48676 IBEW Local No. 461 HW Plan SPD · BARGAINING UNIT EMPLOYEES ... NOTICE OF THE PRIVACY...

IBEW LOCAL NO. 461WELFARE FUND

SUMMARY PLAN DESCRIPTION

BENEFITS AND ELIGIBILITY RULESOCTOBER 2017

IBEW Local No. 461 Welfare FundSummary Plan Description

Table of Contents

PAGEINTRODUCTIONSECTION I - SCHEDULE OF BENEFITSCLASS BActive Employees and Their Dependents...................................................................... ACLASS BRetired Or Disabled Members And Their Eligible Dependents Who are

not Eligible for Medicare............................................................................................. GCLASS CRetired Or Disabled Members And Their Eligible Dependents Who are

Eligible for Medicare ................................................................................................... HSECTION II - ELIGIBILITY RULESBARGAINING UNIT EMPLOYEES ....................................................................................1Disqualifying Employment..............................................................................................1Initial Eligibility (Bargaining Unit Employees................................................................1Continuation of Eligibility – Employer Contributions ....................................................2Reserve Accumulation Account "Hour Bank\.................................................................2Self-Payment of Contributions .......................................................................................2Work Outside Trust Fund Jurisdiction - Reciprocity......................................................3Reinstatement of Eligibility ............................................................................................3SELF-PAY WHEN DISABLED............................................................................................4Continuation of Eligibility During Disability ..................................................................4Total and Permanent Disability......................................................................................4Self-Payment ..................................................................................................................5PARTICIPATION AGREEMENTS FOR NON-BARGAINING UNIT

PARTICIPANTS.............................................................................................................5USERRA CONTINUATION COVERAGE.............................................................................6EFFECTIVE DATES OF COVERAGE...................................................................................9SPECIAL ENROLLMENT RIGHTS ...................................................................................11TERMINATION DATES OF COVERAGE ..........................................................................13GENERAL PROVISIONS.................................................................................................14Change of Eligibility Rules............................................................................................14A Note of Explanation...................................................................................................14Family and Medical Leave.............................................................................................14Qualified Medical Child Support Orders .......................................................................15COBRA CONTINUATION COVERAGE.............................................................................17Employee Right to Elect Continuation Coverage.........................................................17Your Spouse's Right to Elect Continuation CoverageSpouse's Right to Elect Continuation Coverage ..........................................................18Dependent Children's Right to Elect Continuation Coverage......................................18Disabled Eligible Employee...........................................................................................19Employee Obligations to Notify the Plan Office of a Qualifying Event .......................20Second Qualifying Event...............................................................................................20Proof of Insurability is Not Necessary to Elect Continuation Coverage .....................21


Table of Contents

Procedure for Obtaining Continuation Coverage.........................................................21Termination of Continuation Coverage........................................................................21RETIREE PROGRAM ......................................................................................................23Coverage Classifications Defined.................................................................................23General Eligibility Requirements..................................................................................24Self-Payment of Contribution.......................................................................................24Benefit Limitations .......................................................................................................25SECTION III - GENERAL DEFINITIONSSECTION IV –COMPREHENSIVE MEDICAL BENEFITSIntroduction..................................................................................................................40Preferred Provider Organization (PPO) .......................................................................40Non-Preferred Provider Organization (PPO) ...............................................................40The Deductible Amount ................................................................................................40Maximum Deductible Amount for Families..................................................................40Co-Payment...................................................................................................................40Co-Payment Limit for Individuals ................................................................................41COVERED EXPENSES.....................................................................................................41Hospital Expense Benefits............................................................................................41Hospital Pre-Admission Testing ...................................................................................43Surgical Expense Benefits ............................................................................................43Second Surgical Opinion Benefits ................................................................................45Diagnostic X-Ray and Lab Benefits ..............................................................................45In-Hospital Physician Benefits .....................................................................................46Therapy Benefits...........................................................................................................46Pregnancy Expense Benefits ........................................................................................46Newborn Dependent Child Benefits .............................................................................47Chiropractic Expense Benefits......................................................................................48Home Health Care Benefits ..........................................................................................49Elective Sterilization Benefits ......................................................................................49Mental Health & Substance Abuse Benefits.................................................................50Preventive Care Benefits and Routine Physical Examination .....................................51Prescription Drug Benefits ...........................................................................................52Hearing Care Benefits...................................................................................................52Organ Transplant Benefit .............................................................................................53Other Covered Charges.................................................................................................54Limitations ....................................................................................................................55SECTION V – DENTAL CARE BENEFITSPredetermination of Benefits .......................................................................................60The Maximum Amount..................................................................................................60Covered Expenses.........................................................................................................60Treatment in Progress When Eligibility Terminates....................................................62Limitations ....................................................................................................................63SECTION VI – VISION CARE BENEFITSThe Maximum Amount..................................................................................................66


Table of Contents

Covered Expense...........................................................................................................66Limitations ....................................................................................................................67Laser Eye Surgery .........................................................................................................67Vision Therapy .............................................................................................................68SECTION VII – LOSS OF TIME, DEATH AND DISMEMBERMENT

BENEFITSWeekly Loss of Time Benefits – Active Employees Only .............................................70Death and Dismemberment Benefits ...........................................................................71SECTION VIII – MEDICAL SAVINGS BENEFITHow the Medical Savings Benefit Works .....................................................................73What the Money Can Be Used For ................................................................................73How to Use the Medical Savings Benefit .....................................................................73Forfeiture of Medical Savings Benefit ..........................................................................74Qualifying Medical Expenses........................................................................................74Ineligible Medical Expenses .........................................................................................75SECTION IX – SUPPLEMENTAL BENEFIT ACCOUNTFunding .........................................................................................................................78Access to Funds.............................................................................................................78Reimbursable Benefits..................................................................................................79Reimbursement Procedure...........................................................................................79Accruing Account Balances...........................................................................................79Excluded Expenses .......................................................................................................80Work in an Area Outside of the Jurisdiction of the FPlan ...........................................80Forfeiture of the SBA ....................................................................................................80ACA Opt-Out of Account ...............................................................................................81SECTION X – GENERAL PLAN EXCLUSIONS AND LIMITATIONSRoutine Care and Elective Procedures .........................................................................83Medical Necessity .........................................................................................................83Work Related Disabilities .............................................................................................83Organ Transplants ........................................................................................................84Reasonable and Customary Charges............................................................................84Treatment Sponsored by Governmental Units ............................................................84Treatment Without Charge...........................................................................................85Illegal Occupation or Act or Commission of Felony.....................................................85Experimental or Investigative Treatment or Procedures............................................85General Limitations ......................................................................................................85Subrogation and Reimbursement ................................................................................88Offset.............................................................................................................................90SECTION XI – OTHER GENERAL PLAN PROVISIONSPhysical or Dental Examination and Autopsy ..............................................................93Free Choice of Physician...............................................................................................93Workers' Compensation Not Affected..........................................................................93Time Limits for Filing Claims ........................................................................................93Circumstances That May Result In Loss Of Eligibility Of Benefits ..............................94


Table of Contents

Claims Review and Appeal Procedures ........................................................................94External Review of Denied Health Care Claims ........................................................ 102Further Action ............................................................................................................ 103Coordination of Benefits With Other Group Plans.................................................... 103Coordination of Benefits with Medicare.................................................................... 106SECTION XII – STATEMENT OF PARTICIPANT'S RIGHTSSECTION XIII – OTHER IMPORTANT INFORMATIONThe Trustees Interpret the Plan................................................................................ 113The Plan Can Be Changed.......................................................................................... 113No Guarantee of Coverage ........................................................................................ 114Your Plan is Tax Exempt............................................................................................ 114Right to Receive and Release Necessary Information ............................................. 114Facility of Payment .................................................................................................... 114Right of Recovery ...................................................................................................... 115Payment of Claims ..................................................................................................... 115IMPORTANT PLAN INFORMATION............................................................................ 115NOTICE OF THE PRIVACY PRACTICES OF THE IBEW LOCAL NO. 461

WELFARE FUND


Introduction Letter PAGE i

IBEW LOCAL NO. 461 WELFARE FUND

INTRODUCTION

TO: ALL PARTICIPANTS

We are pleased to distribute this new Summary Plan Description (SPD)/PlanDocument (together called the "Summary") incorporating all Plan changes adoptedthrough October 1, 2017. This Summary explains the benefits available under yourWelfare Plan, summarizes the eligibility rules for participation in the Plan, and presentsyour rights as a Participant. You should take time to read this new Summary so thatyou are up-to-date on the protection provided.

Article V, subsection 5.01(a) of the International Brotherhood of ElectricalWorkers Local Union No. 461 Welfare Trust Fund Agreement (the "Trust Agreement")authorizes the Trustees to formulate and adopt a program of benefits. This document,entitled the "International Brotherhood of Electrical Workers Local Union No. 461Welfare Fund Summary Plan Description," codifies the principal elements of suchprogram. This Summary is both the SPD and Plan Document. The provisions ofbenefits and the operation and administration of the Plan pursuant to this Summaryshall at all times remain subject to, and controlled by, the Trust Agreement.

The Trustees have elected to provide many of the plan benefits directly fromthe assets of the Trust Fund. The Trustees have also elected to use the services of theBlue Cross Blue Shield of Illinois (BCBSIL) Preferred Provider Network, and purchasedinsurance for catastrophic loss. This arrangement is expected to result in cost savingswhich will contribute to greater financial security for the Plan, and which may alsoallow the Trustees to improve benefits more frequently.

All rights and powers of the Plan as provided herein shall vest in the Trustees.Consistent with their obligation to maintain, within the resources available, a soundand economical program providing reasonable benefits for Participants andDependents, the Trustees expressly reserve the right, in their sole discretion, to:

1. establish, amend, or terminate the amount, eligibility requirements orconditions with respect to any benefit;

2. alter the method of paying any benefit;

3. amend any provision of this Summary at any time and from time totime; and

4. interpret this Summary.


Introduction Letter PAGE ii

The Plan shall pay benefits as provided in this Summary only to the extent thatthe Plan's assets allow. No benefits shall be payable at any time after the Plan hasterminated and all Plan assets are expended.

After you read it, keep this Summary in a convenient place. If you havequestions about your benefits, please call or write the Plan Office for assistance, andhave your Summary available for reference. We encourage each eligible person to usemedical care and these benefits wisely and only when genuinely necessary.

Sincerely,

THE BOARD OF TRUSTEES

Management Trustees Union TrusteesBruce Anderson, Chairman Joel Pyle, II, SecretaryTim Assell Michael AngeloCraig Martin Steve MusichThomas J. Cook Mark Seppelfrick

The Union Administrative Office is open:Monday, through Friday from 8:00 a.m. to 4:30 p.m.

591 Sullivan Road, Suite 100Aurora, IL 60506(630) 897-0461(630) 897-7605 FAX


Introduction Letter PAGE iii

IMPORTANT INFORMATION

TERMS AND CONDITIONS OF THE PLAN

This booklet describes the terms and conditions governing the IBEW LocalNo. 461 Welfare Fund (the "Plan"). By law, the Board of Trustees (the "Trustees")possesses the right to amend, modify or terminate any and all benefits, changeeligibility rules and vary the contributions, if any, required from Eligible Persons. If youhave questions not answered by this booklet, please contact the Plan Office.

NO AGENT MAY INTERPRET THE PLAN DOCUMENTS

Only the Plan Office and/or appropriate benefit administrators may answerquestions relating to the Plan and the benefits described in this Summary PlanDescription ("SPD"). Employer representatives, Union representatives and the Plan'sindividual Trustees are not authorized to bind the Plan regarding the Plan's benefits oreligibility requirements. Only the full Board of Trustees or the appropriate benefitsadministrator can issue Plan interpretations. If you want information regarding anyprovision of this booklet or any of the Plan documents, contact the Plan Office.

NO GUARANTEE

None of the benefits provided by the Plan are guaranteed by the Trustees, anyparticipating Employer, Union or any other individual or entity. The Plan's benefitsoriginate only from Plan assets collected and available for such purposes. The Boardof Trustees reserves the right to interpret, amend, modify or terminate all or a part ofthis SPD and other Plan documents and to take any action it deems appropriate topreserve the financial stability of the Plan.

DETERMINATION BY TRUSTEES BINDING

A Board of Trustees—representing the Employees, selected by participatingLocal Unions, and representing the participating Employers, selected by theEmployers—govern the Plan. The Trustees are responsible for the operation of thePlan and the benefits provided from the Plan. They interpret the Plan documents,prescribe procedures for the operation of the benefit Plans and determine (a) who willbe Eligible Persons, (b) the type and amount of benefits provided and (c) the mediumfor providing benefits.

The Trustees or, where Trustee responsibility has been delegated to others,such delegates shall have complete authority to apply and interpret this document andto determine the level of proof that will be required to establish eligibility for benefitsor coverage for incurred expenses.


Introduction Letter PAGE iv

You should submit all questions regarding the benefit Plans, arising in anymanner or between any parties or persons in connection with this Plan or its operation,whether as to any claim for benefits, or as to the construction of language or meaningof this booklet, or as to any writing, decision, instrument or accounting in connectionwith the operation of the Plan, or otherwise, to the Trustees or, where Trusteeresponsibility has been delegated to others, to such delegates for a decision. Thedecision of the Trustees or their delegates will bind all persons dealing with the Plan orclaiming any benefits hereunder, except to the extent that such decision may bedetermined to be arbitrary or capricious by a court having jurisdiction over suchmatter.

ASSIGNMENTS

Benefits provided by the Plan are assignable to only a Hospital, a Physician or aDentist, provided the required assignment is received by the Plan prior to the benefitpayment. For network providers, the assignment shall occur automatically.

PERMANENCY OF BENEFITS

The Trustees, Unions and Employers have established no deadline ortermination date for the benefits described herein or the existence of the Plan.Circumstances, needs and perspectives, though, change from time to time. As aresult, the Trustees reserve the right, in their sole discretion, to amend, change orterminate the benefits, the eligibility requirements or conditions for receiving a benefitand the continued operation of the Plan. The Plan can pay benefits only to the extentits assets allow and will pay no benefits following its termination and disbursement ofall of its assets. No Trustee nor any Employer nor Union shall be liable, in any manner,if the Plan shall be insufficient to provide for the payment of the benefits specifiedherein.

The Plan may be amended, changed or terminated in accordance with theTrust Agreement. The Plan may be terminated by any of the circumstances recited inthe Trust Agreement, including but not limited to, the discontinuance of all Employercontributions to the Plan or the written agreement of the Unions and Employers toterminate the Plan.

If the Plan is terminated, the Trustees shall determine the disposition of allassets of the Plan, provided that such distribution shall be made only to benefit youand your Dependents and to defray the cost of doing so.

COMPLIANCE WITH PLAN PROVISIONS

Failure of the Trustees to insist upon compliance with any provision of a Plan atany time will not affect their right to insist upon compliance with such provision at anyother time.


Introduction Letter PAGE v

INCOMPETENCE

Payments made to you or your Dependents are subject to provisions allowingfor payment to someone else where either you or your Dependent is a minor orotherwise not legally able to give a valid receipt for payment.

OVERPAYMENT

If the Plan pays any amount to or on behalf of you or your Dependent to whichyou or your Dependent is not entitled, the Plan may reduce future payments due to oron behalf of you or any of your Dependents by the amount of any such erroneouspayment. This right of offset shall not, however, limit the rights of the Plan to recoversuch overpayments in any other manner.

OCCUPATIONAL INJURIES

If you are a Participant and injured on the job, immediately notify yoursupervisor. The Plan does not pay benefits for Occupational Bodily Illness or Injury.At your first opportunity, apply for worker's compensation benefits.

If you are injured doing work as an Employee, the Plan generally does not paybenefits until you submit the final decision on your claim for worker's compensationbenefits. However, at the discretion of the Trustees, the Plan may advance youbenefits but you must pursue your worker's compensation claim and must reimbursethe Plan for any payments received.

The Plan does not advance benefits for an Illness or Injury incurred in, orarising out of, any work for pay or profit other than as an Employee. It also does notadvance benefits to Dependents.


Introduction Letter PAGE vi

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Section I – Schedule of Benefits Page A

SECTION I

SCHEDULE OF BENEFITS

SCHEDULE OF BENEFITS – CLASS AACTIVE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS

CLASS A SCHEDULE OF BENEFITS1

In-Network BCBSIL Out-of-Network

Deductible

$100 per person$300 per family (per

calendar year, combinedwith out-of-network

deductible)

$100 per person$300 per family (per

calendar year, combinedwith out-of-network

deductible)

Co-pay Dollar Maximum$1,600 per person

$3,300 per family (percalendar year)

$3,100 per person$6,300 per family (per

calendar year)Lifetime Maximum None None

Preventive ServicesACA Preventive Care Services(general listing available atwww.healthcare.gov)

Covered at 100% (nodeductible, no co-pay)

Covered at 80% of R&C (nodeductible, no co-pay)

Health MaintenanceExam – includes chest x-ray,EKG, annualOBGYN exam,mammogram & select labprocedures

Covered at 100% (nodeductible, no co-pay;

one per person percalendar year)

Covered at 80% of R&C(no deductible, no co-

pay; one per person percalendar year)

Fecal Occult Blood ScreeningCovered at 100%

no deductible, no co-payCovered at 80% of R&Cno deductible, no co-pay

Flexible Sigmoidoscopy ExamCovered at 100%

no deductible, no co-payCovered at 80% of R&Cno deductible, no co-pay

Prostate Specific Antigen(PSA) Screening

Covered at 100%no deductible, no co-pay

Covered at 80% of R&Cno deductible, no co-pay

Major Medical

Hospital Confinement,Surgery & Physician Services

Covered at 80% Covered at 65%

1 Patient is responsible for any out-of-network charges over the Reasonable and Customary ("R&C").


Section I – Schedule of Benefits Page B



Physician Office Services

Office VisitsCovered at 80% after the

deductibleCovered at 65% of R&Cafter the deductible

Outpatient & Home VisitsCovered at 80% after the


Office ConsultationsCovered at 80% after the


Urgent Care VisitsCovered at 80% after the


Emergency Medical Care

Hospital Emergency Room –medically necessary

Covered at 80% after thedeductible

Covered at 80%after the deductible

Ambulance Services –medically necessary


Covered at 80%after the deductible

Diagnostic ServicesLaboratory & PathologyTesting


Covered at 65% of R&Cafter the deductible

Diagnostic Tests & X-raysCovered at 80% after the


Radiation TherapyCovered at 80% after the


Maternity Services

Pre-natal careCovered at 100% (nodeductible, no co-pay)


Post-natal care Covered at 80% after thedeductible


Delivery & Nursery care Covered at 80% after thedeductible


Pregnancy benefits are not provided for children (except for routine pre-natal visitsunder the Preventive Services benefit).

Hospital Care

Semi-private Room, In-patientCovered at 80% after the


Inpatient ConsultationsCovered at 80% after the


ChemotherapyCovered at 80% after the


Alternatives to Hospital Care


Section I – Schedule of Benefits Page C



Skilled Nursing Care

Inpatient: 80% afterdeductible

Outpatient: paid as HomeHealth Care

Inpatient: 65% of theR&C after deductibleOutpatient: paid as HomeHealth Care

Hospice Care

Inpatient: paid as MajorMedical 80% after the

deductibleOutpatient: paid as Home

Health Care Benefit

Inpatient: paid as MajorMedical 65% of R&C

after the deductibleOutpatient: paid as HomeHealth Care Benefit

Home Health care

Maximum 4 hours/dayup to 30 days/calendar

year 80% afterthe deductible

Maximum 4 hours/dayup to 30 days/calendaryear 65% ofR&C after the deductible

Residential Treatment Facility

Surgical ServicesSurgery – includes relatedsurgical services



Voluntary Sterilization

Female: Covered underPreventive Care Services

Male: Covered at 80% afterthe deductible


Human Organ Transplants

Organ TransplantsCovered at 80% after the


Mental Health & Substance Abuse Treatment

In-patient Mental Health CareCovered at 80% after the


In-patient Substance AbuseCare



Out-patient Mental HealthCare



Out-patient Substance AbuseCare



Other Services

Outpatient DiabetesManagement Program

Covered at 80% afterthe deductible

Covered at 65% ofR&C after thedeductible


Section I – Schedule of Benefits Page D



Chiropractic SpinalManipulation


– Maximum 24 visitsper person, per calendar

year

Not Covered if Out-of-Network

Chiropractic Diagnostic X-ray& Laboratory


one per person, percalendar year

maximum


Outpatient Physical,Occupational Therapy &Speech Therapy (Facility,Clinic & Physician's Office)

Covered at 80% afterthe deductible,

40 visit (combined)maximum percalendar year


Durable Medical Equipment


Rental up to purchaseprice covered under

Major Medical


Prosthetic & OrthoticAppliances


1 per person, per year,per diagnosis


Massage, Acupuncture andNaprapathy

Covered at 80% afterthe deductible,

12 visit maximum percalendar year

Not covered if Out-of-Network

Private Duty Nursing Not covered

CLASS A SCHEDULE OF BENEFITS

Vision, Dental and Hearing Aid Benefits

Vision$600 per person, per benefit period (benefit period istwo years). Benefits do not accumulate toward the Co-Payment Limit.

Laser Eye surgery (Lasik)50% of R&C after the deductible. Lifetimemaximum of $2,000 per eye. Benefits do notaccumulate toward the Co-Payment Limit.


Section I – Schedule of Benefits Page E


Vision, Dental and Hearing Aid Benefits

Hearing Aid

80% of R&C after the deductible. Maximumpayable $2,500 per ear, per person every 5 years.Benefits do not accumulate toward the Co-PaymentLimit.

Dental(no PPO network)

Preventive – No deductible. Covered at 100%(exam, cleaning & x-rays)

Restorative & Routine Care – Covered at 80% (X-rays,restorative care, extractions, periodontics & implants)

No deductible.Orthodontics – (Dependent children only up to age 19 or

23 (if a full-time student))Maximum 36-month treatment. Covered at 80%.

All Dental (preventive, restorative, routine care &orthodontics) have a combined maximum of $1,500per person, per calendar year and benefits do notaccumulate toward the Co-Payment Limit..

TMJCovered at 50% of the R&C up to a lifetime maximum of$3,000 for both In-network & Out-of-network. Benefitsdo not accumulate toward Co-Payment Limit.


Prescription DrugsCoverage is through Sav-RX

No prescriptions arecovered when filled ata Wal-Mart

Sav-RX PreferredPharmacy

Non-Preferred Pharmacy

Generic DrugsIf a brand name isavailable as a generic butelected to be filled as abrand name, you will beresponsible for all costsabove the 80% coverageof the generic cost.


Brand Name Drugs Covered at 70% Covered at 70%


Life and Loss of Time

Life Insurance - Death (all causes)


Section I – Schedule of Benefits Page F


Life and Loss of Time

Participant Only $1,000Weekly Loss of Time Benefits

Non-Occupational Injury orIllness Benefit

Payment Begins:

For accident 1st day disabled andFor sickness 8th day disabled

Weekly Payment Rate - $400

Maximum Payment Period – 18 weeks

Occupational Injury or IllnessBenefit

Not Covered.


Section I – Schedule of Benefits Page G

SCHEDULE OF BENEFITS – CLASS BRETIRED EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS

WHO ARE NOT ELIGIBLE FOR MEDICARE

Your benefits are the same as those listed for Class A except as noted below:

Death Benefit – All causes(Retirees ONLY)

$500

Weekly Loss of TimeBenefit

Non-Occupational or Occupational – Not Covered

Comprehensive MajorMedical Benefits

Generally the same as Class A Benefits except:Excludes Elective Sterilization for men

Prescription DrugsCoverage is through Sav-RX

No prescriptions arecovered when filled ata Wal-Mart


Non-Preferred Pharmacy

Generic DrugsIf a brand name isavailable as a generic butelected to be filled as abrand name, you will beresponsible for all costsabove the 80% coverageof the generic cost.


Brand Name Drugs Covered at 70% Covered at 70%Dental Care Benefit Same as Class A

Vision Care Benefit Same as Class A

Patient is responsible for all out-of-network charges over Reasonable andCustomary


Section I – Schedule of Benefits Page H

SCHEDULE OF BENEFITS – CLASS CRETIRED EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS

WHO ARE ELIGIBLE FOR MEDICARE

Death Benefit – Allcauses, Retiree only

$500

Weekly Loss of TimeBenefit

Non-Occupational or Occupational – Not Covered

Major Medical BenefitsGenerally the same as Class A Benefits except:

Excludes Elective Sterilization for men

Medicare Hospital(Part A)

Deductible – Not covered

Medicare ProfessionalServices (Part B)

Deductible – Not coveredPlan Pays 100% of patient's 20% of Medicare's

AllowableAmounts in Excess of Medicare's Allowable – Not

coveredPrescription Drug Benefits

Coverage is throughSav-RX

No prescriptionsare covered whenfilled at a Wal-Mart


Non-PreferredPharmacy

Generic DrugsIf a brand name isavailable as a genericbut elected to be filledas a brand name, youwill be responsible forall costs above the80% coverage of thegeneric cost.


Brand Name Drugs Covered at 70% Covered at 70%

Dental Care Benefit Not CoveredVision Care Benefit Not Covered

5% Coverage onBenefits in Excess of$3,000

Notwithstanding the foregoing, after the Plan pays$3,000 during a calendar year on behalf of an individual

covered by Class C, then all Class C benefits payablethereafter during such calendar year on behalf of such

individual shall be covered by the Plan at 5%.


Section I – Schedule of Benefits Page I



Section II – Eligibility Rules Page 1

SECTION II

ELIGIBILITY RULES

BARGAINING UNIT EMPLOYEES

Disqualifying Employment

A Participant who works in Disqualifying Employment shall forfeit all of theunused accumulated hours in his/her hour bank.

"Disqualifying Employment" has three (3) components:

1. employment for a non-contributing employer, or self-employment as anon-contributing employer,

2. in a position as an electrician or a supervisor in the electrical industry,

3. within the geographical area that includes the State of Illinois plus theremainder of any Standard Metropolitan Statistical Area which falls inpart within the State of Illinois.

A Participant who engages in any Disqualifying Employment will forfeit theaccumulated unused hours in his/her hour bank irrespective of whether theParticipant has also performed work for a Contributing Employer during thesame time period.

All Employees working for a Contributing Employer or Employers within thejurisdiction of the Plan shall be eligible to receive benefits after meeting the followingeligibility requirements. Eligibility is based on Work Month and Eligibility Month.

Initial Eligibility

You will become initially eligible on the first day of the month following atwo-month accounting period if you have been employed by a Contributing Employeror Employers and those Employers have made contributions to the Plan on your behalffor at least 300 hours worked within a period of twelve (12) consecutivecalendar months or less. Your initial period of eligibility continues for the remainderof that "Eligibility Month."



Continuation of Eligibility – Employer Contributions

After your period of initial eligibility, you continue to be eligible so long as youare working for a Contributing Employer or Employers and those Employers madecontributions on your behalf for at least one hundred fifteen (115) hours in one month.You are then eligible the first day of the month following a two-month accountingperiod in which the hours were worked.

For example, because the contributions for hours worked in any month are notmade to the Plan until the following month, your current work earns future eligibilityas follows:

Contribution Month Eligibility MonthWork Performed During..... Determines Eligibility For.....

January AprilFebruary MayMarch JuneApril JulyMay AugustJune SeptemberJuly OctoberAugust NovemberSeptember DecemberOctober JanuaryNovember FebruaryDecember March

Reserve Accumulation Account "Hour Bank"

After initial eligibility all hours worked in excess of the one hundred fifteen(115) credited hours per month required thereafter for continued monthly eligibility willbe credited to your individual Hour Bank. Accumulated hours in your Hour Bank allowyou to continue your eligibility during periods of unemployment and underemployment.The Hour Bank maximum can afford you up to six (6) months of eligibility. If youbecome ineligible for more than thirty-six (36) months any accumulated bank hourswill become forfeit.

Self-Payment of Contributions

After becoming initially eligible, you may be allowed to make self-payments ofcontributions if you are in danger of losing eligibility due to a period of unemployment.To be eligible to make self-payments, you must be available for work at coveredemployment in the industry with an Employer who participates in this Plan.



If your monthly contributions are less than the required one hundred fifteen(115) any available hours in your hour bank are utilized and then you can self-pay thedifference based on the number of hours short at the current contribution rate.

Self-payments must be received at the Plan Office within ten (10) days of thedate the Termination Notice is received by you. All Notices are sent by first class mailto the last known address on file at the Plan Office so it is important that any addresschanges are reported immediately.

Eligibility by means of self-payments can be continued for no more than twelve(12) consecutive Benefit Months, whether or not the self-payment is full or partial.Coverage will terminate the last day of the month for which your last self-payment wasmade as required.

After your right to make self-contributions is exhausted, you may be able toelect COBRA Continuation Coverage at a self-contribution level based on the actualcost of coverage to the Plan. This is allowed for a maximum of twenty-four (24)months.

When you are eligible by self-payments, you and your eligible Dependents arecovered by the same benefits as all other Employees; all normal Plan provisions apply.

Work Outside Trust Fund Jurisdiction - Reciprocity

The Trustees of this Plan have entered into contracts known as ReciprocityAgreements with the Trustees of similar IBEW Welfare Funds which, once you areeligible in this Plan, may allow contributions you earn for work in IBEW jurisdictionsoutside the jurisdiction of this Trust Fund to be transferred for eligibility credit in thisPlan. If you plan to work at covered employment outside the jurisdiction of this Plan,you should contact the IBEW Local 461 Union Office to ask whether you would beallowed to transfer contributions for that work. All reciprocity transfers are processedthrough the Electronic Reciprocal Transfer System (ERTS). All Participants are requiredto file a reciprocity form through the Internet via their Local Union. Please contact theLocal Union for more information.

You are not allowed to transfer contributions to establish initial eligibility underthis Plan unless you are a Local 461 member.

Reinstatement of Eligibility

If you once establish eligibility under this Plan and lose that eligibility at a laterdate, you will be reinstated when you meet the requirements under "Continuation ofEligibility" in these Rules, provided you remain ineligible for at least one month. If youremain ineligible more than thirty-six (36) months, you must meet the requirementsunder "Initial Eligibility" in these Rules to become eligible again.



SELF-PAY WHEN DISABLED

If a Participant is prevented from engaging in covered employment by totaldisability, he will be allowed to make self-payment of contributions for up to twelve(12) consecutive Benefit Months. The self-payment amount is determined by theBoard of Trustees.

Continuation of Eligibility During Disability

If you become disabled and are unable to perform covered employment whileyou are eligible in this Plan, you must either utilize your banked contributions orremit self-payments to maintain eligibility.

All disability absences will be considered a single disability unless:

1. You return to active covered employment for at least one day and yousubmit evidence satisfactory to the Trustees that the cause(s) of thelatest disability absence cannot be connected with the cause(s) of anyprior disability absences, or

2. You return to active covered employment for at least two weeks eventhough a connection can be established between the cause(s) of twosuccessive disability absences.

The Trustees retain the right to have you medically examined by a physician oftheir own choice at the Plan's expense to determine whether a disability qualifies underthis Rule.

Total and Permanent Disability

In order for you to be eligible to make self-payments when totally and permanentlydisabled, you must:

1. Be totally and permanently disabled, and so unable to perform any work forremuneration or profit on the date you would otherwise lose eligibility underthese Rules, and

2. Be awarded a disability benefit from the Social Security Administration, and

3. Have a minimum of five (5) years of continuous eligibility in this Plan prior tothe disability.

This self-payment provision applies to the Employee coverage and yourDependents (if any) until the earlier of:

1. The date you are eligible in any other group health care plan; or



2. The date you are no longer totally disabled, or

3. The date you become eligible for Medicare,

When you are covered by a total and permanent disability self-payment, you arenot covered by Weekly Loss of Time Benefits.

Self-Payment

You will be required to make self-payments in the amount equal to theself-payment rate(s) established for active Participants.

Vision and Dental Election

Each year, you may opt out of the dental and vision coverage offered by thePlan. If you opt out of coverage, you will not receive any compensatory benefits andyou and your dependents will not have any dental and/or vision benefits between forthe calendar year. If you wish to opt out of dental and/or vision coverage, contact theFund Office.

PARTICIPATION AGREEMENTS FOR NON-BARGAINING UNIT PARTICIPANTS

Employers, that have executed a Participation Agreement, must contribute atthe prescribed rate as determined by the Board of Trustees for all full time (as definedin their Participation Agreement) Non-Bargaining Unit Employees regardless of thenumber of actual hours worked by such Employees. Employers are required to remitfringe benefit contributions by the fifteenth (15th) of the month with all regularMonthly Payroll Reports.

Eligibility will begin on the first day of the second calendar month after theemployer has contributed the required contributions on the Participant's behalf (e.g., acontribution due and payable in March buys coverage in May). The Participant willremain eligible so long as the employer continues to remit the required contributionsper month for all applicable employees in accordance with payment requirements (witheach monthly contribution buying coverage for the second following month; e.g., acontribution due and payable in September buys coverage in November).

Delinquent contributions for all non-bargained employees must be receivedprior to the first day of the month for which all such coverage is being provided orcoverage will cease and will not be reinstated.

Eligibility ceases on the first day of the calendar month following the last monthfor which coverage was provided by the contribution received from the Employer.When an employee terminates employment, coverage will be continued through thesecond month following his termination of employment, provided the Employer made



the required contributions through and including the month of termination (e.g., if anemployee terminates employment in May, coverage will continue for June and July).

Non-Bargaining Unit Participants are not eligible for Loss of Time Benefits.Non-Bargaining Unit Participants shall not receive contributions to the SupplementalBenefit Account (except for Participants employed by Local Union 461 and the JointApprenticeship and Training Fund, who shall receive such contributions).

Each year, you may opt out of the dental and vision coverage offeredby the Plan. If you opt out of coverage, you will not receive anycompensatory benefits and you and your dependents will not have anydental and/or vision benefits between for the calendar year. If you wish toopt out of dental and/or vision coverage, contact the Fund Office.USERRACONTINUATION COVERAGE

The Uniformed Services Employment and Reemployment Rights Act("USERRA") is a federal law providing protections for Employees who leaveemployment to serve in the Uniformed Services. For Plan purposes, USERRA appliesonly to health coverage (i.e., medical, dental, drug, vision).

If you satisfy USERRA's eligibility requirements, you are entitled to electcontinuation coverage for yourself and your Dependents during your absence fromemployment for Uniformed Service. You are also entitled to immediate reinstatementin the Plan upon your return from Uniformed Service as if you had been continuouslyemployed during the Uniformed Service. If you do not satisfy USERRA's eligibilityrequirements, you are not entitled to any of the protections described in this section.

Continuation of Coverage During Uniformed Service. The law requiresthat coverage by the Plan continue during a leave covered by USERRA. Coverage mustbe the same as provided to similar Employees; thus, if coverage changes for similarEmployees, it will also change for the person on leave. The employee's cost of suchcoverage will equal:

1. For leaves of 30 days or less, no charge;

2. For leaves of 31 days or more, the COBRA premium (up to 102% of thefull contribution).

You will be deemed to be on military leave of absence effective on the date youleave employment to enter Uniformed Service. If your leave of absence is less than 31days, your Plan coverage will be continued for the duration of the leave. If your leaveof absence is 31 days or more, your Plan coverage will terminate as of the date youbegin your military leave of absence, subject to the USERRA continuation of healthcoverage provisions described below.



If you fail to provide advance notice of your Uniformed Service, your Plancoverage will terminate on the date you leave employment to enter Uniformed Service,and you will not be eligible to continue coverage unless the failure to provide advancenotice is excused. The Trustees will, in their sole discretion, determine if your failureto provide advance notice is excusable under the circumstances and may require thatyou provide documentation to support the excuse. If the Trustees determine that yourfailure to provide advance notice is excused, you may elect to continue coverageretroactive to the date your military leave of absence began, provided that you electsuch coverage and pay all amounts required for the continuation coverage, asdiscussed below.

After the Plan receives notice of your military leave of absence, you will havethe option of continuing your coverage pursuant to the Plan. USERRA continuationcoverage is similar, but not identical, to COBRA continuation coverage. The rules forelection of continuation coverage are the same as the COBRA election rules describedin this Summary Plan Description, provided that the COBRA election rules do notconflict with USERRA. If you do not elect continuation coverage within the applicableCOBRA timeframe, you will lose the right to USERRA continuation coverage and suchright will not be reinstated.

You must make timely self-payments at the COBRA rate determined by theTrustees from time to time to purchase COBRA continuation coverage. The COBRApayment rules apply to payment for USERRA continuation coverage, provided theCOBRA payment rules do not conflict with USERRA. If you do not submit payment forall amounts required to continue coverage within the applicable COBRA timeframe, youwill lose the right to USERRA continuation coverage and such right will not bereinstated.

Maximum Period of Coverage during Uniformed Service. Continuedcoverage under this provision will terminate on the earlier of the following events:

a. The date you fail to return to employment with the Employer aftercompletion of your leave. Employees must return to employmentwithin:

1) the first full business day of completing Uniformed Service, forleaves of 30 days or less. A reasonable amount of travel timewill be allowed for returning from such Uniformed Service;

2) 14 days of completing Uniformed Service, for leaves of 31 to 180days;

3) 90 days of completing Uniformed Service, for leaves of morethan 180 days;



b. 24 months from the date your leave began;

c. The date that the Plan no longer provides group health care coverage toany Employees;

d. The day after the date you fail to elect continuation coverage asrequired by the COBRA continuation coverage election rules; or

e. The first day of the month for which a timely self-payment has notbeen.

The Plan will provide continuation coverage to the extent required by USERRA.You may also have continuation coverage rights under COBRA. As noted above,although the COBRA and USERRA provisions are similar, COBRA continuation coverageand USERRA continuation coverage are not identical. As long as you remainsimultaneously eligible for both COBRA and USERRA continuation coverage, you willreceive the more generous benefit rights that apply under these statutes. The COBRAand USERRA continuation coverage periods will run concurrently. Please contact thePlan Office for more information about USERRA continuation coverage.

Reinstatement of Coverage Following Uniformed Service. USERRArequires that coverage be reinstated upon your return to work. Reinstatement willapply whether coverage pursuant to the Plan was maintained during the leave or not.To be eligible for reinstatement, you must have provided advance notice of yourUniformed Service (unless failure to provide such notice is excused), be honorablydischarged from the Uniformed Service and return to work within:

a. The first, full business day after your Uniformed Service ends, for leavesof 30 days or less. A reasonable amount of travel time will be allowedfor returning from such Uniformed Service;

b. 14 days after your Uniformed Service ends, for leaves of 31 to 180days;

c. 90 days after your Uniformed Service ends, for leaves of more than 180days.

You may be allowed more time to return to work if your Uniformed Servicecauses a Sickness or Injury or worsens a Sickness or Injury. Your failure to returnwithin the times stated must be due to such a Sickness or Injury. In that case, youmay take up to a period of two years to return to work. If, for reasons beyond yourcontrol, you cannot return to work within two years, you must return as soon as isreasonably possible. Your USERRA rights may be limited if your period of UniformedService exceeds 5 years (note, however, that many periods do not count against this



5-year rule, such as periods during which you were retained on active duty due to waror national emergency).

Upon reinstatement, all provisions and limits of the Plan will apply to the extentthat they would have applied had you not taken leave. The eligibility period will bewaived.

These rules are intended to comply with the requirements of USERRA. TheUSERRA provisions will control in the event of any inconsistencies between the Plandocuments and USERRA.

NOTE: For complete information regarding your rights pursuant to USERRA,contact your Employer.

EFFECTIVE DATES OF COVERAGE

Employees

Your effective date of coverage as an Employee will normally be the date yousatisfy the requirements of the Eligibility Rules.

Dependents

Your effective date of coverage as a Dependent will be the date the Employeewho sponsors you becomes eligible or the date you first satisfy the definition ofDependent, whichever is later.

Working spouses of Participants must enroll in their employers' health plans.Spouses that do not enroll in their employers' health plans will have their coveragereduced to twenty percent (20%) of allowable charges rather than eighty percent(80%) of the BCBSIL approved amount for in-network services and sixty-five percent(65%) of the BCBSIL approved amount for out of network services unless they qualifyfor the hardship exemption.

The Participant must provide information regarding their maritalstatus and the spouse's employment status (if they are married) on anannual basis.

Hardship Exemption

The Working Spouse Rule will not apply if your spouse:

1. Has gross annual wages of less than twenty thousand dollars ($20,000), or



2. Has gross annual wages greater than or equal to twenty thousand dollars($20,000) but less than thirty thousand dollars ($30,000) and must pay more than onehundred dollars ($100) per month toward the cost of the least expensive health planoffered by his or her employer.

You are responsible for demonstrating your spouse's entitlement to a hardshipexemption by submitting a letter to the Plan Office attesting to your spouse's wagesand cost of coverage from your spouse's employer on company letterhead. The PlanOffice will determine whether a spouse with variable wages qualifies for the hardshipexemption by looking at the spouse's average wages over the past twelve (12)months.

Additional provisions and exceptions to the Working Spouse Rule:

1. The Working Spouse Rule only applies to your spouse's claims, not to claimsincurred by your children.

2. It applies to Retirees as well as Active Employees.

3. It does not apply to COBRA coverage, meaning that if your spouse terminatesemployment and declines COBRA, this Plan will pay its normal benefits.

4. The Working Spouse Rule only applies to medical and drug expenses.

5. The Rule applies without regard to whether your spouse's employer: requires itsemployees to pay for part of the premium, offers an incentive to induce employeesnot to enroll, offers a single-only coverage option. It also applies if the employeronly offers medical coverage as an option under a cafeteria plan.

6. No reductions will apply to a particular claim if you can demonstrate that yourspouse's claim would have been denied under the employer's plan.

7. The provision will also be waived if the only health plan offered by your spouse'semployer is an HMO plan, and your residence is more than twenty-five (25) milesoutside the HMO service area.

8. If your spouse is covered under his or her employer's plan, then your spouse mustreceive his or her medical care in accordance with that plan's rules. This Plan willnot cover the amount of the other plan's noncompliance penalties, or any chargesincurred because of failure to follow the other plan's rules, including failure to useHMO providers or follow the HMO's referral procedures.

9. You are required to provide accurate and timely information to the Plan about yourspouse's employment status and benefit entitlement, and the Plan Office mayrequire verification of this information from your spouse's employer.



SPECIAL ENROLLMENT RIGHTS

Persons Who Lose Other Coverage. If you are eligible for benefits but didnot enroll yourself or your eligible Dependent for coverage when you were first eligibleto do so, you will be allowed to enroll yourself and your eligible Dependent forcoverage if all of the following four conditions are met:

You were and/or your eligible Dependent was covered under adifferent group health plan or health insurance coverage at thetime coverage previously was offered; and

Your and/or your Dependent's coverage ended because of(a) loss of eligibility (including legal separation, divorce, death,termination of employment, reduction in the number of hours ofemployment), (b) termination of the employer's contributiontoward such other coverage, (c) exhaustion of coverage underCOBRA, (d) denial of a claim due to operation of a lifetime orannual limit, or (e) if coverage was provided by an HMO, you areno longer residing, living or working in the service area of theHMO and the HMO does not provide coverage for that reason;and

You request enrollment in this Plan for yourself and/or yourDependents no later than 30 days after the date other coveragewas lost for one of the reasons listed in item 2 above.

Acquisition of Eligible Dependent. Employees and Dependents may enrollunder the Plan following the acquisition of a new Dependent if all of the followingfour conditions are met:

You and your Dependent are eligible for coverage;

A spouse and/or a child becomes your Dependent throughmarriage, birth, adoption, or placement for adoption; and

You request enrollment for yourself, your spouse (whether ornot previously eligible), and/or the child(ren) newly acquiredthrough the marriage, birth, adoption or placement for adoptionwithin 30 days of the event.

Loss of Eligibility Under Medicaid or a State Children's HealthInsurance Program (SCHIP). If you did not enroll yourself or your eligibleDependents for coverage when you were first eligible to do so, you will be allowed to



enroll yourself and your eligible Dependents for coverage if all of the following fourconditions are met:

You and/or your Dependent are currently eligible for coverageunder the Plan;

You and/or your Dependent were covered under Medicaid orSCHIP;

You and/or your Dependent loses eligibility under Medicaid orSCHIP; and

You request enrollment for yourself and/or your Dependentwithin 60 days of the date Medicaid or SCHIP coverageterminates.

Eligibility for Financial Assistance Under Medicaid or SCHIP. If you didnot enroll yourself or your eligible Dependents for coverage when you were firsteligible to do so, you will be allowed to enroll yourself and your eligible Dependents forcoverage if all of the following three conditions are met:

You and/or your Dependent are eligible for coverage under thePlan;

You and/or your Dependent become eligible for financialassistance through Medicaid or SCHIP, for example through apremium assistance subsidy, for coverage under the Plan; and

You request enrollment for yourself and/or your Dependentwithin 60 days of the date you or your Dependent becomeseligible for the financial assistance.

Effective Date of Coverage. The effective date of coverage for purposes ofthese special enrollment rights will be:

For birth – date of birth;

For adoption or placement for adoption – date of adoption or thedate you acquire the legal obligation for total or partial supportof the child;

For marriage, loss of coverage or loss of coverage or financialassistance under Medicaid or SCHIP – no later than the first dayof the first calendar month beginning after receipt of completedrequest for enrollment.



You must promptly notify the Plan Office in writing of any change ofaddress or employment that results in regaining eligibility for coverage.

TERMINATION DATES OF COVERAGE

Employees

Your coverage as an Employee under the Plan terminates when the earliest ofthe following events occurs:

1. The last day of the month in which you fail to meet the requirements forcontinuing eligibility as shown in the Eligibility Rules, including a failureto make any self-payments of contributions in a timely manner;

2. The date you begin working in Disqualifying Employment;

3. Termination of the coverage classification under which you werecontinuing your eligibility;

4. The date you leave covered employment to perform service in theUniformed Services, except for temporary duty of thirty (30) days orless;

5. The date the Plan terminates;

6. The date of your death.

Dependents

Your coverage as a Dependent under the Plan terminates when the earliest ofthe following events occurs:

1. The date the Employee who sponsors you loses eligibility;

2. On the first of the month next following the date you fail to meet thedefinition of Dependent.

The surviving spouse of an eligible retiree will be eligible under the sameprovisions as his/her spouse until he/she either remarries, or becomes eligible forMedicare, or is covered under another Plan.



GENERAL PROVISIONS

Change of Eligibility Rules

The Trustees, at their discretion, are empowered to change or to amend theseEligibility Rules at any time.

A Note of Explanation

The Eligibility Rules represent the requirements which must be satisfied for youand your Dependents to become and to remain eligible for benefits from this Plan. Inthe event the requirements are not satisfied, eligibility is lost and benefits are notpayable. The Trustees reserve the right to deny benefits to any claimant who is, intheir opinion, attempting to subvert the purpose of the Plan or who does not present abona fide claim.

Remember: Changes in employment may have an effect on Employer contributionspaid on your behalf. For example, Employer contributions may cease in the event you:

1. Change job classifications from covered to non-covered employment,even if that employment is with the same employer; or

2. Change employment from a participating to a non-participatingEmployer.

You and your Dependents may obtain, upon written request to the Union Office,information as to the address of a particular Employer and whether that Employer isrequired to pay contributions to the Plan.

Family and Medical Leave

You may be eligible for up to twelve (12) weeks of unpaid, job protected leave forcertain family and medical reasons under the Family and Medical Leave Act of 1993.You are eligible under the Act if:

1. You are employed by an employer with at least fifty (50) employees at yourwork site or with at least fifty (50) employees within a seventy-five (75)mile radius of your work site; and

2. You have been employed by the employer at least twelve (12) months; and

3. You have worked at least one thousand, two hundred fifty (1,250) hours forthe employer during the twelve (12) months immediately before therequested leave.



Your employer determines whether you are eligible for family or medical leave underthe Act, not this Plan or its Trustees.

Both you and your employer are required to notify the Plan Office if you take a familyor medical leave and to provide certain other information as required by the Trustees.Your coverage in the Plan will continue during the period of your family or medicalleave, provided self-payments are made or your employer makes contributions to thePlan at the same rate and in the same amount as if you were continuously employedduring the period of your leave and fully complies with all requirements established bythe Trustees.

Qualified Medical Child Support Orders

The Plan shall recognize and comply with "Qualified Medical Child SupportOrders." The Plan shall also recognize as Qualified Medical Child Support Orders"National Medical Support Notices" that comply with the provisions of applicable finalregulations. The Plan's procedure for processing medical child support orders that areclaimed to be Qualified Medical Child Support Orders is described below.

Receipt of Order

The Plan Office shall promptly notify the Participant and each alternaterecipient (i.e., a person to receive benefits according to the Order) of the Order'sreceipt and the Plan's procedures for determining whether a medical child supportorder is a Qualified Medical Child Support Order. The Plan Office shall forward a copyof the order to Fund Counsel.

Determination of Qualification

Within a reasonable period after receipt of such Order, the Plan Administrator,with the assistance of the Fund Counsel, shall determine whether such order is aqualified medical child support order and notify the Participant and each alternaterecipient of such determination.

The procedures to determine whether medical child support orders are qualifiedmedical child support orders shall follow the criteria established by Section 609 of theEmployee Retirement Income Security Act of 1974, as amended and any applicableregulation and administration actions by agencies charged to enforce Section 609.Those criteria include:

1. Inclusion of the order in a judgment order or decree made pursuant tostate domestic relations law or is made pursuant to state domestic relationslaw or made pursuant to a law relating to medical child support described in42 U.S.C. 1396g issued by a court of competent jurisdiction or



administrative process that has the force or effect of law in the state issuingthe order.

2. Creation, assignment or recognition of the right of an alternate recipient toreceive Plan benefits to which a participant or a beneficiary is entitled.

3. Whether the alternate recipient is a child of the Participant or a childadopted by or placed for adoption with a Participant.

4. Inclusion of the name and last known mailing address of the affectedParticipant and the name and last known mailing address of the alternaterecipient.

5. Inclusion of a description of the type of coverage to be provided by the Planor the manner in which such coverage is to be determined.

6. Identification of the period for which the order applies.

7. Identification of the Plan as the plan to which the order supplies.

8. Verification that the order does not require the Plan to provide benefits or aform of benefits other than one provided by the Plan, provided that the Planshall satisfy requirements of applicable laws relating to medical childsupport described in 42 U.S.C. 1908.

Status of Alternate Recipients

Alternate Recipients shall be deemed Plan Participants for purposes ofapplicable reporting and disclosure requirements and shall be treated as Planbeneficiaries for all other purposes.

Direct Payments

Payments for benefits or claims for reimbursements made by AlternateRecipients under Qualified Domestic Child Support Orders shall be made to theAlternate Recipients or their legal guardians as applicable.

Notification Issues

The Plan Office shall notify an Alternate Recipient or the Alternate Recipient'slegal guardian of its determination concerning a medical child support order which isclaimed to be a Qualified Medical Child Support Order within a reasonable time afterreceipt. Alternate Recipients shall be entitled to designate a representative for thereceipt of copies of notices that are sent to the Alternate Recipient with respect to amedical child support order. The custodial parents or guardians of minor Alternate



Recipients shall be considered their designated representatives absent an expresswritten request of other representatives.

COBRA CONTINUATION COVERAGE

This section is intended to explain to you and your eligible Dependents, in a summaryfashion, about rights and obligations under the Continuation Coverage provisions ofthe Consolidated Omnibus Budget Reconciliation Act, or "COBRA." You, your spouse(if any), and your Dependents (if any) should take time to read this section carefully.

Certain terms are used in this section and are defined as follows:

Continuation Coverage – the coverage available to you and your family in the eventyou lose eligibility due to a Qualifying Event. If you elect Continuation Coverage, thePlan must provide coverage which, as of the time such coverage is provided, isidentical to the coverage provided for other similarly situated beneficiaries. DeathBenefits and Accidental Death and Dismemberment Benefits are not provided.

Qualified Beneficiary – an individual who is covered under the Plan on the daybefore a Qualifying Event, as well as a newborn child or child placed for adoption withyou during the period of Continuation Coverage. Qualified Beneficiaries are you, yourspouse or your Dependent child(ren).

Qualifying Event – an event that causes you and/or your family to lose coverageunder the Plan. The specific events which are Qualifying Events for you, your spouseand/or your children are explained in detail in the following sections. Depending onthe Qualifying Event, Continuation Coverage is available for eighteen (18), twenty-nine(29) or thirty-six (36) months.

Employee Right to Elect Continuation Coverage

You, as a Qualified Beneficiary, have the right to choose Continuation Coverage if youlose eligibility for coverage under the Plan due to a reduction in the amount ofemployer contributions remitted or termination of employment for any reason, unlesstermination is due to gross misconduct on your part. Either of those circumstances iswhat is known as a "Qualifying Event" for you, as an employee. These QualifyingEvents entitle you and/or your family to elect eighteen (18) months of ContinuationCoverage.

The Trustees, through the Plan Office, determine when a Qualifying Event occurs as aresult of a reduction of employer contributions or a termination of employment basedon information contained on submitted employer contribution forms. The Plan Officewill determine when the COBRA Qualifying Event has occurred within one hundredtwenty (120) days following receipt of the employer contribution form. The Plan Officewill mail the COBRA election notice within sixty (60) days after it has determined that



you or a qualified beneficiary has lost eligibility for coverage. You have sixty (60) daysfrom the date you receive the election notice to elect to receive ContinuationCoverage. If you do not make an election for coverage within sixty (60) days, you nolonger have a right to receive Continuation Coverage.

If you qualify for Continuation Coverage under COBRA but do not elect such coveragefor your entire family, your spouse and/or Dependent children are still entitled to electContinuation Coverage for themselves.

Your Spouse's Right to Elect Continuation Coverage

Spouses of employees or Retired Participants covered under the Plan, as QualifiedBeneficiaries, have the right to choose Continuation Coverage for themselves if theylose their group health care coverage under the Plan for any of the following reasons:

Termination of your employment (for reasons other than grossmisconduct), or a reduction in the hours worked by you which results inyour losing eligibility under the Plan;

Your death if you are a Participant in the Plan;

Divorce or legal separation from you; or

You become entitled to Medicare and are not eligible to continuecoverage for your spouse under another portion of the Plan or choosenot to continue such coverage.

These reasons are known as Qualifying Events for your spouse. The first QualifyingEvent entitles your spouse to elect eighteen (18) months of Continuation Coverage.The other Qualifying Events would entitle your spouse to elect thirty-six (36) months ofContinuation Coverage.

Your Dependent Children's Right to Elect Continuation Coverage

All of your Dependent children covered under the Plan, as Qualified Beneficiaries, havethe right to Continuation Coverage if they lose their eligibility for coverage under thePlan for any of the following five reasons:

Termination of their parent's employment (for reasons other than grossmisconduct) or a reduction in the number of hours worked by theirparent, who is the covered Employee under the Plan;

Death of the parent, who is the covered employee under the Plan:

Divorce or legal separation of their parents;



You become entitled to Medicare and either are not eligible to continuecoverage for the children or choose not to continue such coverage; or

The child or children cease to satisfy the Plan's definition of a"Dependent child."

These reasons are known as Qualifying Events for your Dependent children. The firstQualifying Event entitles your Dependent child (ren) to elect eighteen (18) months ofContinuation Coverage. The other Qualifying Events would entitle your dependentchildren to elect thirty-six (36) months of Continuation Coverage.

A newborn or adopted child will automatically be extended COBRA coverage if theparents already have COBRA coverage. This may involve an increase in the COBRApremium charged. A newborn child or an adopted child (or the child's custodian orguardian) has a right; separate from his or her parents to elect Continuation Coveragefor eighteen (18) or thirty-six (36) months, depending on the Qualifying Event, even ifthe child's parent(s) do not elect Continuation Coverage.

Continuation Coverage for Disabled Persons

If you, as a covered employee, your spouse, or any Dependent child, as QualifiedBeneficiaries, qualify for Social Security disability benefits at the time of a QualifyingEvent that entitles the Qualified Beneficiary to elect eighteen (18) months ofContinuation Coverage (or any time during the first sixty (60) days after you losecoverage due to a Qualifying Event), you may purchase up to an additional eleven (11)months of Continuation Coverage (or a total of twenty-nine [29] months).

This additional Continuation Coverage may be purchased not only for the disabledperson but also for other eligible family members who are not disabled (subject to theapplicable premium).

To obtain this additional Continuation Coverage, the Qualified Beneficiary must bedetermined eligible for Social Security disability benefits before the end of the eighteen(18)-month Continuation Coverage period and must notify the Plan Office during theeighteen (18) month period and within sixty (60) days after the Social SecurityAdministration awards Social Security benefits to the disabled person.

The Plan is permitted to charge a higher premium (up to one hundred fifty percent[150%] of the regular COBRA premium) for the additional eleven (11) months ofContinuation Coverage available to disabled persons and their families. The higherpremium applies to the disabled person and for other family members who opt foradditional COBRA coverage.

Eligibility for extended Continuation Coverage because of disability ends the first day ofthe month that is more than thirty (30) days after the date that the person is



determined under the Social Security Administration to be no longer disabled. Federallaw requires a disabled person to notify the Plan within thirty (30) days of a final SocialSecurity Administration determination that they no longer are disabled.

Employee Obligations to Notify the Plan Office of a Qualifying Event

Under COBRA, you or a family member must notify the Plan Office immediately abouta divorce, legal separation, or a child losing Dependent status under the Plan. If suchan event is not reported to the Plan Office within sixty (60) days after it occurs,Continuation Coverage will not be permitted.

Your surviving spouse (or Dependent child) should contact the Plan Office immediatelyafter your death. This assures that Continuation Coverage is offered to your survivingspouse and children at the earliest possible date.

The law requires the COBRA election notice to be sent to the last known address onfile at the Plan Office. If the election notice is sent to the wrong address due to yourfailure to notify the Plan Office about a change in address, the sixty (60) day time limitwill not be extended and you may lose the opportunity to elect COBRA.

You are also required to notify the Plan Office if you or any family members arecovered under another group health care plan at the time you received a COBRAelection notice (e.g., if you are covered as a Dependent under your spouse's plan) or ifyou elect Continuation Coverage, at any time you or a family member later becomescovered under another group health care plan, including Medicare.

The Plan Office may require you to provide information about your coverage underanother group health care plan. The Plan may seek reimbursement directly from you ifmedical expenses are paid by the IBEW Local 461 Welfare Fund through Blue CrossBlue Shield of Illinois because you or your Dependents do not notify the Plan of otherhealth care coverage.

Second Qualifying Events

The following rules concerning the occurrence of a second Qualifying Event only applyif the original Qualifying Event was termination of the employee's employment (forreasons other than gross misconduct) or reduction in the number of hours worked bythe employee. If a second Qualifying Event should occur during the eighteen (18)months of coverage available as a result of the first Qualifying Event [or, twenty-nine[29] months if the eleven (11) month extension due to disability applies], then youmay purchase additional Continuation Coverage for up to a total of thirty-six (36)months. An example of a second Qualifying Event would be:

Death of the employee, if he or she is a covered employee under thePlan;



Divorce or legal separation of the employee and his/her spouse;

The employee, if a covered employee under the Plan, becomes enrolledin by Medicare (Part A, Part B, or both); or

For Dependent children, the Dependent child ceases to satisfy the Plan'sdefinition of a "Dependent child" (The rules for second qualifying eventsalso apply to newborn or adopted children.)

This thirty-six (36) months total of Continuation Coverage available when a secondQualifying Event occurs includes the number of months you have already been coveredunder Continuation Coverage because the first Qualifying Event. The thirty-six (36)month total is not in addition to any months of Continuation Coverage you havealready had because of the first Qualifying Event. The Plan Administrator must benotified within sixty (60) days of the second Qualifying Event or the additionalextended coverage will not be allowed.

Proof of Insurability is Not Necessary to Elect Continuation Coverage

You and your family members do not have to show that you are insurable to purchaseContinuation Coverage; however, you must make the required self-payment(s) forsuch coverage in accordance with specific due dates. The amount(s) and the duedate(s) will be shown on the COBRA election notice.

Procedure for Obtaining Continuation Coverage

Once the Plan Office knows that an event has occurred which qualifies you or otherfamily members for Continuation Coverage, the Plan Office will attempt to notify you oryour family member of their rights to elect Continuation Coverage. Once you receivethis election notice, you will have sixty (60) days after the date on the election noticewithin which to notify the Plan Office whether or not you want the ContinuationCoverage. If you do not elect the coverage within the sixty (60) day time period, yourright to continue your continuation coverage will end.

Termination of Continuation Coverage

The law provides that Continuation Coverage may be canceled by the Plan for any ofthe following reasons:

1. The Plan no longer provides group health care coverage to any Employees

2. The required self-payment for Continuation Coverage is not paid on time



3. The person remitting Continuation Coverage payments becomes covered under anygroup health care plan, after the Qualifying Event, that does not include apre-existing condition exclusion

4. The person remitting Continuation Coverage payments becomes entitled toMedicare.

Although your Continuation Coverage may be canceled as soon as you are covered byMedicare, a spouse or Dependent child receiving Continuation Coverage at that timemay continue purchasing such coverage for up to eighteen (18) or thirty-six (36)months minus any months of Continuation coverage received immediately prior to yourcoverage under Medicare. This option applies only if a spouse or Dependent child isnot also covered by Medicare.



Other Coverage Options

There may be other coverage options for you and your family since you are now beable to buy coverage through the health insurance marketplace (exchange). On theexchange you could be eligible for a tax credit that lowers your monthly premiumsright away, and you can see what your premium, deductibles, and out-of-pocket costswill be before you make a decision to enroll. Being eligible for COBRA does not limityour eligibility for coverage for a tax credit. Additionally, you may qualify for a specialenrollment opportunity for another group health plan for which you are eligible (suchas a spouse’s plan), even if the plan generally does not accept late enrollees, if yourequest enrollment within 30 days.

For More Information

For more information about your rights under ERISA, including COBRA, the HealthInsurance Portability and Accountability Act (HIPAA), and other laws affecting grouphealth plans, visit the U.S. Department of Labor’s Employee Benefits SecurityAdministration (EBSA) website at www.dol.gov/ebsa or call their toll-free number at 1-866-444-3272 For more information about health insurance options available througha health insurance marketplace, visit www.healthcare.gov. For specific informationabout this Plan or how to elect COBRA through the Plan, call the Plan Office at 630-897-0461.

RETIREE PROGRAM

Coverage Classifications Defined

Employees eligible to participate in the Retiree Program and their eligibleDependents, if any, are covered under one of two benefit classes, depending onwhether the covered person is also eligible for Medicare.

Class B

Coverage for Employees and/or eligible Dependents who are NOT eligible forMedicare

Class C

Coverage for Employees and/or eligible Dependents who ARE eligible forMedicare (Medicare coverage includes both Part A & B)



For example, you and your spouse would both be covered under Class B if neither ofyou are eligible for Medicare. If you are eligible for Medicare and your Spouse is not,you would be eligible in Class C and your spouse would be eligible in Class B.

General Eligibility Requirements

Each normal or early retired Employee may continue coverage for himself andhis Dependents through this Plan under the Retiree Program provided he meets all ofthe following requirements:

1. He is at least fifty-five (55) years old; and

2. He has been eligible in this Plan at least sixty-four (64) of the eighty(80) Eligibility Months immediately prior to his retirement under thisRetiree Program; and

3. He is eligible in this Plan at the time of his retirement.

If you are eligible to participate in the Retiree Program, you must exercise that optionwhen first eligible to do so. If you do not exercise your option to participate in theRetiree Program immediately upon retirement, you will not be allowed to beginparticipation at a later date.

The rate of self-payment for retirees between ages fifty-five (55) and sixty-two(62) will be based upon one hundred fifteen (115) hours per month at the currentcontribution rate.

The rate of self-payments for retirees over age sixty-two (62) will be determined bythe Board of Trustees. Please contact the Plan Office for the applicable rate.

Self-Payment of Contribution

If the Participant is age sixty-two (62) to sixty-five (65) in Class B coverage, therate established by the Board of Trustees will provide coverage for the Participant andhis Dependents. If the Participant is eligible for Medicare and his spouse is sixty-two(62) to sixty-five (65), the Participant has no self-payment and is in Class C coverage;however, the spouse must pay the rate established by the Board of Trustees tomaintain coverage. If the Participant is eligible for Medicare but the spouse is not yetsixty-two (62), the Participant has no self-payment for Class C coverage but forcoverage for the spouse must pay the full self-payment rate of 115 hours per month atthe current collective bargaining rate to maintain continuous coverage.

The self-payment amounts required for eligibility in the Retiree Program arethose determined by the Trustees to be necessary to run the Plan. Self-paymentsmust be received at the Plan Office on or before the first day of the coverage month



for which the payment is due. You will receive only one notice describing theself-payment procedure; you are responsible for making subsequent monthlypayments on time and without further Notice. All notices are sent by mail to the lastknown address on file at the Plan Office so it is important that any address changesare reported immediately.

Self-payments are required on a monthly basis. A change in coveragecircumstances (such as eligibility for Medicare) will re-determine the covered person'sCoverage Class effective the first day of the calendar month co-incident with or nextfollowing the date the change in circumstance occurs.

Benefit Limitations

All normal Plan provisions apply to Retiree Program coverages.

Employees and their Dependents eligible in Class B are not covered for WeeklyLoss of Time Benefits.

Employees and their Dependents eligible in Class C are not covered for:

1. Weekly Loss of Time Benefits; or

2. Dental Care or Vision Care Benefits

Please see the Schedule of Benefits and the Benefits Section as described formore information.


Section III - General Definitions Page 26

SECTION III

GENERAL DEFINITIONS

Accident or Injury

An Accident or Injury must contain some degree of unexpected violence, such as a fall,blow, laceration, contusion, or abrasion caused directly and independently of othercauses, while the person is an Eligible Person.

Affordable Care Act

The Affordable Care Act means the Patient Protection and Affordable Care Act and theHealth Care and Education and Reconciliation Act of 2010 and the regulations andguidance promulgated thereunder.

Behavioral Disorders

Behavioral Disorders include but are not limited to:

Attention Deficit Disorder Childhood Disorders-treatment of reading or learning disorders

or developmental disability

Code

The Code is the Internal Revenue Code of 1986 and the regulations and guidancepromulgated thereunder.

Custodial Care

Custodial Care means care, services or supplies, which are furnished mainly to train orto assist in personal hygiene or other activities of daily living, rather than to providetherapeutic treatment. Care, services or supplies will also be considered "CustodialCare" if they can be safely and adequately provided by persons who do not have thetechnical skills of a covered health care provider.

Dentist

Dentist means a person who is currently licensed to practice dentistry by thegovernmental authority having jurisdiction over the licensing and practice of dentistry.



Elective or Voluntary Sterilization

Elective Sterilization is sterilization not medically required but requested by the patientand will include among others, vasoligation, vasectomy, salpingectomy, and tuballigation.

Eligibility Rules

The Eligibility Rules shall apply to Active Employees and their Dependents, Totally andPermanently Disabled Employees and their Dependents, and Self-Pay Employees andtheir Dependents and Retirees and their Dependents.

Eligible Dependents

Eligible Dependents are the following:

1. The legal spouse of the eligible Employee provided he/she is notlegally separated from the eligible Employee; or

2. Any natural child, adopted child or child placed for adoption of theeligible Employee and the legal spouse if:

a. the child is less than twenty-six (26) years of age; or

b. the child is twenty-six (26) years of age or older andhe/she is totally and permanently disabled because of aqualifying physical handicap or mental retardation. To beconsidered a qualified physical handicap or mentalretardation under this definition, it must:

1) occur before the child reaches age twenty-six (26);and

2) be certified by a Physician; and

3) render the child incapable of self-sustainingemployment so as to make the child dependentupon the parents for financial support andmaintenance.

Initial proof of such disability and financialdependency must be furnished to the Trusteeswithin sixty (60) days of the child's reachingtwenty-six (26) years of age. Subsequent proofsmay be required by the Trustees after the child



reaches twenty-six (26), but not more frequentlythan annually.

In order to qualify under the definition of an eligible Dependentthe following conditions must be met:

a. legal documentation is presented, upon request,supporting the Dependent's status, or

b. a "Qualified Medical Child Support Order" (QMCSO)entered by an appropriate court as defined underapplicable federal law. Normally, such an order will beissued in a divorce or other family law action, whichrecognizes the child's right to health benefits under thePlan.

Dependent coverage terminates on the date:

1. The qualifying disability ceases; or

2. The QMCSO terminates; or

3. The Employee's coverage is terminated; or

4. The first day of the following the month in which the dependentreaches the age twenty-six (26).

If an Eligible Dependent child is also entitled to benefits under this Plan as anEmployee, the child can elect to be covered as a Dependent or an Employee.

If one spouse is covered under the Plan pursuant to the terms of a CollectiveBargaining Agreement and one spouse is covered under the terms of a ParticipationAgreement:

1. Their children may be covered as Dependents of the husband orthe wife; but not both

2. Neither may be covered as the Dependent of the other at thesame time.

If both the husband and the wife are covered under the Plan pursuant to theterms of a Collective Bargaining Agreement:

1. Their children may be covered as Dependents of the husband andthe wife;



2. One spouse may also be covered as the Dependent of the otherspouse.

The term Eligible Dependent does not include a Participant's step-child.

Note: This Plan has a Working Spouse Rule that requires spouses to enroll intheir employers’ health plans.

Eligible Employee

An Eligible Employee means any person who: (1) is working within the jurisdiction ofand covered under the terms of the Collective Bargaining Agreement orNon-Bargaining Unit Participation Agreement entered into between the Trustees andthe Employer, and (2) is eligible for benefits as set forth in the IBEW Local No. 461Welfare Eligibility Rules.

Eligible Person

An Eligible Person means either the Participant or such Participant's EligibleDependents.

Employee or Active Employee

An Employee or Active Employee means a person, actively employed by an Employer,on whose behalf Employer contributions are required to be made.

Employer

Employer or Contributing Employer means any association or individual employer whohas duly executed a collective bargaining agreement with the Union or a Welfare Fundparticipation agreement, and is required to make contributions to this Plan on behalf ofits Employees.

ERISA

ERISA means the Employee Retirement Income Security Act of 1974, as amended.

Expense Incurred

Expense Incurred includes only those charges made for services and supplies, whichare reasonably priced and reasonably necessary for treatment of the Injury orSickness.



Experimental or Investigative

Experimental or Investigative means the use of any treatment, procedure, facility,equipment, drugs, devices or supplies not yet recognized as acceptable generalmedical practice and any such items requiring federal or governmental agencyapproval for which such approval has not been granted at the time the service wasprovided. The Trustees have the sole authority to determine whether the treatmentshall be considered "experimental or investigational" for the purposes of this Plan.

Notwithstanding the above, to the extent required under the Affordable Care Act, thePlan will not deny as Experimental or Investigational any qualified individual (asdefined below) the right to participate in an approved clinical trial (as defined below);deny, limit or impose additional conditions on the coverage of routine patient costs (asdefined below) for items and services furnished in connection with participation in theapproved clinical trial; and will not discriminate against any qualified individual whoparticipates in an approved clinical trial. For purposes of this section, the followingdefinitions apply:

1. "Routine patient costs" include items and services typicallyprovided under the plan for an Eligible Person not enrolled in anapproved clinical trial. However, such items and services do notinclude (a) the investigational item, device or services itself;(b) items and services not included in the direct clinicalmanagement of the patient, but instead are solely provide dinconnection with data collection and analysis; or (c) a serviceclearly not consistent with widely accepted and establishedstandards of care for the particular diagnosis.

2. "Qualified individual" is a group health plan participant orbeneficiary who is eligible, according to the trial protocol, toparticipate in an approved clinical trial for the treatment of canceror other life-threatening disease or condition and either thereferring health care professional is a participating provider andhas concluded that the participant's or beneficiary's participationin the approved clinical trial would be appropriate; or theparticipant or beneficiary provides medical and scientificinformation establishing that the individual's participation in theapproved clinical trial would be appropriate.



3. "Approved clinical trial" is a phase I, phase II, phase III, orphase IV clinical trial that is conducted in relation to theprevention, detection or treatment of cancer or other life-threatening disease or condition and is either:

a. Approved or funded by one of the following:

1) The National Institute of Health,

2) The Centers for Disease Control and Prevention,

3) The Agency for Health Care Research and Quality,

4) The Centers for Medicare and Medicaid Services,

5) A cooperative group or center of any of the aboveentities or the Department of Defense or Department ofVeterans Affairs,

6) A qualified non-governmental research entity identified inthe guidelines issues by the National Institutes of Healthfor center support grants, or

7) The Department of Veterans Affairs, the Department ofDefense, or the Department of Energy if certainconditions are met.

b. Conducted under an investigational new drug applicationreviewed by the Food and Drug Administration, or

c. A drug trial that is exempt from having such aninvestigational new drug application.

4. "Life-threatening condition" is a disease or condition from whichthe likelihood of death is probable unless the course of thedisease or condition is interrupted.

If an in-network provider is participating in an approved clinical trial and the in-network provider will accept the qualified individual as a participant in the approvedclinical trial, the qualified individual is required to use the in-network provider insteadof a non-network provider.

Hospital

A Hospital is any legally constituted institution, which meets all the followingrequirements:



1. Maintains permanent and full time facilities for bed care of five (5)or more resident patients; and

2. Has a doctor in regular attendance; and

3. Continually provides a twenty-four (24) hour-a-day nursing serviceby registered nurses; and

4. Is primarily engaged in providing diagnostic and therapeuticfacilities for medical and surgical care of injured and sick personson a basis other than as a rest home, nursing home, convalescenthome, a place for the aged, a place for drug addicts, or a placefor alcoholics; and

5. Is operating lawfully in the jurisdiction where it is located.

In-patient

In-patient means a person who is a resident patient using and being charged for theroom and board facilities of the hospital.

Medicare

Government Health Insurance Program for people sixty-five (65) or older, certaindisabled people under sixty-five (65), and people who have permanent kidney failure.As referred to in this document, Medicare means both Parts A & B of Medicare.

Medical Equipment

Medical Equipment means equipment, which meets all of the following requirements:

1. Is primarily and customarily used to serve a medical purpose; and

2. Is generally not useful to a person in the absence of illness orInjury; and

3. Is necessary and reasonable for the treatment of an illness orInjury, which is covered by the terms of this Plan.

To be considered "medical equipment," a device must make a meaningful contributionto the treatment of a patient's illness or Injury or to the improved functioning of amalformed or damaged body member. Equipment, which primarily serves a comfort orconvenience function for the patient or the patient's caretaker (such as a wheelchairramp or a vehicle lift device), is not considered "medical equipment."



Medically Necessary

Medically Necessary means only those services, treatments or supplies provided by aHospital or Physician that are required to identify or treat an Eligible Person's Sicknessor Injury and which are:

1. consistent with the symptoms or diagnosis and treatment of theEligible Person's condition, disease, ailment or Injury;

2. appropriate according to standards of good medical practice;

3. not solely for the convenience of an Eligible Person, Physician orHospital; and

4. the most appropriate which can be safely provided to the EligiblePerson.

A minimum Hospital stay of up to 48 hours in connection with childbirth for the motherand newborn child following normal vaginal delivery and a minimum Hospital stay ofup to 96 hours in connection with childbirth for the mother and newborn childfollowing a cesarean section shall be considered Medically Necessary. If a Hospitalstay in excess of the above-noted time periods is requested, the Hospital stay in excessof the above-noted time period will be considered to be Medically Necessary if itsatisfies the requirements set forth in subsections (a), (b), (c) and (d) above.

N.E.C.A.

National Electrical Contractors Association

Non-Occupational Accidental Bodily Injury or Sickness

Non-Occupational Accidental Bodily Injury or Sickness is an Injury or Sickness thatdoes not arise out of or in the course of employment, except that this provision shallnot apply to the Death Benefit.

Occupational Bodily Injury or Sickness

An Occupational Bodily Injury or Sickness is an Injury or Sickness arising out of theEligible Person's employment or caused or aggravated by employment, for whichbenefits are, or may be, payable in whole or in part under any Worker's CompensationLaw, Employer's Liability Law, Occupational Diseases Law, or similar law. Employment,for this purpose, refers to any activity involving ages or profit, not simply collectivebargaining employment.



Optician, Optometrist and Ophthalmologist

Optician, Optometrist and Ophthalmologist means any person who is qualified andcurrently licensed (if licensing is required in the State) to practice each such professionby the appropriate government agency or authority having jurisdiction over thelicensing and practice of such a profession, and who is acting within the usual scope ofhis practice.

Out-patient

Out-patient means a person who receives hospital services and treatments, but is notan in-patient.

Participant

An Eligible Employee or Retiree.

Physician, Doctor, or Surgeon (M.D.)

Physician, Doctor, or Surgeon (M.D.) means an individual holding an unlimited licenseto practice medicine and surgery as a physician as recognized by the state in which hepractices, provided he is acting within the scope of his license. To the extent thatbenefits are provided and while practicing within the scope of his license, the term"Physician" includes a Medical Doctor (M.D.), Osteopath (D.O.), Doctor of DentalSurgery (D.D.S.), Doctor of Dental Medicine (D.M.D.), Podiatrist (D.P.M.), Chiropractor(D.C.), Licensed Clinical Psychologist (Ph.D.) or Optician (O.D.). Notwithstanding theforegoing, to the extent required by the Affordable Care Act and available guidance, ifa practitioner's service is covered under the Plan, the plan will not discriminate basedon the practitioner's license or certification, if the practitioner is licensed to providesuch services in the state in which the services are performed and the practitioner isacting within the scope of that license. .

Pregnancy

Pregnancy includes resulting childbirth, miscarriage, and any complications ofpregnancy.

Protected Health Information (PHI)

Information created or received by a health care provider, health plan, employer, orhealth care clearinghouse that relates to past, present, or future physical or mentalhealth or condition of an individual the provision of health care to an individual, on thepast, present or future payment for the provision of health care to an individual thatidentifies the individual or to which there is a reasonable basis to believe theinformation can be used to identify an individual.



Qualifying Medical Expenses

Substantiated out-of-pocket health care expenses incurred by or on behalf of anEmployee or Dependent, which qualify as medical care under Code Section 213(d) forthe diagnosis, care, medication, treatment or prevention of disease, affecting anystructure or function of the body and transportation primarily for and essential for suchmedical care, as set forth in Sections VIII and IX, with the following requirements:

1. Are required to be paid by the Employee, Former Employee orDependent;

2. Are not payable under the regular benefits provided by this Planor by any other insurance or group health benefits available to theEmployee, Former Employee or Dependent;

3. Have not been previously taken as a tax deduction by theEmployee, Former Employee or Dependent; and

4. Are not expenses for long-term care services.

In no event shall Qualifying Medical Expenses be provided in the form of cash otherthan reimbursement.

Qualifying Premium Expenses

Coverage costs such as self-payment contributions or premiums for continuation ofcoverage when the Employee does not work sufficient hours to maintain eligibility;COBRA continuation coverage; coverage under the Retiree Program; and substantiatedpremium payments for qualified long-term care insurance, dental insurance, and visioninsurance. Premium Expenses do not include premiums for accident or healthinsurance as defined in Code Section 213(d); fixed indemnity, cancer or hospitalindemnity insurance premiums paid by an Employer; premiums that are or could bededucted pre-tax through a Code Section 125 cafeteria plan (including a spouse's plan)or other premiums specified in Section IX.

Notwithstanding the above, Qualifying Premium Expenses shall also include MedicareParts B and D Medicare Supplement policies, group Medicare Advantage premiums,and group health plan premiums for Retirees (unless the premium is paid or couldhave been paid pre-tax from another source).

Reasonable and Customary Charge

Reasonable and Customary Charge is determined by uniform reference standards asadopted by the Board of Trustees. To be considered Reasonable and Customary, thecharge by any provider for a service must be similar to the charges generally incurred



for cases of comparable nature and severity by a physician of similar training andexperience in that geographical area. Area means a metropolitan area, county or suchgreater area as is necessary to obtain a representative cross-section of providersrendering such service or furnishing such supplies.

With respect to medical equipment, a charge will be considered "reasonable" only ifthe following requirements are met:

1. The expense of the equipment must be clearly proportionate tothe therapeutic benefits ordinarily derived from its use; and

2. The equipment may not be substantially more costly than amedically appropriate and realistically feasible alternative patternof care; and

3. The equipment may not serve essentially the same purpose asequipment already available to the patient.

Retiree

A former Employee eligible for Plan benefits.

Routine Physical Examination

A Routine Physical Examination is an examination done by a physician for screeningpurposes. If there is no diagnosis or symptoms presented on a claim form or itemizedbill by the physician, the care will be considered routine.

Sickness or Illness

Sickness or Illness means a deviation from a healthy condition which:

1. Alters the state of the body; and

2. Interrupts or disturbs the performance of vital functions; and

3. Tends to undermine or weaken the constitution.

Sickness does not include a limitation on or a loss of body function or a temporaryindisposition, which does not progressively undermine or weaken the constitution.



Skilled Nursing Care Facility

Skilled nursing care facility means an institution or that part of any institution, whichoperates to provide convalescent or nursing care and:

1. Is primarily engaged in providing to inpatients:

a. skilled nursing care and related services for patients whorequire medical or nursing care; or

b. rehabilitation services for the rehabilitation of injured,disabled or sick persons; and

2. Has a requirement that the health care of every patient be underthe supervision of a physician; and

3. Has a physician available to furnish necessary medical care in caseof emergency; and

4. Has policies, which are developed with the advice (and withprovision for review of such policies from time to time) by a groupof professional personnel, including one (1) or more physiciansand one (1) or more registered professional nurses, to govern theskilled nursing care and related medical or other services itprovides; and

5. Has a physician, a registered professional nurse or a medical staffresponsible for the execution of such policies; and

6. Maintains clinical records on all patients; and

7. Provides twenty-four hour nursing services which is sufficient tomeet nursing needs in accordance with the policies developed asprovided in paragraph two (2), and has at least one (1) registeredprofessional nurse employed full time; and

8. Provides appropriate methods and procedures for the dispensingand administering of drugs and biologicals; and

9. In the case of an institution in any state in which state orapplicable local law provides for the licensing of institutions of thisnature; and

a. is licensed pursuant to such law; or



b. is approved by the agency of the state or localityresponsible for licensing institutions of this nature asmeeting the standards established for such licensing; and

10. Meets any other conditions relating to the health and safety ofindividuals who are furnished services in such institution orrelating to the physical facilities thereof.

Surgical Procedure

Surgical procedure means certain invasive procedures, including the reduction offractures or dislocations, in addition to recognized cutting procedures.

Totally Disabled and Total Disability

Totally Disabled and Total Disability, unless otherwise specifically defined, refer todisability resulting solely from a Non-Occupational Accidental Bodily Injury or Sicknessthat prevents an Employee from engaging in any occupation or employment forcompensation or profit or prevents a Dependent from engaging in substantially all thenormal activities of a person of like age and sex in good health and the person iseligible for Social Security Disability Benefits. A copy of the Social SecurityAdministration Award Letter is required for proof of Total Disability.

Trust Agreement

Trust Agreement means the Agreement and Declaration of Trust establishing the IBEWLocal No. 461 Welfare Fund and that instrument as may be amended from time totime.

Trust Fund

Trust Fund or Fund means the IBEW Local No. 461 Welfare Fund.

Trustees

Trustee means the Employer Trustees and the Union Trustees, collectively, as selectedunder the Trust Agreement, and as constituted from time to time in accordance withthe provisions of the Trust Agreement.

Union

Union means those Unions, which have executed an Agreement of CollectiveBargaining with an Employer who, in accordance with such Agreement of CollectiveBargaining, participates in and contributes to the IBEW Local No. 461 Welfare Fund.


Section IV – Comprehensive Medical Benefits Page 40

SECTION IV

COMPREHENSIVE MEDICAL BENEFITS

Introduction

When you or your Dependent require covered expenses or supplies that are medicallynecessary because of Injury or Sickness, benefits are payable as stated in theSchedule of Benefits. There may be some expenses that have other benefit levels.You must contact Hines and Associates at (888) 236-2652 to pre-certify all hospitaladmissions. The telephone number for Hines and Associates is also on the back ofyour Plan ID Card.

Preferred Provider Organization (PPO)

This plan uses a "Preferred Provider Organization" or "PPO" known as BlueCross Blue Shield of Illinois or "BCBSIL" to obtain medical treatment on a discountedbasis. Using a PPO hospital or doctor is voluntary, but the Trustees encourage you todo so if possible because it will save money for both you and the Plan. To qualify forthe discount, you must identify yourself as a PPO member, so be sure to carry and topresent the Identification Card which is issued to you when you become initiallyeligible. Contact BCBSIL at 866-461-4239 for a directory of PPO Providers.

Non-Preferred Provider Organization (PPO)

If you do not use a PPO provider, benefits will be paid at the lowerOut-of-Network percentage.

The Deductible Amount

The deductible amount is the amount that you have to pay from your ownpocket before any benefits are payable. That amount, as shown in the Schedule ofBenefits, generally applies to each individual person each calendar year.

Maximum Deductible Amount for Families

When three (3) or more people of the same family satisfy the family deductiblein the same calendar year, a deductible is not required for other family members inthat year. This is called the "family limit" on the deductible amount.

Co-Payment

The Major Medical Benefits do not pay covered expenses in full; the amountyou or your Dependent has to pay depends on the type of treatment.



Co-Payment Limit for Individuals

The Plan limits the out-of-pocket expense due to the co-payment requirementfor most (not all) conditions per person, per calendar year. When an individualreaches the co-payment limit of one thousand, six hundred dollars ($1,600) per personand three thousand, three hundred dollars ($3,300) per family for in-network servicesand three thousand, one hundred dollars ($3,100) per person and six thousand, threehundred dollars ($6,300) per family for out-of-network services in a calendar year, thePlan will pay one hundred percent (100%) of such person's covered expenses incurredin the rest of the year. This amount is based on eligible expenses only; it does notapply to expenses applied toward any deductibles or "Treatment With SpecialLimitations".

THE PLAN WILL NOT COVER ANY AMOUNT OVER WHAT ISCONSIDERED TO BE A REASONABLE OR CUSTOMARY CHARGE FOR ANYSERVICES RENDERED.

COVERED EXPENSES

Hospital Expense Benefits

All non-emergency hospital admissions must be pre-certified with Hines andAssociates.

Daily Benefit

The Plan pays for the following daily hospital expenses:

1. Room and board charges up to the semi-private room rate and thereasonable and customary amount charged in the area;

2. General nursing services;

3. Treatment at an intensive or coronary care unit;

Miscellaneous Charges While Confined

The Plan pays for medically necessary services and supplies furnished by thehospital during the Eligible Person's confinement. Examples of eligible miscellaneousitems include: the use of an operating room, X-rays, laboratory tests, blood, drugsand medications prescribed by a physician and used while confined.



Out-Patient Hospital Treatment

The Plan pays for hospital charges due to treatment when the Eligible Person isnot charged for a room under certain circumstances:

1. When surgery is performed at the hospital on an out-patientbasis; or;

2. For emergency treatment of a Non-Occupational Accidental BodilyInjury or Sickness on the day of the accident or the next twofollowing days; or

3. Tests required by the hospital prior to admission.

Charges Related to Hospital Treatment

The Plan pays for certain charges which are not billed by the hospital but arerelated to hospital treatment eligible under the Plan. Examples of related chargesinclude:

1. Charges for Medically Necessary professional local ambulanceservices for transportation to the hospital or between hospitals ifnecessary for more highly specialized care; and;

2. Charges made by a physician, other than the operating physicianor his assistant, for the administration of anesthesia by other thanlocal infiltration; and

3. Charges made by a radiologist or pathologist.

Limitations

Hospital Expense Benefits are not payable for:

1. Personal conveniences or grooming items such as guest traymeals, television rental, barber or beautician services or admissionkits;

2. Confinement, which is not medically necessary, including earlyadmission or late discharge and confinement related to electivesurgical procedures such as sterilization reversal procedures orcosmetic surgery.

Hospital Expense Benefits may be subject to additional exclusions andlimitations for some conditions; see the Treatment with Special Limitations section.



Hospital Expense Benefits are also subject to all General Plan Exclusions andLimitations.

Hospital Pre-Admission Testing

Benefits will be payable if you or your Eligible Dependent undergoes diagnostictests and X-rays in a hospital's out-patient department prior to actual admission to thehospital for treatment of the condition which makes the tests necessary provided:

1. The tests or x-rays are otherwise eligible expense under theHospital Expense Benefit; and

2. The patient is scheduled for subsequent admission to the hospitalfor treatment of the condition which makes the tests necessary,and

3. The tests are ordered by a physician.

Amounts paid for Pre-Admission Testing will be applied to the maximumHospital Miscellaneous charges for that confinement.

However, in the event that the scheduled admission does not take place, thetesting may still be covered if the admission is postponed or canceled for one or moreof the following reasons:

1. The tests show a condition requiring medical treatment prior toadmission; or

2. A medical condition is developed that delays the admission; or

3. A hospital bed is not available on the scheduled date ofadmission; or

4. The tests indicate that, contrary to the attending physician'sexpectation, the admission is not necessary.

Pre-Admission Testing Benefits are also subject to all General Plan Exclusionsand Limitations.

Surgical Expense Benefit

When a surgical procedure is performed on you or your Dependent fortreatment of a Non-Occupational Accidental Bodily Injury, the Plan will pay the surgicalfee charged by a physician up to the reasonable and customary amount charged in thearea and as described in this section.



Surgical procedures may be performed in a hospital, physician's office orelsewhere. Surgical benefits include charges for necessary and related pre- andpost-operative care and any anesthetic customarily administered by the surgeon.

When a mastectomy is considered an eligible surgical procedure under thePlan, the Plan will also provide benefits for:

1. reconstruction of the breast on which the mastectomy has beenperformed;

2. reconstruction of the other breast to produce a symmetricalappearance; and

3. prostheses and treatment of physical complications ofmastectomy, including lymphedemas (swelling of the lymphvessels or lymph nodes).

Limitations

Surgical Expense Benefits are not payable for:

1. Dental work or treatment, except as specifically provided; or

2. Elective cosmetic or plastic surgery procedure such as rhinoplastyor breast augmentation. Breast reduction (reductionmammoplasty) may be considered an eligible expense in certaincases which are determined to be "medically necessary. Examplesof medical necessity include: severe skin disorder (such as rashor ulceration under the breast) and/or severe musculoskeletalsymptoms (such as back pain or shoulder disfiguration) whichgenerally requires that no less than five hundred fifty (550) gramsof tissue be removed from each breast; breast reconstructivesurgery in connection with a mastectomy is covered forreconstruction of the breast on which the mastectomy hasbeen performed, surgery and reconstruction of the otherbreast to produce a symmetrical appearance andprostheses and physical complications for all stages ofmastectomy; or

3. Cosmetic or reconstructive surgery which is not necessary forprompt repair of a Non-Occupational Accidental Bodily Injury,which occurs while the patient is eligible.

Charges by an assistant surgeon will be considered as a covered expenseprovided his assistance is considered medically necessary.



Surgical Expense Benefits are also subject to all General Plan Exclusions andLimitations.

Second Surgical Opinion Benefits

When you or your Dependent wishes to secure a second opinion regarding themedical necessity or an in-patient surgical procedure of a non-emergency nature, thePlan will pay the physician's fee and related expenses provided:

1. You or your Dependent is examined in person by a board certifiedspecialist; and

2. The specialist submits a written report of his findings andrecommendation; and

3. The specialist physician who renders the second surgical opiniondoes not also perform the recommended surgical procedure.

Second Surgical Opinion Benefits are also subject to all General Plan Exclusionsand Limitations.

Diagnostic X-Ray and Lab Benefits

When you or your Dependent incurs out-patient expense for laboratory andx-ray examinations, x-ray or radium therapy treatment to aid in diagnosis ofNon-Occupational Accidental Bodily Injury or Sickness, the Plan will pay thoseexpenses up to the reasonable and customary amount charged in the area and asdescribed in this section.

Diagnostic Benefits are payable for examination and testing in a physician'soffice, clinic or hospital out-patient department.

Limitations

Diagnostic X-Ray and Lab Benefits are not payable for:

1. Testing or examination not recommended as medically necessaryto diagnose Sickness or Injury (e.g., marital or employmentexaminations, research studies, camp or school admission);

2. X-ray or testing related to dental care or treatment;

3. Eye examination for prescribing corrective lenses, includingcontact lenses; or



4. Testing or examination performed while the Eligible Person ishospital confined.

Diagnostic X-ray and Lab Benefits are also subject to all General Plan Exclusionsand Limitations.

In-Hospital Benefits

When you or your Dependent requires non-surgical treatment by a physicianfor Non-Occupational Accidental Bodily Injury or Sickness while confined in a hospital,the Plan will pay the reasonable and customary medical fee charged by the physician.

Benefits may be paid for medical treatment rendered during a period ofconfinement when a surgical procedure is also performed.

In-Hospital Physician Benefits pay for one physician's visit per day when youare confined in a hospital for reasons other than surgery. If surgery is recommendedand performed, these benefits are not paid on or after the day of surgery unless youare seen by a physician, other than the one who performed the surgery, for aco-existent medical condition.

In-Hospital Physician Benefits are subject to all General Plan Exclusions andLimitations and may be subject to additional exclusion and limitations for someconditions.

Therapy Benefits

Physical therapy, occupational therapy and speech therapy when prescribed by amedical doctor and performed by a licensed therapist or, as appropriate, anotherprovider acting within the scope of the provider's license. Charges for chiropractictreatment will be considered under the chiropractic benefit.

Pregnancy Expense Benefits

When you or your Dependent Spouse incurs expense for hospital confinementor treatment by a physician due to Pregnancy, including normal childbirth, Caesareansection or miscarriage, the plan will pay those expenses on the same basis as anySickness or Injury, up to the reasonable and customary amount charged in the areaand as described in this section. Obstetrical procedures are eligible under the SurgicalExpense Benefits of the Plan.

Benefits for Pregnancy are effective immediately for expenses incurred on orafter the Eligible person's individual effective date of coverage. Pregnancy is notconsidered a pre-existing condition.



The Plan also covers maternity care benefits when provided by a certified nursemidwife. Delivery must be in an approved hospital or birthing center.

The Plan will not restrict benefits for any hospital length of stay in connectionwith childbirth for the mother or newborn child to less than forty-eight (48) hoursfollowing a vaginal delivery, or less than ninety-six (96) hours following a delivery bycesarean section. However, the Plan may pay for a shorter stay if the attendingprovider (e.g., your physician, nurse midwife, or physician assistant), after consultationwith the mother, discharges the mother or newborn earlier. The Plan will not set thelevel of benefits or out-of-pocket cost so that any later portion of the forty-eight (48)hour (or ninety-six [96] hour) stay is treated in a manner less favorable to the motheror newborn than any earlier portion of the stay. The Plan does not require priorauthorization of stays up to forty-eight (48) hours (or ninety-six [96] hours) in coveredfacilities.

Limitations

Pregnancy Expense Benefits are not payable for Pregnancy expenses incurredby a Dependent child. However, certain preventive care services, as required by theAffordable Care Act, are covered expenses. The newborn of a dependent child is notconsidered eligible for any benefit under the Plan.

Pregnancy Expense Benefits are subject to all the limitations which apply toindividual benefits payable for any Sickness or Injury, including the General PlanExclusions and Limitations.

Newborn Dependent Child Benefits

Benefits are payable for newborn who is an Eligible Dependent, up to thereasonable and customary amount charged in the area and as described in thissection.

Crib Care

Benefits for the care of each newborn Dependent child are payable in the samemanner as hospital room and board and miscellaneous charges are paid under HospitalExpense Benefits. Crib care is payable during the period the mother of the child ishospital confined as a result of giving birth to the child.

Newborn Examination

Benefits for medical examination and care of a newborn Dependent, whilehospital confined, by a physician specializing in pediatrics are payable for the day ofbirth or the next following day.



Newborn Circumcision

Benefits for circumcision of a newborn Dependent male child by a physician arepayable in the same manner as Surgical Expense Benefits.

Birth Coverage

Benefits for special care and treatment medically required by a newbornDependent child as a result of:

1. Sickness contracted or Injury suffered; or

2. Congenital defect; or

3. Premature birth.

Benefits are payable in the same manner as any other disability, up to thereasonable and customary amount charged in the area.

Limitations

Newborn Benefits are not payable for expenses incurred:

1. After the mother of the child is no longer hospital confined as aresult of giving birth to such child unless the child requiresextended confinement; except however,

2. During a period of confinement for the mother which is longerthan that for a normal delivery.

Newborn Dependent Child Benefits are not payable for expense incurred by thenewborn child or children of an Eligible Person's Dependent child.

Newborn Dependent Child Benefits are also subject to all General PlanExclusions and Limitations.

Chiropractic Expense Benefits

When you or your Dependent is treated by a chiropractor or, as appropriate,another provider acting within the scope of the provider's license, in connection withthe detection, treatment and correction of structural imbalance, subluxation ormisalignment of the vertebral column for the purposes of alleviating pressure or spinalnerves, benefits for all related services, supplies and procedures will be paid asdescribed in this section. Covered services include office visits, manipulations,adjustments and diagnostic x-ray or laboratory services.



Limitations

This Plan does not provide benefits for:

1. More than one treatment per day;

2. Services or conditions other than those indicated above.

Expenses related to chiropractic treatment, other than the Chiropractic Servicesspecified above are not covered expenses. Chiropractic services are subject to allGeneral Plan Exclusions and Limitations.

Home Health Care Benefits

When you or your Dependents incur expenses for Home Health Care, and whensuch expenses are deemed medically necessary, the Plan will reimburse part-timeintermediate skilled nursing care up to the maximum set forth in the Schedule ofBenefits.

Limitations

Services must be rendered by a registered nurse or, as appropriate, anotherprovider acting within the scope of the provider's license. Home Health Care Benefitsare also subject to all General Plan Exclusions and Limitations.

Elective Sterilization Benefits

Charges in connection with an elective sterilization are paid under the Plan'sMajor Medical Benefit.

Limitations

Elective Sterilization Benefits are not payable for:

1. Expense incurred by a Dependent other than an eligibleDependent spouse, except as required by the Affordable Care Act;

2. More than one sterilization procedure per Eligible Family, exceptas required by the Affordable Care Act; and

3. Expense incurred for the purpose of reversing a sterilizationprocedure.

Elective Sterilization Benefits are also subject to all General Plan Exclusions andLimitations.



Mental Health & Substance Abuse Benefits

The Plan covers mental health benefits and treatment of alcoholism andsubstance abuse, in-patient and out-patient rehabilitation programs, out-patienttreatment for Attention Deficit Disorder (ADD) including prescriptions for ADD.Recognized facilities may include non-hospital facilities specializing in substance abusetreatment as well as hospital in-patient facilities. All treatment In-patient must bepre-certified by the Member Assistance Program (MAP).

Limitations

Benefits for treatment of mental and nervous disorders are not payable for:

1. Behavioral Disorders;

2. Charges related to primal therapy, rolfing, psychodrama,megavitamin therapy, vision perception training, or carbon dioxidetraining.

3. Charges related to marriage, family, parental, child career, socialadjustment, pastoral or financial counseling services.

4. Counseling for adoption, custody, family planning, Pregnancy, orcatastrophic illness diagnosis in the absence of psychiatricdiagnosis generally recognized and accepted by the medicalprofession such as the American Psychiatric Association'sDiagnostic and Statistical Manual of psychiatric diagnosis.

5. Court-ordered confinement – Any confinement of a CoveredPerson in a public or private institution as the result of a courtorder.

6. Educational or vocational testing or training – Testing and/ortraining for educational purposes or to assist an individual inpursuing a trade or occupation.

7. Biofeedback, recreational or educational therapy, or other formsof self-care or self-help training or any related diagnostic testing.

Treatment of Mental and Nervous Disorders are also subject to General PlanExclusions and Limitations.



Preventive Care Benefits and Routine Physical Examination (WELLNESS

BENEFITS)

When you, your Dependent spouse, or your Dependent child incurs eligibleexpenses for a Routine Physical Examination performed by a physician, the Plan willpay those reasonable expenses up to the amounts shown in the Schedule of BenefitsSection and as described in this Section.

Eligible expenses include the physician's professional fees, immunizations anddiagnostic x-ray or laboratory charges. The examination may be performed in aphysician's office, clinic or hospital out-patient department.

Additionally, the Plan intends to comply with preventive services as requiredunder the Affordable Care Act and interpretive guidance. The Plan covers items orservices with an A or B rating as recommended or defined by the U.S. PreventiveService Task Force, immunizations recommended by the Centers for Disease Control(CDC), preventive care and screenings for infants, children and adolescents supportedby Health Resources and Services Administration (HRSA) and screenings for womensupported by HRSA subject to the following:

1. Preventive care benefits covered under the Affordable Care Act are notpayable under other portions of the Plan.

2. The Plan will use reasonable medical management techniques to controlcosts of services provided under the Affordable Care Act. However, ifthe Plan does not have an in-network provider to provide a particularpreventive care item or service, the Plan will cover the item or serviceprovided by an out-of-network provider without cost-sharing, uponreceipt of substantiating documentation.

3. If a preventive care benefits item or service is billed separately from anoffice visit, and the primary purpose is not the delivery of suchpreventive care item or service covered under the Affordable Care Act,then the Plan will impose the applicable deductible and coinsurance withrespect to the office visit.

4. The following services are excluded from the preventive care benefits,unless otherwise required under the Affordable Care Act:

a. Testing or examination related to Non-Occupational AccidentalBodily Injury or Sickness or Pregnancy (including resulting childbirth or complications);

b. Testing or examination related to or as a condition ofemployment or to the issuance of any insurance policy;



c. Services that are not consistent with preventive care benefitsunder the Affordable Care Act;

d. Additional testing or services to confirm an Illness or Injurydiagnosed as a result of a preventive care examination orprocedure;

e. Preventive care services under the Affordable Care Act arecovered when performed for preventive screening reasons andbilled under the appropriate preventive services codes. Otherservices are covered under the applicable Plan benefit, not theWellness Benefit services benefit.

Preventive Care and Routine Physical Examination Benefits are also subject toall General Plan Exclusions and Limitations. Benefits are not payable under any otherbenefit.

Prescription Drug Benefits

The Plan will pay for Prescription Drugs, in generic or brand form, whenprescribed by a physician, and after applicable co-payments have been satisfied.Benefits for Active Participants are provided through the Sav-RX Prescription DrugProgram. You should automatically receive a prescription drug card when you becomeeligible under the Plan. Benefits are paid based upon the Schedule of Benefits.

Hearing Care Benefits

When you or your Dependent incurs expenses for hearing care, the Plan willpay those expenses up to the amount shown in the Schedule of Benefits and asdescribed in this Section.

Hearing Care Benefits are divided into three main parts: a physical examinationby a specialist physician (otologist or otorhinolaryngolist) or, as appropriate, anotherprovider acting within the scope of the provider's license; a test of hearing ability andcondition by a specialist physician, a licensed audiologist or, as appropriate, anotherprovider acting within the scope of the provider's license; and the purchase of ahearing aid, if required.

Fitting and purchase of a hearing aid includes the reasonable charges for themanufacture of ear molds by a specialist physician, licensed audiologist or, asappropriate, another provider acting within the scope of the provider's license; and thepurchase of a hearing aid, including hearing aid rental and audiologist consultationfees during an evaluation period (whether or not a hearing aid is found to besatisfactory and is purchased).



Eligibility

The benefit is available to all Eligible Employees and their Dependents on arecurring basis each five years.

The Maximum Amount

All payments under Hearing Care Benefits are limited to the maximum amountshown in the Schedule of Benefits. The maximum amount applies to you and each ofyour Dependents separately. The maximum amount cannot be reinstated and is notrenewed if eligibility is lost and then regained at a later date.

Limitations

Hearing Care Benefits are not payable for:

1. Charges for hygienic cleaning of the hearing aid;

2. Batteries and their installation;

3. Charges for repair due to accidental damage or for replacement ofa lost hearing aid.

Hearing Care Benefits are also subject to all General Plan Exclusions andLimitations.

Organ Transplant Benefit

When you or your Dependent require organ transplant procedures (asapproved by Medicare), benefit payments by the Plan are subject to the rulesdescribed in this section in addition to those governing individual benefits.

Co-Payment

1. PPO: the Plan pays covered expenses based upon the BCBSIL approvedamounts in lieu of benefit amounts or payment formulas applicable to anyother Non-Occupational Accidental Bodily Injury or Sickness.

2. Non-PPO: The Plan pays covered expenses in lieu of benefit amounts orpayment formulas applicable to any other Non-Occupational AccidentalBodily Injury or Sickness.

Payments made by the Plan shall be applied to the Transplant Benefit as theexpense is incurred on and after the date a transplant is determined to be MedicallyNecessary.



Limitations

Transplant Benefits are not payable for:

1. Expense incurred by any person other than an Eligible Person asdetermined by the Eligibility Rules, including but not limited to aliving tissue or organ donor, and

2. Transplants other than those approved by Medicare, and

3. Treatment employing Experimental or Investigational medical orsurgical procedures, and

4. Participation in study programs, except as required by theAffordable Care Act.

Transplant Benefits are also subject to all General Plan Exclusions andLimitations.

Other Covered Charges

The following Medically Necessary charges are covered:

1. The services of a legally qualified physician;

2. The services of a graduate registered nurse (R.N.), provided thoseservices are not rendered by someone who ordinarily resides inyour home or by a member of your or your spouse's family;

3. Casts, splints, trusses, braces and crutches and artificial limbs andeyes replacing limbs or eyes which are lost while a person iseligible for these benefits;

4. Whole blood or blood plasma, including the cost of theiradministration, other than those charges for "elective" testing anddonation. Autologous transfusion procedures will be considered ifmedically necessary due to surgery and only those pints used as aresult of the surgery will be considered an eligible expense;

5. Anesthetics and oxygen, including their administration, or rental ofequipment;



6. Rental, up to the purchase price, of durable medical equipment(such as wheel chair, hospital bed, or braces) based on at leastone (1) purchase estimate for such equipment;

7. Drugs and medicines which require a physician's prescription andare legally obtained from a licensed pharmacist that are notvitamins, minerals, food supplements or substitutes;

8. Cardiac rehabilitation (not to exceed six [6] weeks unlessmedically necessary) following a heart attack or surgery;

9. Treatment for allergies such as allergy therapy and/or allergyextract.

10. Acupuncture for pain or nausea if rendered by a licensed provider.

11. Massage therapy if referred by a physician for a specific conditionif rendered by a licensed provider.

12. Naprapathy if rendered by a licensed provider.

Limitations

Benefits are not payable for:

1. Services that are not Medically Necessary;

2. Occupational Bodily Injury and Sickness;

3. Eye refraction (for fitting glasses only), eyeglasses, lasik surgery,hearing aids or dental prosthetic appliances or charges for thefitting of any of these applications, unless such appliances arerequired due to a Non-Occupational Accidental Bodily Injury;

4. Cosmetic or reconstructive surgery which is not necessary for theprompt repair of a Non-Occupational Accidental Bodily Injury,which occurs while the patient is eligible;

5. Dental care or treatment except as specifically provided;

6. Rest cures or Custodial care;

7. Ambulance service or transportation between cities, such as by airambulance, railroad or bus;

8. Maintenance or repairs of durable medical equipment;



9. Shoes or shoe inserts for treatment of the feet, unless prescribedby a physician and custom-fitted for the patient;

10. Orthoptics or aniseikonia;

11. Testing or examination not recommended as medically necessaryto diagnose Sickness or Injury (e.g., pre-marital or employmentexamination or research studies); or

12. Experimental or investigational procedures.

13. Vitamins, supplements, except as required under the AffordableCare Act.

14. Lifestyle drugs, for example: Viagra, diet drugs, or drugs forsmoking cessation, except as required under the Affordable CareAct

The Medical Benefits are also subject to all General Plan Exclusions andLimitations. All benefits are subject to additional exclusions and limitations for someconditions.


Section IV – Benefits With Special Limitations Page 58


Section IV – Benefits With Special Limitations Page 59



October 2017Section V – Dental Care Benefits Page 60

SECTION V

DENTAL CARE BENEFITS

When you or your Dependent incurs expenses for dental care, the Plan will paythose expenses to a maximum amount as shown in the Schedule of Benefits and asdescribed in this Section. The Plan also requires co-payments for eligible types of careso you will share the cost of your treatment. Co-payment levels are specified for eachgroup of eligible expenses. The annual deductible does not apply to dental benefits.

Predetermination of Benefits

You are not required to have the dentist submit an estimate of charges beforework begins. However, the Trustees recommend that the dentist give the ClaimsOffice a description of the procedures to be performed and the estimated fees beforetreatment starts if the total charges will be over two hundred dollars ($200). This willlet you and your dentist know if the treatment plan is considered reasonable and whatbenefits will be paid.

The Maximum Amount

All payments under Dental Care Benefits are limited to the maximum amountshown in the Schedule of Benefits for the type of care involved. The maximumamount applies to you and each of your Eligible Dependents separately for all coveredexpenses. The maximum amount applies to payments for treatment each calendaryear and is renewed each January 1st. Benefits not used in a prior year cannot becarried forward to increase the maximum amount for the next calendar year.

Covered Expenses

Dental Care Benefits are divided into four main parts: preventive; diagnosticexpenses; restorative expenses (such as most fillings and extractions); prosthodonticsexpenses (such as gold work and dentures or orthodontics). The percentage payableby the Plan is determined separately for each type of treatment group.

1. Preventive Expense. The Plan pays one-hundred percent (100%)of the reasonable expense for the following dental care:

Oral Examinations, twice (2) per calendar year;

Preventive treatment consisting of:

(1) Oral prophylaxis (cleaning and scaling of teeth) butnot more than twice (2) in a calendar year;



(2) Topical sodium and stannous fluoride treatment orsealants are available only to eligible persons underage nineteen (19), but not more than onetreatment per tooth in a calendar year; and

Space Maintainers for replacement of deciduous prematurelylost teeth for an eligible person under age nineteen (19).

Diagnostic Expense. The Plan pays one hundred percent (100%) of thereasonable and customary expenses for x-rays, consisting of:

Bitewing x-rays, not more than twice in a calendar year; and

Full mouth x-rays, once in a thirty-six (36) consecutive monthperiod.

2. All Other Dental Expenses

Restorative Expenses. The Plan pays eighty percent (80%) of thereasonable and customary expenses for the following dental care:

Extractions not related to orthodontics;

Oral surgery, including medically necessary administration oflocal or general anesthetics;

Fillings, other than gold;

Periodontal treatment (diseases of gums);

Endodontic treatment (pulp infection and root canal therapy);

Injections of antibiotic drugs;

Prosthodontics Expenses. The Plan pays eighty percent (80%) of thereasonable expense for the following dental care:

Initial installation of complete or partial bridgework fixed orremovable;

Initial installation of gold fillings or crowns as abutments,provided that amalgam, silicate, plastic or other materials willnot adequately restore the teeth;

Replacement of previously existing gold restorations providedthat:



(1) Amalgam, silicate, plastic or other materials will notadequately restore the tooth, and

(2) The previous restoration was installed five (5) ormore years prior to this replacement.

Replacement of previously existing complete or partialremovable dentures or fixed bridgework provided that:

(1) the previous denture or bridgework was installedthree or more years prior to its replacement.

Dental implants.

Orthodontic Expense. When a Dependent child through theage of eighteen (18) (through the age of twenty-two [22] ifdependent is a full-time student) undergoes OrthodonticTreatment, the Plan pays eighty percent (80%) of thereasonable and customary expense for the following servicesand supplies during the first thirty-six (36) months oftreatment:

diagnostic procedures, including cephalometric x-rays;

surgical therapy, including repositioning of the jaw orfacial bones or teeth to correct malocclusion;

appliance therapy (braces), including related periodicoral exams, surgery and extractions.

Treatment in Progress When Eligibility Terminates

The Plan will generally not pay for Expenses Incurred after the date you or yourDependent's eligibility terminates, even if the Claims Office has predetermined thepayments for a treatment plan submitted before the termination date. For purposes ofthe Dental Care Benefit, Expense Incurred means the date a dental service ortreatment is performed, except for the following services or treatments:

1. Dentures or bridgework – the date the impressions are taken.

2. Crowns, in-lays, on-lays – the date the teeth are first prepared.

3. Root canal therapy – the date the pulp chamber is opened.



Accordingly, the Plan will pay for services or supplies related to the followingcovered expenses if the treatment is rendered and delivered to the patient withinninety (90) days after the termination date and the following conditions are met:

1. A prosthetic device (such as full or partial dentures) if the dentisttook the impressions and prepared the abutment teeth while thepatient was covered under the Plan;

2. A crown if the dentist prepared the tooth for the crown while thepatient was covered under the Plan; and

3. Root canal therapy if the dentist opened the tooth while thepatient was covered under the Plan.

Limitations

Dental Care Benefits are not payable for:

1. Any service rendered, supply ordered or treatment plan begunbefore coverage became effective;

2. Treatment other than by a licensed dentist or other appropriatelylicensed provider, except that scaling or cleaning of teeth andtopical application of fluoride may be performed by a licensedDental Hygienist if the treatment is rendered under thesupervision and guidance of and billed for by the dentist;

3. Services or supplies that are primarily cosmetic in nature,including charges for personalization or characterization ofdentures;

4. Replacement of a lost, missing or stolen prosthetic device;

5. Services rendered through a medical department, clinic or similarfacility provided or maintained by the patient's employer orgovernmental agency;

6. Services or supplies which do not meet accepted standards ofdental practice, including charges for services or supplies whichare experimental in nature;

7. Any duplicate appliance or prosthetic device;

8. Athletic mouth guards;



9. A plaque control program (a series of instructions on the care ofthe teeth);

10. Periodontal splinting;

11. Services which are provided under other sections of this Plan;

12. Myofunctional therapy (correction of harmful habits);

13. Sealants and fluorides painted on the teeth in an attempt toprevent further decay (more than once a year);

14. Services or supplies which are not necessary according toaccepted standards of dental practice;

15. Oral hygiene or dietary instructions.

16. Occusual guards or bite splints.

Dental Care Benefits for Orthodontic Treatment are not payable for:

1. a Dependent other than a Dependent child;

2. any orthodontic treatment program begun on or after theDependent child's nineteenth (19th) birthday, (or twenty-third[23rd] birthday if a full-time student);

3. any orthodontic treatment procedures performed after the firstthirty-six (36) months of treatment.

Dental Care Benefits are also subject to all General Plan Exclusions andLimitations.


Section VI – Vision Care Benefits Page 66

SECTION VI

VISION CARE BENEFITS

When you or your Dependent incurs expense for vision care, the Plan will paythose expenses up to the maximum amount shown in the Schedule of Benefits and asdescribed in this Section. There is no deductible required by the Plan before VisionCare Benefits become payable. Vision Benefits renew every even calendar year.

The Maximum Amount

Payments under the Vision Care Benefits are limited to the individual maximumas shown in the Schedule of Benefits and renew every other calendar year. Forexample, the benefit periods January 1, 2013 through December 31, 2014 andJanuary 1, 2015 through December 31, 2016.

Covered Expense

Services or supplies must be provided by an Optician, Optometrist, orOphthalmologist to be considered Covered Expenses. Typical services are shownbelow.

1. Vision Examination - A vision screening includes:

a. a check of principle vision functions, and;

b. determination of vision ability and condition.

2. Vision analysis may be done. Vision analysis includes:

a. complete case history;

b. measuring and recording of visual acuity, corrected anduncorrected;

c. examination of fundus, media, crystalline lens, optic discand pupil reflex for pathology, anomalies or Injury, cornealcurvature measurements, retinoscopy;

d. fusion determination, distance and near, subjectivedetermination, distance and near, and stereopsisdetermination, distance and near;

e. color discrimination and amplitude or accommodation;

f. analysis of findings, lens prescription (if needed); and



g. measuring and recording of visual acuity, distance andnear, with new prescription if required.

3. Contact Lenses or Lenses and Frames. Related services andsupplies include:

a. professional advice on frame selection;

b. facial measurement, and preparation of specifications foroptical laboratory and verifying and fitting of prescriptionglasses or contact lenses;

c. re-evaluation and progress report after fitting newprescription and subsequent servicing.

Limitations

Vision Care Benefits are not payable for:

1. Examinations or materials more frequently than specifically provided;

2. Lenses, frames or contact lenses which are lost or broken except atthe normal intervals when benefits are available;

3. Special procedures such as orthoptics, vision training or aniseikonia;

4. Non-prescription sun glasses or tinted glasses;

5. Services or supplies not listed as covered vision expenses;

6. Services, treatment or supplies, related to medical or surgicaltreatment of the eyes;

7. Services, treatment or supplies which are rendered or finished beforethe date a person becomes initially eligible or after the date aperson's eligibility terminates;

Laser Eye Surgery to correct vision deficiencies

The Plan will pay the covered amount for a Lasik procedure or RadialKeratotomy Surgery at 50% after the applicable deductible up to a maximum of twothousand dollars ($2,000) per eye per lifetime.

Vision Care Benefits are also subject to all General Plan Exclusions andLimitations.



Vision Therapy

Vision Training/Therapy is a separate benefit and must be performed by anoptometrist, an opthamologist, or an MD trained in vision therapy. The benefit is paidat 100% and has a maximum allowable expense of $400 per person per year.Coverage is for Class A and Class B Participants and their eligible Dependents.


Section VII – Loss of Time, Death and Dismemberment Benefits Page 70

SECTION VII

LOSS OF TIME AND DEATH BENEFITSWeekly Loss of Time Benefits – Active Employees Only

If you become totally disabled from Non-Occupational Accidental Bodily Injuryor Sickness, the Plan will pay the Weekly Benefit shown in the schedule of Benefits.

Application for Loss of Time Benefits

For the Plan to consider Loss of Time, you must submit a fully completed claimform.

1. Both you and the physician must complete the form.

2. The Plan must receive a "Return to Work Notice" completed byyour physician.

Period of Disability

All disability absences will be considered as having occurred during a singleperiod of disability unless evidence acceptable to the Trustees is furnished that:

1. The cause of the latest disability absence cannot be connectedwith the causes of any prior disability absences, and the latestdisability absence occurs after return to active work for at leastone day; or

2. The causes of the latest disability absence can be connected withthe causes of a prior disability, but the two were separated by areturn to active work for at least two weeks.

Limitations

No benefits are payable under this benefit provision for any period or day ofdisability for which the Employee is not under the regular care and attendance of aphysician. A Chiropractor is not considered a Physician for the purposes of disabilitybenefits.

No benefits are payable under this benefit provision for any period on or afterthe date an Employee retires, even if such Employee would normally be consideredeligible based on Employer contributions for hours worked before retirement.

The benefits provided under this provision are not assignable.



Weekly Loss of Time Benefits are also subject to all General Plan Exclusions andLimitations.

Death Benefits – Participants Only

If you die from any cause, a Death Benefit is payable in the amount specified inthe Schedule of Benefits. The Plan Office must be provided with acceptable proof ofdeath on forms provided by the Trustees.

Beneficiary Designation

You must file a written designation of Beneficiary with the Plan Office on aproperly completed form. If you have not made an irrevocable designation ofBeneficiary, you may name a new Beneficiary without your prior Beneficiary's consent,by filing a new form with the Plan Office. The change of Beneficiary will be effectiveretroactively to the date you sign the form, whether or not you are living when thePlan Office receives it. The Plan is not responsible for any payments made before thechange of Beneficiary form is received. If you do not designate a Beneficiary or if yourBeneficiary does not outlive you, the Death Benefit will be paid to the living in thefollowing order:

1. Spouse;

2. Children, including legally adopted children;

3. Parents;

4. Brothers and sisters; or

5. Executor or administrator of the Employee's estate.

If two (2) or more persons are entitled to the Death Benefit, they will shareequally.

Notice of Claim

Written notice of the death of a Participant whose coverage has been continuedunder this provision must be given to the Plan Office within twelve (12) months of thedate of death. If written notice is not given within such twelve (12) month period, thePlan will not be liable for any person on account of that death.


Section VIII – Medical Savings Benefit Page 73

SECTION VIII

MEDICAL SAVINGS BENEFIT

The Medical Savings Benefit is a flexible spending account that currentlyprovides an annual benefit of five hundred dollars ($500) per Participant. Each yearthe Trustees will determine whether an allocation to the Medical Savings Benefit will bemade and if so, the amount of the allocation.

How the Medical Savings Benefit Works

As of January 1, each year, the Trustees will determine the amount that will beallocated to the Medical Savings Benefit. This is the total amount payable per calendaryear for the Participant and their eligible Dependents. The total allocated amount isavailable immediately.

To qualify for the Medical Savings Benefits, you must be eligible on the dateservices were incurred. An expense is considered incurred when services are provided,not when you are billed or when you pay for services.

What the Money Can Be Used For

The Medical Savings Benefit can be used to pay for Qualifying MedicalExpenses NOT reimbursed by the IBEW Local 461 Welfare Plan or any other benefit orinsurance plan under which you or your Dependents are eligible. Among the eligibleitems are:

a. Your medical deductibles;

b. The medical, dental or vision care co-payments;

c. Federally recognized covered medical, dental or vision careexpenses not eligible for payment under this or any other Plan;

Qualifying Medical Expenses will be reimbursed from the Medical SavingsBenefit before being reimbursed from the Supplemental Benefit Account. In no eventshall Qualifying Medical Expenses be provided in a form other than reimbursement.

How to Use the Medical Savings Benefit

To receive payment from your Medical Savings Benefit:

a. You should accumulate at least twenty-five dollars ($25) inreimbursable expenses before you file a claim for payment fromyour Medical Savings Benefit.



b. Fill out a request form, provided by the Administration Office,indicating which expenses you want reimbursed from your MedicalSavings Benefit.

c. Submit, along with the form, itemized bills or Explanation ofBenefits forms.

d. Send the above items to IBEW Local 461 Welfare Fund MedicalSavings Plan, 6525 Centurion Drive, Lansing, MI 48917.

e. You must apply for Medical Savings Benefits within 90 days of theend of the calendar year for which your medical savings apply (byMarch 31 of the following year).

Forfeiture of Medical Savings Benefits

Amounts contributed to the Medical Savings Benefit during the calendar year butremaining in your account at the end of the processing period (March 31 of thefollowing year) cannot be returned to you or used to reimburse expenses incurred in asubsequent calendar year. These amounts are forfeited to the Plan to offsetadministrative expenses. These amounts cannot be returned to you as cash or anyother form of compensation.

Qualifying Medical Expenses

There are a wide range of Qualifying Medical Expenses for your Medical SavingsBenefit and Supplemental Benefit Account, including prescriptions, over-the-countermedications, medical co-payments, and health insurance deductibles, for you, yourspouse, and your eligible children.

The tables below provide examples of Qualifying Medical Expenses.

Acid controllers*

Acupuncture Alcoholism treatment Allergy & sinus

medicine*

Ambulance services Antibiotics*

Anti-diarrheals*

Anti-gas products*

Anti-itch & anti-fungal*

Anti-parasitictreatments*

Arthritis creams*

Artificial limbs & teeth

Automobile modified forphysically handicapped*

Baby rash ointments*

Bandages Birth control pills*

Blood pressuremonitoring

Braces & supports Braille publications

(above regular printedcost)

Breast pumps andlactation devices

Catheters

Chiropractic care Christian Science

practitioners Cold sore remedies*

Contact lens supplies &solutions

Contact lenses Cough, cold & flu

treatments*

Crutches Dental treatment Denture adhesives Dentures Diagnostic services



Diagnostic tests &monitors

Dietary and weight losssupplements*

Digestive aids*

Disability care expenses Drug addiction

treatment Electrolysis, hair

removal*

Eye examination &glasses

Family planning items Feminine creams*

Fertility treatments orabortions

Fiber supplements*

First aid supplies Flu shot Guide dog or animal

aides and veterinaryexpenses

Hearing aids &batteries

Hemorrhoidal preps*

Hospital services Immunization Incontinence pads,

diapers*

Insulin

Insulin & diabeticsupplies

Laboratory fees Laser eye surgery Laxatives*

Lead paint removal*

Legal healthcareorders*

Lodging & meals formedical care

Medical & testingdevices

Motion sickness*

Nursing services Nutritional

supplements*

Obstetrical expenses Organ transplant Orthodontia (not for

cosmetic reasons) Orthopedic shoes and

inserts*

Ostomy products Oxygen Pain relievers*

Physical exam Physical therapy Prescription drugs Psychiatric care Reading glasses

Respiratory treatments*

Shampoo psoriasis orlice*

Sleep aids & sedatives*

Smoking cessationprograms

Snoring cessation aids*

Special schooling fordisabilities

Speech therapy, lipreading

Stomach remedies*

Sunscreen (SPF 15+broad spectrum)

Surgery Telephone & TV for

deaf Transportation & travel

exp for medical care Vaporizers &

humidifiers*

Vitamins and herbalsupplements*

Weight loss program totreat obesity

Wheelchairs Wheelchairs, walkers,

canes Wigs & hair transplant*

X-rays and body scans

The items marked with an * are eligible with a prescription, a doctor's directive, orletter of medical necessity. Prescription means a written or electronic order for amedicine or drug that meets the legal requirements of a prescription in the state inwhich the medical expense is incurred and that is issued by an individual who is legallyauthorized to issue a prescription in that state.

Ineligible Medical Expenses

(The expenses below are never eligible for reimbursement)

Childcare regular services COBRA premiums Cosmetics Cosmetic surgery Dance or swim lessons Deodorant Diaper services Exercise equipment Fitness programs, dues

Funeral expenses Hair transplants Healthcare tax exp Household help Illegal substances,

treatments, or operations Insurance premiums Long-term care premiums

and expenses Maternity clothes

Medicare premiums Moisturizers and wrinkle

creams Retiree medical insurance

premiums Teeth whitening services &

products Toothpaste & mouth wash


Section IX – Supplemental Benefit Account Page 78

SECTION IX

SUPPLEMENTAL BENEFIT ACCOUNT

The Supplemental Benefit Account (SBA) is health reimbursement arrangementthat provides for coverage of deductibles, co-payments and other benefits under theplan (please refer to the "Covered Benefits" in this section for a detailed listing of thecovered benefits).

Funding

For every hour worked, employer contributions are placed into the individual'sSBA. Contributions are required from the employers for Active Participants workingwithin the jurisdiction of and covered under the terms of the Collective BargainingAgreement and for Non-Bargaining Unit (NBU) Participants employed by Local Union461 or the Joint Apprenticeship and Training Fund.

Notwithstanding any provision to the contrary in the Summary, Plan or TrustAgreement, as of June 1, 2017, the SBA shall be a vested, nonforfeitable benefit. As avested benefit, each Participant's SBA account can only be used for the purpose ofpaying SBA benefits on behalf of such Participant and paying expenses ofadministering the Plan. If the Plan is terminated, merged with another plan ortransfers its assets and/or liabilities to another plan, then the SBA assets shall continueto be used solely for the purpose of providing SBA benefits on behalf of Participants tothe extent of their SBA account balances as of the date of merger, termination ortransfer (and for paying administrative expenses). The Trustees may not use aParticipant's SBA account for any purpose other than as outlined in this paragraph.

An Employee's Eligibility to access the SBA account continues even after theEmployee's eligibility for benefits under the Plan has terminated, provided theEmployee must be a member in good standing with the Union at the time the requestfor reimbursement is submitted.

Access to Funds

1. Employees. An Employee shall have access to the funds accumulated inhis SBA to obtain reimbursement for out-of-pocket expenses incurred bythe Employee or by an Employee's Dependents for Qualifying MedicalExpenses and Qualifying Premium Expenses, provided such Employee isa member in good standing with the Union at the time the request forreimbursement is submitted.

2. Retirees. A Retiree shall have access to the funds accumulated in hisSBA to obtain reimbursement for out-of-pocket expenses incurred bythe Retiree and the Retiree's Dependents for Qualifying Medical



Expenses and Qualifying Premium Expenses, provided such Retiree is amember in good standing with the Union at the time the request forreimbursement is submitted.

3. Former Employees Not Yet Retired. A former Employee who is not yetretired shall have access to the funds accumulated in his SBA to obtainreimbursement for out-of-pocket expenses incurred by the formerEmployee or by the former Employee's Dependents for QualifyingMedical Expenses and Qualifying Premium Expenses, provided suchformer Employee is a member in good standing with the Union at thetime the request for reimbursement is submitted.

Reimbursable Benefits

Eligible expenses include reimbursement of self-payments, your cost-sharing forCovered Benefits, Qualifying Medical Expenses and Qualifying Premium Expenses thatare incurred while the Participant is eligible for coverage under the Plan and SBA. SeeSection VIII for examples of Qualifying Medical Expenses. An expense is "incurred"when the Employee, Retiree or other Dependent is furnished the medical care orservices giving rise to the claimed expense. The determination of whether anindividual is a Dependent whose Qualifying Medical Expenses and Qualifying PremiumExpenses are covered by the SBA shall be made at the time such expenses areincurred.

Reimbursement Procedure

Participants must submit an itemized bill, for dental and vision services. For allother services the Participant must submit the appropriate payment voucher orrejection from Blue Cross Blue Shield of Illinois to the Plan Office.

The Plan will reimburse Qualifying Medical Expenses from the SBA only afterthe Participant's Medical Savings Benefit is exhausted.

Claims will be reimbursed on a weekly basis however; Participants can submitclaims as frequently as they want. The Plan Office will hold the claims until the nextreimbursement period.

In no event will Qualifying Medical Expenses or Qualifying Premium Expensesbe provided in the form of cash other than reimbursement.

Accruing Account Balances

The account balance will continue to grow each year if the Participant does notuse it.



Excluded Expenses

Expenses incurred prior to May 1, 2014

Expenses incurred before you were eligible for the Plan and SBA

Expenses for which you are eligible to receive reimbursement from anothersource

Expenses for which you have taken or will take a deduction for income taxpurposes

Automobile insurance premium allocable to medical coverage

Insurance premiums for health care coverage (except as specifically included asQualifying Premium Expenses)

Premiums for fixed indemnity cancer insurance, fixed indemnity hospital insurance,life insurance, income protection, disability, loss of limbs, sight, or similar benefits

Occupational Bodily Injury or Sickness

Expenses that are not Qualifying Medical Expenses or Qualifying PremiumExpenses

Work in an Area Outside of the Jurisdiction of the Plan

Contributions from employers outside the Plan’s jurisdiction should be remittedat the current contribution rate which includes the SB allocation at the IBEW Local 461Collective Bargaining Agreement (CBA) rate. If contributions are reciprocated that areless than the current contribution rate but in excess of the amount determined by theBoard of Trustees (currently ten dollars and eleven cents [$10.11]) then that excessamount will be credited.

Forfeiture of SBA

Amounts accruing in the SBA will be forfeited to the Plan in the followinginstances:

1. Small Accounts. If the Participant has an account balance of less thanone hundred dollars ($100) and he/she has had no contributions to theaccount for more than twenty-four (24) months, the account will beclosed and the monies will be utilized by the Plan.

2. Upon Death. Upon the death of the Participant.



3. Forfeiture Due to Opt-Out. If the Participant elects to opt-out of theSBA Program (described below)

ACA Opt-Out of Account

Annual Opt-Out. Participants will be given the opportunity to opt-out of theSBA and waive future reimbursements from the SBA annually while they remaincovered under the Plan to the extent required under the ACA.

1. Periods Prior to June 1, 2017: If a Participant elects to opt-out of SBA,any amounts remaining in his account will be forfeited to the Plan andwill not be reinstated in the event the Participant subsequently elects toreenroll in the SBA. Upon opt-out of the SBA, any future SBAcontributions received on the Employee's behalf will be forfeited to thePlan until the Employee reenrolls in the SBA.

2. Effective on and after June 1, 2017: If a Participant elects to opt-out ofthe SBA, the account will be frozen as of the date of opt-out and anySBA contributions received on the Employee's behalf will be forfeited tothe Plan until the account is reinstated. Participant's frozen accountswill be reinstated on the January 1 following the twelve-month period towhich the opt-out applied, unless the Participant elects to opt-out for asubsequent twelve-month period.

Loss of Plan eligibility. Employees will be given the opportunity to opt-out ofthe SBA and waive future reimbursements from his account upon loss of Plan eligibility.

1. Periods Prior to June 1, 2017: If the Employee elects to opt out of hisaccount, any remaining amounts will be forfeited to the Plan and will not bereinstated in the event the Employee regains eligibility.

2. Effective on and after June 1, 2017: If the Employee opts-out of hisaccount, the account will be frozen as of the date of opt-out. TheEmployee's frozen account will be reinstated if the Employee regains Planand SBA eligibility. However, the account will remain subject to theforfeiture rule for small accounts.

Becoming eligible for Retiree coverage. Retirees will be given the opportunityto opt-out of the SBA and waive future reimbursements from his account uponbecoming eligible for Retiree coverage.

1. Periods Prior to June 1, 2017. If the Retiree elects to opt out of hisaccount, any remaining amounts will be forfeited to the Plan.



2. Effective June 1, 2017. If the Retiree opts-out of his account, the accountwill be frozen as of the date of opt-out. The Retiree's frozen account will bereinstated on the January 1 following the twelve-month period to which theopt-out applied, unless the Retiree elects to opt-out for a subsequenttwelve-month period.


Section X – General Plan Exclusions and Limitations Page 83

SECTION X

GENERAL PLAN EXCLUSIONS AND LIMITATIONS

The following exclusions and general limitations apply to all benefits providedby the Plan unless specifically waived by a particular benefit section.

Routine Care and Elective Procedures

Benefits under this Plan are for the treatment of Non-Occupational AccidentalBodily Injury or Sickness. Routine care, cosmetic surgery, diet medication orsupplements, which are not medically necessary to correct a condition which threatensthe health of an Eligible person are not eligible for Benefits from this Plan unlessspecifically provided for. The Trustees reserve the right to have an Eligible Personexamined by a physician of their own choice and at their own expense to make theirdetermination regarding any benefit payable or eligibility rule of this Plan.

Treatment designed to merely improve bodily functions is not consideredmedically necessary or an eligible expense for benefits.

Medical Necessity

Benefits under this Plan are payable only for services and supplies which areconsidered to be Medically Necessary in view of the patient's condition and diagnosis.For example, non-emergency hospital admission and confinement over a weekend willbe presumed not Medically Necessary and not an eligible expense incurred. Hospitaladmission for surgery which is generally performed on an out-patient basis will not beconsidered eligible for benefits unless such admission is Medically Necessary due, forexample, to a co-existent medical condition.

Work Related Disabilities

Payment will not be made by the Plan for expenses incurred because of anOccupational Bodily Injury or Sickness. If the Eligible Person's claim under Workers'Compensation or any Occupational Disease Law is rejected, the illness or Injury willnot be considered an Occupational Bodily Injury or Sickness and payment will bemade.

1. A claim under Workers' Compensation will be considered to havebeen rejected under the following circumstances:

a. when, after a hearing in the Illinois Industrial Commission (ora corresponding agency in another state), there has been afinal administrative determination denying the claim and nolawsuit seeking court review of the decision has been filed; or



b. when a decision has been rendered by the Illinois IndustrialCommission (or corresponding agency in another state), aparty has sought court review of the decision and a final courtdetermination has been made rejecting the claim.

Occupational Bodily Injury and Sickness claims are not subject tosubrogation/repayment agreements, and as such no coverage for Occupational BodilyInjuries or Sickness can be accessed through any subrogation or repaymentagreement.

Organ Transplants

Payment will be limited to the Reasonable and Customary Charge incurred as aresult of any type of organ transplants, such as, but not limited to the liver, lung,heart, kidney or cornea.

Reasonable and Customary Charges

Payment will not be made by this Plan for any expense incurred or chargemade, which the Trustees determine is not Reasonable or Customary as definedherein.

Treatment Sponsored by Governmental Units

Payment will not be made by the Plan for expenses incurred:

1. While confined in a hospital owned or operated by the FederalGovernment or other government unit; or

2. For treatment by a physician employed by the FederalGovernment or other governmental unit; or

3. For services or supplies furnished by or at the request or directionof the Federal Government, any of its agencies, or othergovernment unit unless the Eligible person is legally required topay.

This exclusion will not prevent coordination of benefits with a plan specificallyestablished by a governmental unit for its own civilian employees and theirdependents. This exclusion also does not apply to services or care rendered to aveteran by the Veteran's Administration for a non-service-connected disability.



Treatment Without Charge

Payment will not be made for expenses that an Eligible Person is not legallyrequired to pay or that would not be charged in the absence of these benefits.

Illegal Occupation or Act or Commission of Felony

Any condition, disability, or expense resulting from or sustained as a result of:1) committing or attempting to commit an illegal act or occupation considered to be afelony in the jurisdiction in which the act occurred, regardless of whether charged orconvicted; 2) committing or attempting to commit assault, battery, criminal trespass,criminal damage to property, theft, robbery, burglary, or arson, regardless of whethercharged with or convicted of a felony; or 3) participating in civil insurrection or riot;provided, however, that this exclusion shall not apply if the condition, disability orexpense resulted from a medical condition.

Experimental or Investigative Treatment or Procedures

Benefits under this Plan are for the treatment of Non-Occupational AccidentalBodily Injury or Sickness by generally recognized medicines, surgery and othertechniques or devices. Experimental or Investigative treatments and procedures areexcluded. Medicines, treatment techniques and devices which are not generallyrecognized by professional peer groups (such as the American Medical Association) orby regulatory governmental authorities (such as the Food and Drug Administration) willbe considered Experimental and will not be considered eligible expenses under thisPlan. For the purposes of this provision, recognized treatment or medicines used in anon-routine manner (frequency or dosage) will be considered Experimental.Notwithstanding anything to the contrary above, Routine Care Costs associated with anApproved Clinical Trial are not considered Experimental.

General Limitations

Benefits of this Plan do not cover any loss caused by, incurred for or resultingfrom:

1. Declared or undeclared war, or any act thereof, or military ornaval services of any country;

2. Services, treatment or supplies received from a dental or medicaldepartment maintained by a mutual benefit association of this oranother employee benefit plan or labor union;

3. Services, treatment or supplies, which are payable or furnishedunder any policy of insurance or other medical benefit plan or



service plan for which the Trustees shall, directly or indirectly,have paid for all or a portion of the cost;

4. Services or treatment rendered or supplies furnished primarily forcosmetic purposes;

a) Unless necessary for the prompt repair of a Non-Occupational Accidental Bodily Injury or Sickness ordisease; and

b) Performed within two (2) years of a covered event.

5. Expenses incurred for services performed or supplies furnished byother than a physician or other provider acting within the scope ofthe provider's license;

6. Services, treatment or supplies rendered or furnished:

a. Before the individual concerned became an Eligible Person;

b. Without the recommendation and approval of a legallyqualified physician; or

c. After the individual concerned is no longer covered underthe Plan.

7. Services related to obesity, diet or weight control, including butnot limited to: exercise programs, surgery, special diet or dietsupplements, amphetamines, or any form of diet medicationwhether or not recommended or supervised by a physician,including dietary or nutritional counseling, books, pamphlets orclasses, except as required by the Affordable Care Act;

8. Mental counseling, physical therapy, supplies or prosthesis forsexual dysfunction or inadequacies;

9. Implantation within the human body of artificial mechanicaldevices designed to replace human organs other than pacemakersor similar such devices which merely assist rather than replace thefunction of the organ;

10. Ambulance service or transportation between cities or states (suchas by ambulance, air ambulance, railroad or bus) unless judged bythe Trustees as essential for treatment of a life-threatening illnessor Injury;



11. Growth hormones; (testing covered if medically necessary)

12. Expenses incurred for the purpose of reversing tubal ligations,vasectomies or other sterilization procedures;

13. Special home construction to accommodate a disabled person;

14. Education, special education, job training or work hardeningwhether or not given in a facility that also provides medical orpsychiatric treatment beyond the first medically necessary visit.Special education or like services, regardless of: the type ofeducation, the purpose of the education, their recommendation ofthe attending physician or the qualification of the individualrendering the educational services;

15. Rest cures or Custodial care;

16. Speech therapy, other than charges for speech therapy that isexpected to restore speech to a person who has lost existingspeech function (the ability to express thoughts, speak words andform sentences) while eligible in the Plan and as the result of adisease or Non-Occupational Accidental Bodily Injury. Speechtherapy to improve speech in the absence of disease orNon-Occupational Accidental Bodily Injury (such as for a learningdisability or speech delay) is considered special education and isnot covered;

17. Supplies or equipment for personal hygiene, comfort orconvenience;

18. Services, treatment or care rendered by a member of the EligibleEmployee's family;

19. Treatment or services for or in connection with marriage, family,child, career, social adjustment, pastoral, or financial counseling;

20. Treatment or services for primal therapy, rolfing, psychodrama,megavitamin therapy, bioenergetic therapy, vision perceptiontraining, or carbon dioxide therapy except as previously providedfor;

21. Charges incurred for travel, whether or not recommended by aphysician.



22. Treatment to improve fertility such as artificial insemination, invitro fertilization, or embryo transfer process or infertility.

23 Expenses for services related to sex transformations or sexualdysfunctions or inadequacies (including impotency), other thandiagnosis and treatment of organic impotency.

24 Voluntary acceptance of extraordinary risks such as speedcontests or fighting.

Subrogation and Reimbursement

A. Plan's Rights to Subrogation and Reimbursement.

The Plan shall be entitled to subrogation or to seek reimbursement with regardto all rights of recovery of an Eligible Person or representatives, guardians,beneficiaries, fiduciaries, trustees, estate representatives, heirs, executors,administrators of any special needs trusts, and any other agents, persons or entitiesthat may receive a benefit on behalf of the Individual (collectively, for purposes of thissection, "Individual"), to the extent of any amounts which the Plan has paid or maybecome obligated to pay on account of any claim against any person, organization orother entity in connection with the injury, sickness, accident or condition to which theclaim relates ("Source"). A Source includes, but is not limited to, a responsible partyand/or a responsible party's insurer (or self-funded protection), no fault protection,personal injury protection, medical payments coverage, financial responsibility,uninsured or underinsured insurance coverages and any employer of a Participantunder the provisions of a Worker's Compensation or Occupational Disease Law, or anyindividual policy of insurance which is maintained by an Individual. The Plan shall alsobe entitled, to the extent of payments made or to be made on account of the claim, toreimbursement from the proceeds of any settlement, judgment or payments from anySource that may result from the exercise of any rights of recovery by the Individual.Such subrogation and reimbursement rights shall apply on a priority, first dollar basisto any recovery whether by suit, settlement or otherwise, whether there is a partial orfull recovery and regardless of whether an Individual is made whole and shall apply toany and all amounts of recovery regardless of whether the amounts are characterizedor described as medical expenses or as amounts other than for medical expenses.Once the Plan makes or is obligated to make payments on behalf of an Individual onaccount of the claim, the Plan is granted, and the Individual consents to, an equitablelien by agreement or a constructive trust on the proceeds of any payment, settlementor judgment, received by the Individual from any Source.

B. Action Required of Eligible Person.

If requested in writing by the Trustees, the Individual shall take, through anyrepresentatives designated by the Trustees, such action as may be necessary or



appropriate to recover payments made or to be made by the Plan from any Source andshall hold that portion of the total recovery from any Source which is due for paymentsmade or to be made in trust for the benefit of the Plan to be paid to the Planimmediately upon recovery thereof. The Individual shall not do anything to impair,release, discharge or prejudice the rights referred to in this section. The Individualshall assist and cooperate with representatives designated by the Plan to recoverpayments made by the Plan and shall do everything that may be necessary to enablethe Plan to exercise its subrogation and reimbursement rights described herein.The Trustees may also require the Individual to execute a Subrogation andReimbursement Agreement ("Agreement") in a form provided by and acceptable to theTrustees, as a condition to receiving benefits for a claim. The Plan has the right tosuspend all benefit payments if the Agreement is not executed by the Individual(s) orif the Agreement is modified in any way by the Individual without the consent of thePlan. However, in its sole discretion, if the Plan advances claims payments in theabsence of an Agreement, or if the Plan advances claims payments in error, saidpayments will not waive, compromise, diminish, release, or otherwise prejudice any ofthe Plan's rights to reimbursement or subrogation. If the Individual is a minor orincompetent to execute the Agreement, that person's parent, the Participant (in thecase of a minor Dependent child), the Participant's spouse, or legal representative (inthe case of an incompetent adult) must execute the Agreement upon request of thePlan. An Individual must comply with all terms of the Agreement, including theestablishment of a trust for the benefit of the Plan. In this regard, the Individualagrees that the amount the Plan has advanced or is obligated to advance in benefitsreceived from any Source will be immediately deposited into a trust for the Plan'sbenefit and the Plan shall have an equitable lien by agreement which shall beenforceable under legal, equitable and/or injunctive action to ensure that theseamounts are preserved and not disbursed. The Plan's subrogation and reimbursementrights shall apply regardless whether the Individual executes an agreement.

C. Enforcement of Rights.

The Plan has the right to recover amounts representing the Plan's subrogation andreimbursement interests under this section through any appropriate legal or equitableremedy, including, but not limited to the initiation of a recognized cause of actionunder ERISA section 502(a)(3), including injunctive action to ensure the claim paymentamounts that the Plan has advanced are preserved and not disbursed, or any otherapplicable federal or state law; the imposition of a constructive trust or the filing of aclaim for equitable lien by agreement against any recipient of monies recovered fromany Source, whether through settlement, judgment or otherwise. The Plan'ssubrogation and reimbursement interests, and rights to legal or equitable relief takepriority over the interest of any other person or entity.

The Plan's equitable lien by agreement imposes a constructive trust upon the assetsreceived as a result of a recovery by the Individual, as opposed to the general assets



of the Individual. Enforcement of the equitable lien by agreement does not requirethat any of these particular assets received or identifiable amounts be traced to aspecific account or other destination after they are received by the Individual.Further, in the event an Individual receives monies as the result of an injury, illness,sickness, accident or condition and the Plan is entitled to such monies in accordancewith this section and is not reimbursed the amount it has paid for such injury, illness,sickness, accident or condition, the Plan shall have the right to reduce future paymentsdue to such Individual or the Employee of whom such Individual is a Dependent or anyother Dependent of such Employee by the amount of benefits paid by the Plan. Theright of offset shall not, however, limit the rights of the Plan to recover such monies inany other manner described in this section.

D. Participant's or Dependent's Attorney's Fees.

The Plan's subrogation and reimbursement rights apply to any recovery by theIndividual without regard to legal fees and expenses of the Individual. The Individualshall be solely responsible for paying all legal fees and expenses in connection with anyrecovery for the underlying injury, illness, sickness, accident or condition, and thePlan's recovery shall not be reduced by such legal fees or expenses, unless theTrustees, in their sole discretion, have agreed in writing to discount the Plan's claim byan agreed upon amount of such fees or expenses.

E. Disavowal of Common Law Defenses.

The Plan specifically disavows any claims that an Individual may make under anyfederal or state common law defense, including, but not limited to, the common funddoctrine, the double-recovery rule, the make-whole doctrine or any similar doctrine ortheory, including the contractual defense of unjust enrichment. This means that thePlan's subrogation and reimbursement rights apply on a priority, first-dollar basis toany recovery of the Individual from any Source without regard to legal fees andexpenses of the Individual and the Individual will be solely responsible for paying alllegal fees and expenses. It also means that the Individual grants and priority firstdollar security, interest and a lien on any recovery received from any Source, whetherby suit, settlement or otherwise, whether there is a full or partial recovery andregardless of whether the amounts are characterized or described as payment formedical expenses or as amounts other than for medical expenses of such injury,sickness, accident or condition.

Offset

In the event any payment is made by the Plan to or on behalf of an Individual who isnot entitled to such payment, the Plan shall have the right to reduce future paymentsdue to such Individual or the Employee of whom such Individual is a Dependent or anyother Dependent of such Employee by the amount of any such erroneous payment.



This right of offset shall not, however, limit the rights of the Plan to recover suchoverpayments in any other manner.


Section XI – Other General Plan Provisions Page 93

SECTION XI

OTHER GENERAL PLAN PROVISIONS

Physical or Dental Examination and Autopsy

The Trustees at their own expense have the right and opportunity to examinethe person of any individual whose Injury or Sickness is the basis of a claim when andas often as it may reasonably require during pendency of claim under the Plan, and tomake an autopsy in case of death, where it is not forbidden by law.

Free Choice of Physician

The covered person has free choice of any physician and the physician-patientrelationship will be maintained.

Workers' Compensation Not Affected

The Plan is not in lieu of and does not affect any requirement for coverage ofWorkers' Compensation insurance.

Time Limits for Filing Claims

The Fund will furnish to the claimant, on request, the forms approved by theTrustees for filing proof of loss covered under this Plan. The Trustees may acceptother written forms as proofs of loss, if in their sole judgement; the written proofscontain complete and credible information as to the occurrence, character and extentof the loss for which the claim is made.

Written proof of expense incurred due to hospital confinement or due to totaldisability must be furnished to the Fund within ninety (90) days after the terminationof the period for which the claim is made. Written proof of other covered expenseincurred must be furnished within ninety (90) days of the date the expense is incurred.Failure to furnish notice or proof of loss within the time period provided in the Plan willnot invalidate or reduce any claim:

1. if it was not reasonably possible to give proof within that time;and

2. if proof is furnished as soon as reasonably possible; and

3. no later than one (1) year from the time proof is otherwiserequired (except this time limit will not apply to a claimant who islegally incapacitated).



4. Medical Savings Benefits must be filed within ninety (90) days ofthe end of the calendar year.

Benefits payable under the Plan for any loss other than Weekly Time LossBenefits will be paid as they accrue and upon receipt of due written proof of loss.Subject to due written proof of loss, Weekly Time Loss Benefits will be paid at thetimes set forth in the applicable benefit provision.

Circumstances That May Result In Loss Of Eligibility Of Benefits

Throughout this booklet the Trustees have tried to bring to your attention thosecircumstances which might lead to a loss of eligibility and to describe any limitations,exclusions, or restrictions applicable to specified benefits.

The Trustees urge you to familiarize yourself with this information, especially asit relates to the requirements which must be met in order to maintain your eligibilityfor benefits.

REMEMBER: You must work the required number of hours or make timelyself-payments in order to maintain your eligibility.

If at any time you are uncertain about how a specific circumstance might affectyour eligibility or benefit coverage, please contact the Plan Office and, if possible, tryto do so before any circumstance arises.

Claims Review & Appeal Procedures

Your Right to Receive an Explanation of and to Ask for Review of an AdverseBenefit Determination

You or your provider must file claims for Plan Benefits with Blue Cross Blue Shield ofIllinois or the Claim processor, TIC International Corporation, collectively the “ClaimsProcessors.”

If you have questions about decisions made on claims or requests for Medical benefits,you can address them by telephone to the Claims processor. Their telephone numberis in the top right hand corner of the first page of the Explanation of Benefits sent toyou by the Claims Processor and on the denial letter notifying you that your claim forbenefits has not been approved.

If you are not satisfied that the Claims Processor's denial of your request for benefitswas proper, ERISA requires that you can ask for review or appeal that "adverse benefitdetermination."



You may designate an Authorized Personal Representative to act on your behalf bynotifying the Plan Office and completing and submitting the form or procedurerequired by the Trustees. Your representative may also act on your behalf bypresenting a power of attorney for health care or other form or procedure required bythe Trustees. If an Authorized Personal Representative is designated, allcorrespondence relating to the claim or subsequent appeal will be sent directly to theAuthorized Personal Representative, unless otherwise specified.

An adverse benefit determination is a denial, reduction or termination of, or a failure toprovide or make payment (in whole or in part) for a benefit, including any denial basedon your eligibility to participate in the Plan and rescissions of health care benefits.

Types of Claims

A. Health Care Claims

Health Care Claims include medical, mental health and substance use disorder,prescription drug, dental, hearing and vision claims.

1. A "pre-service claim" is a claim for a benefit conditioned, inwhole or in part, on obtaining advance approval of medical care.

2. An "urgent care claim" is a claim for medical care or treatmentwhere applying the normal time periods for claims determination couldseriously jeopardize your life or health or your ability to regainmaximum function, or in the opinion of a physician who knows yourmedical condition, would subject you to severe pain that cannot beadequately managed without the care or treatment that you areseeking.

A claim will be found to be an urgent care claim if either (1) a physicianwith knowledge of your medical condition determines that the claim isan urgent care claim or (2) the Plan using the judgment of a prudentlayperson with average knowledge of health and medicine determinesthat it is an urgent care claim.

3. A "post-service claim" is any claim that is not a pre-service claimor an urgent care claim.

4. A "concurrent care claim" is a request to extend the duration or numberof treatments previously approved through a pre-service claim. You mustfollow the review procedure set forth below to appeal or obtain review of anadverse benefit determination on pre-service, post-service urgent care andconcurrent care claims. Except for appeals or requests for review of adversebenefit determinations involving urgent care claims, all appeals or requests for



review must be in writing. You must follow these review procedures before youcan file a civil lawsuit under ERISA to get a court to order the Plan to provideyou with the benefits that you have requested.

B. Loss of Time Claims

C. Death and Dismemberment Claims

Processing Providers for Initial Claims

When a Claim is submitted for Plan benefits, the Claims Processors will determine if theEligible Person is eligible for benefits and will calculate the amount of any benefitspayable. The Plan intends to comply with the claims procedures set forth insection 503 of ERISA.

A. The deadlines for processing the initial determination of a Claim vary asfollows:

1. Health Care Claims will be determined as follows:

(a) Urgent Health Care Claims: within 72 hours of receipt of theClaim.

(b) Pre-Service Health Care Claims: within 15 days of receipt of theClaim.

(c) Post Service Health Care Claims: within 30 days of receipt of theClaim.

(d) Concurrent Care Claims: as soon as possible and in time toreceive a decision before reduction or termination of the benefit.

2. Loss of Time Claims will be determined within 45 days of receiptof the Claim.

3. Other benefit Claims will be determined within 90 days of receiptof the Claim, i.e., Death and Dismemberment.

B. Extension of Initial Determination Period: In some instances, an extension ofthe initial determination period may be requested due to matters beyond the ClaimsProcessor's control. If an extension is necessary, the Eligible Person will be notified.The Claims Processor will notify the Claimant of the extension and the notice willinclude the special circumstances requiring the extension and the date the ClaimsProcessor expects to render a decision, as follows:



1. Pre-Service Health Care Claims: Claimant will be notified withinthe 15-day initial determination period that one 15-day extensionis necessary.

2. Post-Service Health Care Claims: Claimant will be notified withinthe 30-day initial determination period that one 15-day extensionis necessary.

3. Loss of Time Claims: Claimant will be notified within the 45-dayinitial determination period that up to an additional 60 daysmaximum is necessary. However, if a determination is not madewithin the first 75 days, the Claimant will be notified that anadditional 30 days is necessary.

4. Other Benefit Claims: Claimant will be notified within the 90-dayinitial determination period that up to an additional 90 days maybe necessary. The extension cannot be more than 90 days fromthe end of the initial 90-day period, or 180 days total.

C. When additional information is needed to process a claim, the Claimant will benotified, for:

1. Health Care Claims, within the 15- or 30-day initial determinationperiod. An Eligible Person (or his provider, if his provider isnotified) has up to 45 days to provide the requested information.If the Claims Processor receives the requested information in the45-day period, the Claim will be processed within 15 daysfollowing the receipt of the additional information. For an UrgentCare Claim, the deadline for additional information is as soon aspossible but within 24 hours of the receipt of the Claim. TheClaims Processor must notify the Eligible Person of the specificinformation needed and the Eligible Person has at least 48 hoursto provide the information.

2. Claims for Loss of Time Benefits, within the 45 day initialdetermination period. The Claimant has up to 45 days to providethe requested information.

3. Other benefit Claims, within the 90-day initial determinationperiod. The 90-day extension of initial determination period listedabove includes any time needed by the Claims Processor to obtainthis information.



D. If a Claim is denied, in whole or in part, the Claims Processor will send theclaimant a written notice of the Adverse Benefit Determination that includes thefollowing information:

1. For Health Care Claims except Dental and Vision Benefits:

(i) information sufficient to identify the Claim including: dateof service; provider; Claim amount; the denial codes andtheir respective meanings: a description of any standardused in determining the denial;

(ii) a provision stating that diagnosis and treatment codes andtheir corresponding meanings are available upon requestwithout charge, and disclosure of the availability of,

(iii) notice that the Claimant may request an external reviewwith an independent review organization after the Plan'sClaims procedure has been exhausted; and

(iv) contact information for, any applicable ombudsmanestablished under the Affordable Care Act to assistindividuals with the internal Claims and appeals andexternal review processes;

2. The specific reason or reasons the Claim was denied;

3. Reference to the specific Plan provisions on which the denial wasbased;

4. A description of any additional information that the Eligible Personwill need to submit in support of his Claim and an explanation ofwhy the additional information is needed;

5. An explanation of the Plan’s Claim review procedures andapplicable time limits;

6. Copy of any internal rule, guideline, protocol or similar criteria thatwas relied on, or the notice will include a statement that a copy isavailable at no cost upon request if relevant to a Health CareClaim or Loss of Time Claim;

7. Copy of the scientific or clinical judgment, or the notice willinclude a statement that a copy of the scientific or clinicaljudgment is available to a Covered Individual at no cost uponrequest; and



8. A statement of the Eligible Person’s rights under ERISA to bring acivil action and the associated timeframes.

Claim Appeal Procedure

A. Request for Appeal. If you disagree with the Claims Processor's decision on yourclaims, you, or your Authorized Representative, have the right to appeal to theTrustees.

To start the review, you, or your authorized representative, must send a writtenstatement to the Plan Office explaining why you disagree with the Plan's adversebenefit determination to the following address:

IBEW Local No. 461 Welfare Fund6525 Centurion DriveLansing, MI 48917

The mailing address also is found at the top of the first page of your Explanation ofBenefits form and in the letter we send notifying you that the Plan has not approved abenefit or service that you have requested.

You must include in your request all documents, records or comments that you believesupport your position. You must request review of denied Health and Loss of TimeClaims no later than one hundred eighty (180) calendar days after you receive thePlan's decision on your claim for benefits. You must request review of denied Deathand Dismemberment Benefits no later than sixty (60) calendar days after you receivethe Plan's decision on your claim for benefits.

For urgent care claims you or your physician may submit your request for an internalreview orally or in writing. If you choose to submit your request for review orally,please call: (866) 461-4329.

B. Timeframes for Review Appeals

1. Urgent Care Claims. The Trustees will provide you with their decision assoon as possible, taking into account the medical exigencies, but notlater than seventy-two (72) hours after receipt of your request forreview. All necessary information, including the decision on review, willbe transmitted to you or to your authorized representative bytelephone, facsimile, or other available similarly expeditious method. Ifthe decision is communicated orally, you or your authorizedrepresentative will also receive written confirmation of the decisionwithin two (2) business days.



2. Pre-Service Claims. The Plan will notify you of the decision within areasonable period of time appropriate to the medical circumstances, butnot later than 30 days of receiving the appeal request.

3. Post-Service and Loss of Time Claims. Properly filed appeals for post-service Health Care Claims, eligibility Claims and Loss of Time Claimswill be reviewed at the next regularly scheduled appeals meeting of theTrustees, who meet at least quarterly. However, if the request forreview is received within thirty (30) days of the next regular meeting,the request for review will be considered at the second regularlyscheduled meeting following receipt of the request. If specialcircumstances require a further extension of time for processing, adetermination will be made at the third regularly scheduled meetingfollowing receipt of the request for review. Prior to the start of theextension, the Claimant will be advised in writing in advance if thisextension will be necessary, and will be notified of the specialcircumstances and the date by which a determination will be made.Once the decision has been made, the Trustees will mail their decisionto the Eligible Person within five (5) business days after making thedetermination.

Notice of Appeals Decision

When the Plan notifies a Claimant of its decision on a Claim on appeal, it must provide:

1. For a Health Care Claim except Dental and Vision Claims:

(a) information sufficient to identify the Claim involved,including: date of service; provider; Claim amount; andany denial codes and their respective meanings;

(b) a description of any standard used to determine thedenial;

(c) a provision stating that diagnosis and treatment codes andtheir corresponding meanings are available upon requestwithout charge;

(d) for a Health Care Claim based on medical judgement, astatement that the Eligible Person has the right to requestan external review from an independent revieworganization after the Plan's Claims appeal procedureshave been exhausted; and



(e) disclosure of the availability of, and contact informationfor, any applicable ombudsman established under theAffordable Care Act to assist individuals with the internalClaims and appeals and external review processes forHealth Care Claims.

2. The specific reason or reasons for its decision;

3. Reference to the specific Plan provisions on which thedetermination was based;

4. An explanation of the basis for the adverse benefit determination;

5. A statement that the Claimant is entitled to receive, upon requestand free of charge, reasonable access to and copies of, alldocuments, records, and other information relevant to theClaimant's Claim for benefits;

6. A statement describing any further appeal procedures offered bythe Plan including the Claimant's right to obtain the informationabout such procedures;

7. Copy of any internal rule, guideline, protocol or similar criteria thatwas relied on or a statement that a copy is available at no costupon request if relevant to a Health Care Claim or Loss of TimeClaim;

8. A statement that a copy of the scientific or clinical judgment isavailable to the Claimant at no cost upon request if relevant to aHealth Care Claim or a Loss of Time Claim that is denied due to amedical judgement; and

9. A statement that if the Eligible Person's appeal is denied, he orshe has the right to initiate a lawsuit under ERISA section 502(a).Any lawsuit must be initiated within twelve months of the denialon appeal.

Full and Fair Review

In addition to the information found above, the following requirements apply:

1. No fees or costs may be imposed as a condition to requestingreview.



2. Although there are set timeframes within which you must receivethe final determination on your claim, you have the right to allowadditional time if you wish.

3. You will be provided, upon request and free of charge, reasonableaccess to, and copies of, all documents, records, and otherinformation relevant to your claims for benefits.

4. For Health Care claims except Dental and Vision Claims, you willautomatically be provided any new or additional informationconsidered, relied upon or generated during the appeal as well asany new or additional rationale for the denial, if any.

5. You may submit written comments, documents, records, andother information relating to your claim for benefits, and thisinformation will be considered even if it was not submitted orconsidered in the initial benefit determination.

6. The person who reviews your adverse benefit determination willbe someone other than the person who issued the initial adversebenefit determination. The determination on review will be a newdetermination; the initial determination on your claim will not beafforded deference on review.

7. For Health Care Claims and Loss of Time Claims, if your requestfor review involves an adverse benefit determination that is basedin whole or in part on a medical judgment, including whether aparticular treatment, drug or other item is experimental,investigational, or not medically necessary or appropriate, a healthcare professional who has appropriate training and experience inthe field of medicine involved in the medical judgment will beconsulted.

8. For Health Care Claims and Loss of Time Claims, upon request,the medical experts whose advice was obtained in connection withthe adverse benefit determination will be identified, even if theiradvice was not relied upon in making the determination.

External Review of Denied Health Care Claims

The Plan offers claimants the right to request an external review in accordance with,and to the extent required by, available guidance issued by the Departments of Healthand Human Services and Labor and the Internal Revenue Service. Only Health CareClaims (except Dental and Vision Claims) that were denied based on medicaljudgment and rescissions of benefits are eligible for external review. Dental Claims,



Vision Claims, Loss of Time Benefits and all other welfare benefit claims are not eligiblefor external review.

If a claimant wants to have the denied Health Care Claim or rescission reviewed, theclaimant must send a written request for an external review to the Plan no later thanfour months after the date the claimant receives the notice of denial or rescission. Anyclaimant filing a timely request for review may submit additional materials forconsideration on review, including a written explanation of and comments on theissues.

Further Action

In the event a claim for benefits has been denied, no lawsuit or other action againstthe Plan or its Trustees may be filed until the matter has been submitted for review inaccordance with the claims appeal provisions. Further, in the event a claim has beensubmitted for review in accordance with such procedures and the claim has again beendenied, no lawsuit or other action against the Plan or its Trustees may be filed after 12months from the date the Eligible Person has been given written notice of theTrustees' decision on his appeal.

If the time limitation in this section of the Plan is less than that required by law, suchlimitation is hereby extended to conform to the minimum period permitted by law.

Coordination of Benefits With Other Group Plans - How Benefits AreReduced

To alleviate the problem of excess coverage, which needlessly increases thecosts of protection, all the Plan benefits will be coordinated with the followingcoverage, each an "Other Plan":

1. Individual, group, blanket, franchise, general liability, automobilecommon carrier insurance coverage; or

2. Hospital or medical service organizations, group practice, andother prepayment coverage; or

3. Any coverage under any labor-management trusted plans, unionwelfare plans, employer organization plans or employee benefitorganization plans; or

4. Any coverage under governmental programs or any coveragerequired or provided by any statute.



How It Works

The Plan will determine if it pays before or after the Other Plan according to the rulesdescribed below. If the Plan pays primary, or "first," you will be paid medical, dentalor vision benefits in the amount payable pursuant to the terms of this SPD after allapplicable exclusions, limitations and adjustments are applied. If the Other Plan paysfirst, the Plan will pay benefits up to the amount that the Plan would have paid had thePlan paid first, up to 100% of the total allowable expenses. However, the Plan willnever pay benefits (a) in excess of the amount permitted by the applicable exclusions,limitations and adjustments of the applicable benefit program or (b) which, whencombined with amounts payable by the Other Plan, exceed 100% of the billed charges.You may be responsible to pay the provider any remainder of the claim.

The Eligible Person must claim benefits due from the "primary" plan determined bythese rules for its share of eligible expenses, including benefits or services availablefrom prepayment coverage programs such as Health Maintenance Organizations.When this Plan is "secondary" according to the established order of benefitdetermination, benefits payable under the Other Plan includes the benefits that wouldhave been paid if the Eligible Person made a proper claim on the Other Plan or used itsservices. This Plan's liability and its benefit payments will not increase simply becausethe Eligible Person elects not to use the "primary" coverage.

Benefit Determination

The Plan will coordinate benefits with all Other Plans providing coverage to theEligible Person for all claims. The Plan will determine the order of benefit payments asfollows:

1. When the Other Plan does not have a provision for Coordinationof Benefits, they must be considered the primary carrier and mustmake benefit payment first before this Plan will consider payment.

2. When the other group plan does have a provision for Coordinationof Benefits, the order of benefit payments will be determined bythe rules set forth below.

3. If you elect to make COBRA self-payments under this Plan whileyou are also covered by an Other Plan, the Other Plan will payfirst and this Plan's COBRA coverage will pay second.

Claim for a Covered Employee

The Plan covering the employee as an active employee the longest will payprimary. If the employee has retiree coverage through another plan, the active plan isprimary.



When Claim is on the Dependent Spouse

If the Participant's spouse works and is eligible for coverage through his or heremployer (a plan in which the employer contributes some or all of the premiums), thenhis or her plan is primary and the Plan will be secondary for all the spouse's medicalclaims.

When Claim is for a Dependent Child

The Trustees have adopted, in principle, the coordination provision known asthe "birthday rule." The "birthday rule" provides that for claims involving children, theorder of benefit payments will be as follows:

1. The plan covering the parent whose birthday occurs earliest in thecalendar year will pay first.

2. The plan covering the parent whose birthday occurs later in thecalendar year, and having a provision for Coordination of Benefits,will pay second.

If there is a divorce and/or remarriage, the financial and medical responsibilityis generally stipulated by court decree. Participants are required to submit legaldocuments that are requested by the Plan Office so that the order of benefitdetermination can be established. Contact the Plan Office for further information.

Obtaining and Releasing Information

Without the consent of or notice to any person, the Plan may obtain or releaseinformation with respect to any person when the Plan considers it necessary to do soto apply and implement this Coordination of Benefits provision (or a provision of similarpurpose pursuant to the Other Plan). Any person claiming benefits through the Planmust furnish the Plan with any such information that may be needed for this purpose.

Facility of Payment

Whenever the Plan determines that a payment made by the Other Plan shouldhave been made by the Plan, in accordance with this Coordination of Benefitsprovision, the Plan may, in its sole discretion, pay to the organization making thatpayment any amount the Plan determines is warranted to satisfy the intent of thisprovision. Any amount so paid will be considered a benefit paid by the Plan and willrelease the Plan from further liability for that amount.



Right of Recovery

Whenever the Plan determines that payments it made exceed the maximumamount of payment required to satisfy the intent of this Coordination of Benefitsprovision, the Plan, in its discretion, may recover the excess paid from any person to,for or with respect to whom those payments occurred or from any insurance companyor any other organization.

Coordination of Benefits with Medicare

Retirees

If you are not active under Class A or Class B eligibility when you or yourDependent becomes eligible for Medicare in addition to this Plan, the Trustees requirethat you and/or your Dependent to enroll in Medicare Part A & B. This applies whenyou are retired due to attained age or to a qualifying disability.

Effect on Benefits

When a person is eligible in this Plan as a retiree or a Dependent of retiree, andalso eligible for Medicare, Medicare will be primary. Benefits payable by this Plan willbe reduced by the amount Medicare pays, but only if the total of this Plan's normalbenefits and Medicare's payment will be more than one hundred (100%) percent ofeligible expenses.

Once retired, you or your Dependent will be considered to be currently eligibleand covered by Medicare as soon as you would be eligible to enroll whether or not youactually enroll as you should.

The Plan will remain the primary payer of benefits to the end of the quarter ofMedicare entitlement.

Limitations

To comply with Federal regulations, the provision will not apply to an Employeewho is still eligible in this Plan due to Employer contributions or to the spouse of suchan Employee.

Medicare will always be required to pay first when eligible expenses areincurred by:

1. Retired Employees and their Dependents (except for the end ofthe quarter of entitlement); or



2. Employees eligible for Medicare on the basis of permanent kidneyfailure, after the first thirty (30) months of treatment.

Active Employees and/or Their Spouses Who Are Eligible for Medicare

If you are an Active Employee and continue to work beyond the date you oryour spouse become eligible for Medicare at age sixty-five (65), the Plan will remainthe primary payer of benefits. Additionally, the Plan will remain the primary payer ofbenefits for any Active Employee and/or your covered family members who are eligiblefor Medicare due to a disability.

Claims for the Eligible Persons affected by this provision are considered primaryto the Plan first. Any portions not paid should then be submitted to Medicare forpayment. In those cases where Medicare and the Plan cover the same items orservices, the Plan will pay first up to its limits and then Medicare will supplement thePlan's coverage up to the Medicare limits. In some instances, only the Plan willprovide coverage for some items.

Covered persons affected by this provision are advised to pay the premium forPart B (Medical) coverage through Medicare. This assures the most complete coveragefor medical expenses and is required to qualify for participation in certain programsavailable through the Plan.

The requirement for the Plan to pay primary to Medicare ends when you ceaseto meet the definition of an Active Employee. At that time, Medicare automaticallybecomes the primary payer.

If for some reason you or your spouse would rather have Medicare as theprimary payer, you must drop Plan coverage by stating this preference in writing to thePlan Office when you become eligible for Medicare. Regardless of your election, youshould not forget to pay the Part B Medicare premium for medical services for yourown protection. Failure to pay the Part B premium on time will result in the loss ofMedicare protection for medical services. You are considered active until you cease toapply for active employment.


Section XII – Statement of Participant's Rights Page 109

SECTION XII

STATEMENT OF PARTICIPANT'S RIGHTS

Introduction

You have probably heard about ERISA. ERISA stands for the EmployeeRetirement Income Security Act, which was signed into law in 1974.

This federal law establishes certain minimum standards for the operation ofemployee benefits plans including the IBEW Local No. 461 Welfare Fund. The Trusteesof your Plan, in consultation with their professional advisors, have reviewed thesestandards carefully and intend to comply with ERISA.

ERISA requires that Plan participants and beneficiaries be provided with certaininformation about their benefits, how they may qualify for benefits, and the proceduresto follow when filing a claim for benefits. This information has been presented in thepreceding pages of this Summary Plan Description.

ERISA also requires that participants and beneficiaries be furnished with certaininformation about the operation of the Plan and about their rights under the Plan. Thisinformation follows:

READ THIS SECTION CAREFULLY. Only by doing so can you be sure thatyou have the information you need to protect your rights and your best interests underthis Plan.

As a Participant in the Plan, you are entitled to certain rights and protectionsunder the Employee Retirement Income Security Act of 1974 (ERISA).

ERISA provides that all plan participants shall be entitled to the following:

Receive Information About Your Plan and Benefits

Examine without charge at the Plan Administrator's office and at other specifiedlocations such as work sites and union halls, all documents governing the plan,including insurance contracts, collective bargaining agreements, and a copy of thelatest annual report (Form 5500 series) filed by the plan with the U.S. Department ofLabor and available at the Public Disclosure Room of the Employee Benefits SecurityAdministration.

Obtain, on written request to the Plan Administrator, copies of documentsgoverning the operation of the plan, including insurance contracts, collectivebargaining agreements, and copies of the latest annual report (Form 5500 series) and



updated summary plan description. The Plan Administrator may make a reasonablecharge for the copies.

Receive a summary of the plan's annual financial report. The Plan Administratoris required by law to furnish each participant with a copy of this summary annualreport.

You also have the right to

Continue health care coverage for yourself, spouse, or Dependents if there is aloss of coverage under the plan as a result of a qualifying event under COBRA. You oryour Dependents will have to pay for such coverage. Review this summary plandescription and the documents governing the plan for the rules governing your COBRAcontinuation coverage rights.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for plan participants, ERISA imposes duties on thepeople who are responsible for the operation of the plan. The people who operate theplan, called "fiduciaries," have a duty to do so prudently and in the interest of you andother plan participants and beneficiaries. No one, including your employer, your union,or any other person, may fire you or otherwise discriminate against you in any way toprevent you from obtaining a benefit or exercising your ERISA rights.

Enforce Your Rights

If your claim for a benefit is denied or ignored, in whole or in part, you have aright to know why this was done, to obtain copies of documents relating to thedecision without charge, and to appeal any denial, all within certain time schedules.Under ERISA, there are steps you can take to enforce your ERISA rights. For instance:

If you request a copy of plan documents or the latest annual reportfrom the Plan and do not receive them within 30 days, you may file suitin a federal court. In such a case, the court may require the PlanAdministrator to provide the materials and pay you up to $110 a dayuntil you receive the materials, unless the materials were not sent forreasons beyond the control of the Plan Administrator.

If you have a claim for benefits that is denied or ignored, in whole or inpart, after going through the appeals procedures, you may file suit in astate or federal court.

If you disagree with the plan's decision or lack of response to yourrequest concerning the qualified status of a qualified medical childsupport order (QMCSO), you may file suit in federal court.



If it should happen that plan fiduciaries misuse the plan's money, or ifyou are discriminated against for asserting your ERISA rights, you mayseek assistance from the U.S. Department of Labor, or you may file suitin a federal court.

If you file suit against the plan, the court will decide who should paycourt costs and legal fees. If you are successful, the court may orderthe person you sued to pay these costs and fees. If you lose, the courtmay order you to pay these costs and fees – if, for example, it findsyour claim is frivolous.

Each Participant also has a right to receive from the Plan Administrator, a copyof the Plan's procedures regarding qualified medical child support orders (QMCSOs)without charge.

Assistance with Your Questions

If you have any questions about the plan, you should contact the PlanAdministrator. If you have any questions about this statement or about your rightsunder ERISA, or if you need assistance in obtaining documents from the PlanAdministrator, you should contact the nearest office of the Employee Benefits SecurityAdministration, U.S. Department of Labor, listed in your telephone directory or theDivision of Technical Assistance and Inquiries, Employee Benefits SecurityAdministration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington,DC 20210.

You may also obtain certain publications about your rights and responsibilitiesunder ERISA by calling the Employee Benefits Security Administration BrochureRequest Line at 1-800-998-7542, on the Internet athttp://www.dol.gov/dol/ebsa/public/pubs/main.htm, or by contacting the EBSA fieldoffice nearest you.

Nothing in this statement is meant to interpret or extend or change in any waythe provisions expressed in the Plan. The Trustees reserve the right to amend, modifyor discontinue all or part of this Plan whenever, in their judgment, conditions sowarrant. Participants will be notified of any plan changes.


Section XIII – Other Important Information Page 113

SECTION XIII

OTHER IMPORTANT INFORMATION

The Trustees Interpret the Plan

Under the Trust Agreement creating the Welfare Fund, and the terms of thisPlan, the Board of Trustees have the sole authority to make final determinationsregarding any application for benefits and the interpretation of the Plan and anyadministrative rules adopted by the Trustees. The Trustees have full discretionaryauthority to interpret and construe the Plan, all Plan Documents, the Trust Agreement,and all Plan rules and procedures. The Trustees interpretation will be given themaximum deference permitted by law for the exercise of such full discretionaryauthority. The Trustees' decisions in such matters are final and binding on all personsdealing with the Plan or claiming a benefit from the Plan. If a decision of the Trusteesis challenged in court, it is the intention of the parties to the Plan, and the Welfare Planprovides, that such decision is to be upheld unless it is determined to be arbitrary orcapricious.

Any interpretation of the Plan's provisions rests with the Board of Trustees. Noemployer or union, nor any representative of any employer or union, is authorized tointerpret this Plan on behalf of the Board nor can an employer or union act as an agentof the Board of Trustees.

However, the Board of Trustees has authorized the Administrative Manager andthe Plan Office staff to handle routine requests from Participants regarding eligibilityrules, benefits, and claims procedures. But, if there are any questions involvinginterpretation of any Plan provisions, the Administrative Manager will ask the Board ofTrustees for a final determination.

The Plan Can Be Changed

The Trustees have the legal right to change the Plan, subject to any collectivebargaining agreement that applies to it.

Although the Trustees hope to maintain the present level of benefits and toimprove upon them if possible, a primary concern of the Trustees is to protect thefinancial soundness of the Plan at all times. To do so may require Plan changes fromtime to time.

Changes in the Plan may also be required in order to preserve the Fund's taxexempt status under Internal Revenue Service rules and regulations. These rules andregulations may change and as a result, Trustees may find it necessary to change Planprovisions so that the Trust does not lose its tax exempt status.



No Guarantee of Coverage

None of the benefits provided by the Plan are guaranteed by the Trustees, anyparticipating Employer, Union or any other individual or entity. The Plan's benefitsoriginate only from Plan assets collected and available for such purposes. The Boardof Trustees reserves the right to interpret, amend, modify or terminate all or a part ofthis SPD and other Plan documents and to take any action it deems appropriate topreserve the financial stability of the Plan.

Your Plan is Tax Exempt

Your Welfare Plan is classified by the Internal Revenue Service as a 501(c)(9)Trust. This means that the employers contributions to the Trust are tax deductible andare not included as part of your income. Also, in most cases, the benefits paid on yourbehalf are not taxable as personal income and investment earnings on Plan assets areexcluded as taxable income of the Trust since they are specifically set aside for thepurpose of providing benefits to participants.

Right to Receive and Release Necessary Information

To determine the applicability of and to implement the terms of this Plan or thesimilar terms of any other plan, the Plan will not, without consent, notice and signedauthorization to any covered person, release to or obtain from any insurance companyor other organization or individual, any information, with respect to any coveredperson which is considered individually identifiable protected health information unlesssuch information is deemed necessary for payment of medical claims.

Facility of Payment

Whenever payments which should have been made under this Plan inaccordance with its provision have been made under any other plans, the Plan shallhave the right, exercisable alone and at its sole discretion, to pay any organizationmaking such other payments any amounts it shall determine to be warranted.

If any Plan benefits become payable to the estate of an eligible person or to aneligible person or Beneficiary who is a minor or otherwise not competent to give a validrelease, the Plan may pay up to one thousand dollars ($1,000) in benefits to thatperson's relative by blood or connection by marriage who the Trustees find is equallyentitled thereto.

Any payment made by the plan in good faith under this provision shall fullydischarge the Plan to the extent of such payment.



Right of Recovery

Whenever payments have been made by the Plan with respect to allowableexpenses in excess of the maximum amount of payment necessary at the time tosatisfy its provisions, the Plan shall have the right to recover such payments, to theextent of such excess, from among one or more of the following as the Plan shalldetermine:

1. Any individual to whom or from whom such payments were made; or

2. Any insurance company, hospital, physician or any other organization.

The Plan may also recover such excess payments by reducing future benefitpayments, if any, which become due a Participant, Dependent or Beneficiary.

Payment of Claims

Indemnity for loss of life will be payable in accordance with the beneficiarydesignation and the provisions respecting such payment which are prescribed hereineffective at the time of payment. Any other accrued indemnities unpaid at theEmployee's death may, at the option of the Trustees, be paid either to the beneficiaryor to the estate.

Subject to any written direction of the Employee, all or a portion of anyindemnities provided by the Plan for services rendered by a hospital, nursing, medical,surgical, dental or vision service may, at the Trustees' option, and unless the Employeerequests otherwise in writing no later than the time for filing proof of loss, be paiddirectly to the hospital or provider of services.

IMPORTANT PLAN INFORMATION

Name of the Plan

The Plan is the IBEW Local No. 461 Welfare Fund.

Type of Plan

This Plan provides Health Care Benefits for expenses due to hospitalization,surgery, medical treatment, vision or dental care. This Plan also provides benefits forDeath and Dismemberment and Weekly Loss of Time.

Plan Sponsor, Administrator and Named Fiduciary

The Board of Trustees is the Plan Sponsor, Plan Administrator and the namedfiduciary.



Type of Plan Administration

The Administrator is responsible for carrying out the Trustees' policy decisions,record keeping, and accounting.

The Trustees have delegated certain administrative responsibilities to aprofessional Third Party Administrator, TIC International Corporation. TICInternational is responsible for the payment of claims, coordination of benefits,maintains Participant census information and performs other routine activities underthe direction of the Trustees.

Agent for Service of Legal Process

Bennett E. ChoiceReinhart Boerner Van Deuren, s.c.1000 North Water Street, Suite 1700Milwaukee, WI 53202(414) 298-1000(414) 298-8097 (Fax)

Service of legal process may also be made upon any Plan Trustee.

Name and Address of Administrative Manager (Claims and EligibilityInquiries)

TIC International Corporation6525 Centurion DriveLansing, MI 48917-9275(517) 321-7502(866) 461-4329 (IBEW)(517) 321-7508 FAX

Name and Address of Member Assistance Program (MAP)

Employee Resource Systems, Inc.29 East Madison Street, Suite 1600Chicago, IL 60602(800) 292-2780



Name and Address of Preferred Provider Organization

Blue Cross Blue Shield of IllinoisPO Box 1364Chicago, IL 60601Claim Inquiry (800) 571-1043www.bcbsil.com

Name and Address of Prescription Drug Vendor

Sav-RX224 North Park AvenueFremont, NC 68025(877) 728-7910

Name and Title of Each Trustee

The Trustees of this Plan are:

Union Trustees

Joel Pyle, II, SecretaryIBEW Local 461591 Sullivan Road, Suite 100Aurora, IL 60506

Michael AngeloIBEW Local 46127 Julius CourtYorkville, IL 60560

Steve Musich2188 North 4350th RoadSheridan, IL 60551

Mark Seppelfrick1375 Chestnut CircleYorkville, IL 60560

Management Trustees

Bruce Anderson, ChairmanFrank Marshall Electric, Inc.1043 Oliver AvenueAurora, IL 60506

Tim Assell1556 Crescent Lake DriveMontgomery, IL 60538

Craig MartinFrost Electric Company, Inc.749 Morton AvenueAurora, IL 60506

Thomas J. CookValley Electrical Contractors, Inc.P.O. Box 461Oswego, IL 60543



Name and Address of Local Union Office

IBEW Local No. 461 Welfare Fund591 Sullivan Road, Suite 100Aurora, IL 60506Telephone: (630) 897-0461Facsimile: (630) 897-7605 FAX

Parties to the Collective Bargaining Agreement

The Plan is established and maintained under the terms of a collective bargainingagreement. This agreement sets forth the conditions under which participatingEmployers are required to contribute to your Plan.

The parties to the collective bargaining agreement are:

Local Union Number 461,International Brotherhood of Electrical Workers

AndNortheastern Illinois Chapter of the National Electrical Contractors Associations, Inc.,

Internal Revenue Service Employer and Plan Identification Numbers

The Employer Identification Number (EIN) issued to the Board of Trustees is36-2514448 the Plan Number is 501.

Eligibility Requirements

The Plan's requirements with respect to eligibility for benefits are shown in theEligibility Rules in the Eligibility Section of this Document. Circumstances which maycause you to lose eligibility are explained in the Eligibility Rules in the Eligibility Sectionof this Document.

Sources of Trust Fund Income

Sources of Trust Fund income include Employer contributions, Employeeself-payment of contributions and investment earnings. All Employer contributionspaid to the Trust Fund are subject to the provisions in the collective bargainingagreement between the Union and the Employer Association; or are subject to aseparate individual collective bargaining agreement with the Union; or are subject to aPlan Participation Agreement for contributions for non-collectively bargainedemployees. Income is also realized from invested assets.



The agreements specify the amount of contribution, due date of Employercontributions, type of work for which contributions are payable and the geographicarea covered by the labor contract.

Method of Funding Benefits

Benefits payable under this Plan are self-funded and paid directly from theaccumulated assets of the Trust Fund. A portion of Plan assets are also allocated forreserves to meet future liabilities and to carry out the objectives of the Plan.

Fiscal Year of the Plan

The financial records of this Plan are based on a fiscal year which begins June 1and ends May 31.

The Plan May be Terminated

Although the Trustees do not foresee that the Plan will be terminated, the TrustAgreement provides that termination may occur when:

1. The Trustees determine that the Trust Fund assets are not adequateto carry out the purpose for which the Welfare Fund is intended; or

2. There is no longer a collective bargaining agreement or other writtenagreement in effect that requires Employer contributions to be madeto the Trust Fund and negotiations for extension thereof have ceased.

The Trustees are obligated to use the Trust Assets for payment of expensesincurred up to the date of termination and expenses related to the termination as theirfirst priority. Remaining assets, if any, must be used to continue Plan benefits afterthe Plan termination date for those persons eligible when the Plan was terminated.

Upon written request, you may examine the agreement at the AdministrationOffice or other specified locations. Or you may request of a copy of the agreementwhich will be provided for a reasonable charge.



NOTICE OF THE PRIVACY PRACTICES OF THEIBEW LOCAL NO. 461 WELFARE FUND

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BEUSED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.PLEASE REVIEW IT CAREFULLY AND CONTACT THE FUND'S PRIVACY OFFICER IF YOUHAVE ANY QUESTIONS.

The IBEW Local No. 461 Welfare Fund ("Plan") is required by the federal HealthInsurance Portability and Accountability Act of 1996 (HIPAA) to make sure that healthinformation that identifies you is kept private to the extent required by law.

The Plan is also required to give you this Notice regarding

1) the Plan's uses and disclosures of Protected Health Information("PHI")

2) your privacy rights with respect to your PHI;

3) the Plan's duties with respect to your PHI;

4) your right to file a complaint with the Plan and the Secretary of theU.S. Department of Health and Human Services; and

5) the person or office to contact for further information about the Plan'sprivacy practices.

The term "Protected Health Information" (PHI) includes all individuallyidentifiable health information transmitted or maintained by the Plan, regardless ofform (oral, written, electronic) and, when applicable, includes "genetic information."De-identified information, which does not identify an individual and that cannotreasonably be expected to be used to identify an individual, is not PHI.

This Notice and its contents are intended to conform to the requirements ofHIPAA. Please be advised that other entities that provide services to you related toyour participation in the Plan have issued or may issue separate notices regardingdisclosure of PHI that is maintained on the Plan's behalf by those entities.

How the Plan May Use and Disclose PHI About You

The following categories describe different ways that the Plan uses anddiscloses PHI. Not every use or disclosure in each category will be listed. However, allof the ways the Plan is permitted to use and disclose information will fall within one ofthe categories. Except for the purposes described in the categories below, we will use



and disclose PHI only with your written authorization. You may revoke suchauthorization at any time by writing to the Plan's Privacy Officer

Uses and Disclosures to Carry Out Treatment, Payment and Health CareOperations

For Payment. The Plan may use and disclose PHI about you for paymentpurposes such as to determine eligibility for Plan benefits, to facilitate payment for thetreatment and services you receive from health care providers, to determine benefitresponsibility under the Plan, or to coordinate Plan coverage. For example, the Planmay tell your health care provider about your eligibility for benefits to confirm whetherpayment will be made for a particular service. The Plan may also share PHI with autilization review or precertification service provider. Likewise, the Plan may share PHIwith another entity to assist with the coordination of benefit payments.

For Health Care Operations. The Plan may use and disclose PHI about youfor Plan operations. These uses and disclosures are necessary to run the Plan. Forexample, the Plan may use PHI in connection with conducting quality assessment andimprovement activities; underwriting, premium rating, and other activities relating toPlan coverage; reviewing and responding to appeals; conducting or arranging formedical review, legal services, audit services, and fraud and abuse detectionprograms; and general Plan administrative activities. The disclosure of PHI that isgenetic information for underwriting purposes is prohibited and the Plan will notdisclose any of your genetic information for such purposes.

To Inform You About Treatment, Treatment Alternatives or OtherHealth Related Benefits. The Plan may use your PHI for treatment purposes andother related benefits. The Plan may use your PHI to identify whether you may benefitfrom communications from the Plan regarding (1) available provider networks oravailable products or services under the Plan, (2) your treatment, (3) casemanagement or care coordination, or (4) recommended alternative treatments,therapies, health care providers, or settings of care. For instance, the Plan mayforward a communication to a Participant who is a smoker regarding a smoking-cessation program.

For Disclosure to the Plan's Board of Trustees. The Plan may discloseyour PHI to the Plan's Board of Trustees (Plan Sponsor) for plan administrationfunctions performed by the Plan Sponsor on behalf of the Plan including, but notlimited to, reviewing appeals. The Plan may use or disclose "summary healthinformation" to the Plan Sponsor for obtaining premium bids or for modifying,amending or terminating the group health plan. "Summary health information" isinformation that summarizes the claims history, claims expenses or type of claimsexperienced by individuals for whom the Plan Sponsor has provided health benefitsunder a group health plan and from which identifying information has been deleted inaccordance with federal regulations.



Business Associates. The Plan may disclose PHI to its business associatesthat perform functions on the Plan's behalf or provide the Plan with services if theinformation is necessary for such functions or services. For example, the Plan may useanother company to perform billing services on its behalf. All of the Plan's businessassociates are obligated to protect the privacy of your information and are not allowedto use or disclose any information other than as specified in their agreement with thePlan.

Other Uses and Disclosures for Which Consent, Authorization or Opportunityto Agree or Object is Not Required

When Legally Required. The Plan will disclose your PHI when it is requiredto do so by any federal, state or local law

For Public Health Activities. The Plan may disclose your PHI for publichealth activities such as the reporting of vital events such as birth or death or thetracking of products regulated by the Food and Drug Administration.

For Reporting Abuse, Neglect or Domestic Violence. The Plan maydisclose your PHI when required by law to report information about abuse, neglect ordomestic violence to public authorities if there exists a reasonable belief that you maybe a victim of abuse, neglect or domestic violence. In such case, the Plan willpromptly inform you that such a disclosure has been or will be made unless that noticewould cause a risk of serious harm. For the purpose of reporting child abuse orneglect, it is not necessary to inform the minor that such a disclosure has been or willbe made. Disclosure may generally be made to the minor's parents or otherrepresentatives although there may be circumstances under federal or state law whenthe parents or other representatives may not be given access to the minor's PHI.

To Conduct Health Oversight Activities. The Plan may disclose your PHIto a health oversight agency for authorized activities including audits, civiladministrative or criminal investigations, inspections, licensure or disciplinary action.However, the Plan may not disclose your PHI if you are the subject of an investigationand the investigation does not arise out of or is not directly related to your receipt ofhealth care or public benefits.

In Connection With Judicial and Administrative Proceedings. Aspermitted or required by state law, the Plan may disclose your PHI in the course of anyjudicial or administrative proceeding in response to an order of a court oradministrative tribunal as expressly authorized by such order or in response to asubpoena, discovery request or other lawful process, but only when the Plan receivessatisfactory assurance from the party seeking the information that reasonable effortshave been made to you of the request or, if such assurance is not forthcoming, if thePlan has made a reasonable effort to notify you about the request or to obtain anorder protecting your PHI.



For Law Enforcement Purposes. As permitted or required by state law, thePlan may disclose your PHI to a law enforcement official for certain law enforcementpurposes, including the reporting of certain types of wounds, upon the request of a lawenforcement official for locating a suspect, fugitive, material witness, missing person,or crime victim, to report a death, to report a crime on the premises and to report acrime in a medical emergency. A disclosure of information about an individual who isor is suspected to be a crime victim may be made only if a) the individual agrees to thedisclosure or the Plan is unable to obtain the individual's agreement because ofemergency circumstances, b) the law enforcement official represents that theinformation is not intended to be used against the individual and the immediate lawenforcement activity would be materially and adversely affected by waiting to obtainthe individual's agreement and c) the Plan determines disclosure is in the best interestof the individual as determined by the exercise of its best judgment.

To Coroners, Medical Examiners and Funeral Directors. The Plan mayrelease PHI to coroners or medical examiners for duties authorized by law or to funeraldirectors consistent with applicable law.

Organ and Tissue Donation. If you are an organ donor, the Plan mayrelease PHI to organizations that handle organ procurement or transplantation.

For Research. The Plan may disclose your PHI for research subject to certainconditions regarding the manner in which the research is conducted.

In the Event of a Serious Threat to Health or Safety. The Plan maydisclose your PHI if necessary to prevent or lessen a serious and imminent threat toyour health or safety or to the health and safety of the public or another person whenconsistent with applicable law and standards of ethical conduct and the Plan in goodfaith believes such use or disclosure is necessary.

For Specified Government Functions. In certain circumstances, federalregulations may require the Plan to use or disclose your PHI to facilitate specifiedgovernment functions related to the military and veterans affairs, national security andintelligence activities, protective services for the president and others, and correctionalinstitutions and inmates.

For Workers' Compensation. The Plan may release your PHI to the extentnecessary to comply with laws related to workers' compensation or similar programs.

Other Uses and Disclosures

The Plan will not (1) supply confidential information to another entity for itsmarketing purposes in violation of the privacy regulations, or (2) sell your confidentialinformation in violation of the privacy regulations.



Other uses and disclosures of your PHI not covered by this Notice or the lawsthat apply to the Plan will be made only if you provide a written authorization.

The Plan asks you to complete an authorization form if you would likesomeone, such as a spouse, to be able to have access to your PHI.

If you provide the Plan with written authorization to use or disclose your PHI,you may revoke that permission, in writing, at any time. If you revoke yourpermission, the Plan will no longer use or disclose PHI about you for the reasonscovered by your written authorization. You understand that the Plan is unable to takeback any disclosures that the Plan has already made with your permission.

YOUR RIGHTS REGARDING THE PRIVACY OF YOUR PERSONAL HEALTHINFORMATION

You have the following rights:

The right to request restrictions or limitations on the PHI the Plan usesor discloses about you for treatment, payment or health care operations. You alsohave the right to request a limit on the PHI we disclose to someone involved in yourcare or the payment for your care, like a family member or friend. For example, youcould ask that we not share information about a particular diagnosis or treatment withyour spouse. The Plan is not, however, required to agree to your request with theexception of a request for a restriction of a disclosure of PHI pertaining solely to ahealth care item or service for which the health care provider involved has been paidout of pocket that is for purposes of carrying out payment or health care operations(and not for the purposes of carrying out treatment).

To request restrictions, you must make your request in writing to the Plan'sPrivacy Officer. In your request, you must tell the Plan (1) what information you wantto limit, (2) whether you want to limit the Plan's use, disclosure or both; and (3) towhom the limits apply.

The right to request to receive confidential communication of your PHIby an alternative means or at an alternative location if a disclosure of your PHI couldendanger you. The request must he made in writing to the Plan's Privacy Officer andmust specify the alternative location or other method of communication that you prefer(for example, using an alternate address). Your request must include a statement thatthe restriction is necessary to prevent a disclosure that could endanger you. The Plandoes not refuse to accommodate such a request unless the request imposes anunreasonable administrative burden. If the request is granted, the documentation ofyour request will be placed in your record.

The right to access documents regarding your eligibility, payment ofclaims, appeals or other similar documents in your Designated Record Set for



inspection and/or copying. If the information you request is in an electronic healthrecord, you may request that these records be transmitted electronically. Your requestfor access to documents with your PHI must be in writing to the Plan's Privacy Officer.When a request for access is accepted (in whole or in part), you will be notified of thedecisions and you may then inspect the PHI, copy it, or both, in the form or formatrequested at a time and place convenient to you and the Plan. If you would like, youmay receive a summary of the requested PHI instead of your entire record, for areasonable fee. You may also receive a copy of your PHI by mail if you prefer. (ThePlan charges a reasonable, cost-based fee for copying, including labor and supplies [forinstance, paper, computer disks] and for postage if you request that the informationbe mailed. No fee is charged for retrieving or handling the PHI or for processing theParticipant's request for access.)

If a request for access is denied (in whole or in part), the Plan will grant accessto PHI for which there are no grounds to deny access. The Plan will also inform youwhy your request for access was denied, how to appeal the denial (if the denial isreviewable), and how to file complaints with the Plan and/or the U.S. Department ofHealth and Human Services. If you request a review and the denial is reviewable, thePlan will designate a licensed health care professional, not involved in the originaldenial decision, to serve as a reviewing official, and will notify you in writing of thereviewing official's determination.

The right to request to amend your PHI if it is inaccurate orincomplete. You may request that your PHI be amended. That request must be inwriting to the Plan's Privacy Officer and include a reason why your PHI should beamended. If you do not include a reason, the Plan will not act on the request. Whena request for amendment is accepted (in whole or in part), the Plan will inform youthat your request for amendment has been accepted. The Plan will request from youpermission to contact other individuals or health care entities that you identify thatneed to be informed of the amendment(s), and will inform them and other entitieswith whom the Plan does business who may rely on the disputed PHI to yourdetriment. The Plan will identify the record(s) that are the subject of the amendmentrequest and will append the amendment to the record.

If a request for amendment is denied, you will be notified why the request wasdenied (e.g., the information requested was not created by the Plan, is accurate andcomplete, is not part of the record, or may not legally be chanced such as informationcompiled in anticipation of a civil, criminal or administrative proceeding), how to file astatement of disagreement or a request that the Plan provide the request foramendment and the denial in any future release of the disputed PHI, and how to file acomplaint with the Plan or the U.S. Department of Health and Human Services. If youchoose to write a statement of disagreement with the denial decision, the Plan maywrite a rebuttal statement and will provide a copy to the Participant, and the Plan willinclude the request for amendment, denial letter, statement of disagreement, andrebuttal (if any), with any future disclosures of the disputed PHI. If you do not choose



to write a statement of disagreement with the denial decision, the Plan is not requiredto include the request for amendment and denial decision letter with future disclosuresof the disputed PHI unless you request the Plan to do so. When the Plan receivesnotification that your PHI has been amended, the Plan will ensure that the amendmentis appended to your records, and will inform entities with whom it does business thatmay use or rely on your PHI of the amendment and require them to make thenecessary corrections.

The right to obtain an accounting of disclosures of your PHI. The rightto an accounting extends to disclosures, other than disclosures made (1) for thepurposes of treatment, payment or health care operations, including those made tobusiness associates (vendors), (2) to an individual (or personal representative) abouthis or her own PHI, (3) incident to an otherwise permitted use or disclosure,(4) pursuant to an authorization, (5) to persons involved in the patient's care or othernotification purposes, (6) as part of a limited data set, (7) for national security orintelligence purposes and (8) to correctional institutions or law enforcement officials.

To request an accounting of disclosures, you must submit your request inwriting to the Plan's Privacy Officer. Your request must specify a time period, whichmay not be longer than six (6) years. You may request and receive an accounting ofdisclosures once during any twelve (12) month period for no charge. If you requestmore than one accounting within the same twelve (12) month period, a reasonable,cost-based fee may be charged. The Plan will notify you of the cost involved and youmay choose to withdraw or modify your request at that time before any costs areincurred.

You also have the right to an accounting of disclosures of electronic healthrecords for purposes of payment, treatment and health care operations. The right tosuch an accounting depends on whether the Plan maintains such electronic healthrecords and, if so, when the electronic health records were acquired by the Plan andwhen the disclosure occurred.

The right to receive a paper copy of this Notice and any revisions to thisNotice. You may request a copy of this Notice is writing to the Plan's Privacy Officer atany time. Even if you have agreed to receive this Notice electronically, you are stillentitled to a paper copy of this Notice.

You may exercise your rights through a personal representative. Yourpersonal representative will be required to produce evidence of his/her authority to acton your behalf before that person will be given access to your PHI or allowed to takeany action for you. Proof of such authority may take one of the following forms:

a power of attorney for health care purposes;



a court order of appointment of the person as the conservator orguardian of the individual; or

a birth certificate identifying the parent of a minor child.

The Plan retains discretion to deny access to your PHI to a personalrepresentative to provide protection to those vulnerable people who depend on othersto exercise their rights under these rules and who may be subject to abuse or neglect.This also applies to personal representatives of minors.

LEGAL DUTIES OF THE IBEW LOCAL NO. 461 WELFARE FUND REGARDINGYOUR HEALTH INFORMATION

The Plan is required by law to maintain the privacy of your PHI as set forth inthis Notice and to provide to you this Notice of its duties and privacy practices. If yourPHI is improperly accessed, acquired, used, or disclosed, the Plan will notify you, asrequired by law. That notification may include a description of what happened, theinformation involved, and the steps you can take to protect yourself.

The Plan is required to abide by the terms of this Notice, which may beamended from time to time. The Plan reserves the right to change the terms of thisNotice and to make the new Notice provisions effective for all PHI the Plan has aboutyou as well as any information the Plan receives in the future. If the Plan changes itspolicies and procedures, the Plan will revise the Notice and will provide a copy of therevised Notice to you within 60 days of the change.

Minimum Necessary Standard

When using, disclosing or requesting PHI, the Plan will make reasonable effortsnot to use, disclose or request more than the minimum amount of PHI necessary toaccomplish the intended purpose of the use, disclosure or request, taking intoconsideration practical and technological limitations. When required by law, the Planwill restrict disclosures to the limited data set, or otherwise as necessary, to theminimum necessary information to accomplish the intended purpose. However, theminimum necessary standard will not apply in the following situations:

disclosures to or requests by a health care provider for treatment;

uses or disclosures made to the individual or pursuant to anauthorization;

disclosures made to the Secretary of the U.S. Department of Health andHuman Services;

uses or disclosures that are required by law; and



uses or disclosures that are required for the Plan's compliance with legalregulations.

YOUR RIGHT TO FILE A COMPLAINT

You have the right to express complaints to the IBEW Local No. 461 WelfareFund and to the Secretary of the Department of Health and Human Services if youbelieve that your privacy rights have been violated. Any complaints to the IBEW LocalNo. 461 Welfare Fund should be made in writing to the Fund's Privacy Officer. TheIBEW Local No. 461 Welfare Fund encourages you to express any concerns you mayhave regarding the privacy of your information. You will not be retaliated against inany way for filing a complaint.

FOR MORE INFORMATION CONTACT THE PRIVACY OFFICER

For questions about this Notice, to exercise your privacy rights, or to file acomplaint, contact the Plan's Privacy Officer, IBEW Local No. 461 Welfare Fund,6525 Centurion Drive, Lansing, Michigan 48917-9275 (517) 321-7502.

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48676 IBEW Local No. 461 HW Plan SPD · BARGAINING UNIT EMPLOYEES ... NOTICE OF THE PRIVACY...

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Transcript of 48676 IBEW Local No. 461 HW Plan SPD · BARGAINING UNIT EMPLOYEES ... NOTICE OF THE PRIVACY...