as a rest facility, nursing facility, convalescent facility or facility for the aged or for the care and treatment of drug addicts or alcoholics, except as mandated by State Law. It does NOT mean any institution that makes a charge that you or your Dependents are not required to pay.

For the purpose of determining benefits for mental diseases or disorders, "hospital" is defined above or is a place other than a convalescent, nursing or rest home, having accommodations for resident inpatients, facilities for the treatment of mental diseases or disorders, a resident psychiatrist always on duty, and which as a regular practice charges patients for the expense of confinement.

8. "Illness" means a bodily sickness, disorder or disease of the insured.

9. "Injury" means all damage to you or your eligible Dependent's body which is caused by an accident.

10. "Medically Necessary" means any service, supply, treatment, or Hospital confinement (or part of a Hospital confinement) which

 (a) is essential for the diagnosis or treatment of the Injury or Illness for which it is prescribed or performed;

 The determination whether treatment is medically  necessary is  made by the Plan.  THE FACT THAT A PHYSICIAN MAY PRESCRIBE,  ORDER, RECOMMEND, OR APPROVE A SERVICE OR SUPPLY DOES NOT, OF  ITSELF, MAKE IT MEDICALLY NECESSARY OR MAKE THE EXPENSE A  COVERED CHARGE.

Medically Necessary also refers to the type of facility in which the patient receives care.  For example, a hospitalization will not be considered medically necessary if the care could be provided at home or in a less expensive facility such as a skilled nursing facility or outpatient clinic.

11. "Physician" means a duly licensed doctor of medicine authorized to perform medical or surgical services within the lawful scope of his practice, and shall also include any other health care provider or allied practitioner as mandated by State Law.

12. "Reasonable and customary" means the usual charge made by a person, a group or an entity which renders or furnishes the services, treatments or supplies that are covered under this Plan. In no event does it mean a charge in excess of the general level of charges made by others who render or furnish such services, treatments or supplies to persons: (a) who reside in the same area; and (b) whose Illness is comparable in nature and severity. The term "area" means a county or such greater area that is necessary to obtain a representative cross section of the usual charges made.

13. "Totally disabled" when used in reference to the Health coverage means, with respect to you, that you, due solely to Injury or Illness, are prevented from engaging in your regular or customary occupation or employment. With respect to an insured Dependent, this means that he, due solely to Injury or Illness, is prevented from engaging in substantially all of the normal activities of a person of like age and like sex who is in good health. This definition does NOT apply to Life Insurance.

WHENEVER A PERSONAL PRONOUN IN THE MASCULINE GENDER IS USED, IT INCLUDES THE FEMININE, UNLESS THE CONTEXT CLEARLY INDICATES OTHERWISE.

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