INTRODUCTION

PLAN DESCRIPTION 

PLAN SUMMARY

MEDICAL SCHEDULE OF BENEFITS 

Plan Limitations and Maximums 

DENTAL SCHEDULE OF BENEFITS 

PREFERRED PROVIDER ORGANIZATION 

NOTIFICATION PROCEDURES 

MAJOR MEDICAL EXPENSE BENEFITS

MAJOR MEDICAL EXCLUSIONS AND LIMITATIONS 

DENTAL EXPENSE BENEFITS 

DENTAL EXCLUSIONS AND LIMITATIONS 

ELIGIBILITY & EFFECTIVE DATE OF COVERAGE 

Special Enrollment Periods 

Retiree Eligibility 

TERMINATION OF COVERAGE 

CONTINUATION COVERAGE (COBRA)

COORDINATION OF BENEFITS

THIRD PARTY RECOVERY PROVISION

GENERAL PROVISIONS 

Notice of Claim

Payment of Claim

Claim Review and Appeal Process

RIGHTS UNDER ERISA

This Summary Plan Description replaces any and all Summary Plan Descriptions issued by Palmer Chiropractic University System Foundation.

The Plan is funded by Palmer Chiropractic University System Foundation and Employee contributions. The benefits and principal provisions of the Plan are described in this document. They are effective only if an Employee and Dependents are eligible for the coverage, become covered, and remain covered in accordance with the provisions of the Plan.

The purpose of providing a comprehensive medical plan is to protect Covered Employees and their Dependents from serious financial loss resulting from necessary medical care. All health benefits described herein are being provided and maintained for Covered Employees and their Dependents by Palmer Chiropractic University System Foundation hereinafter referred to as the "Company." Hilb, Rogal and Hamilton of Illinois (HRH) will process all benefit payments.

The Summary Plan Description details the benefits, rights and privileges of Covered Persons (as later defined) established by Palmer Chiropractic University System Foundation referred to as the "Plan." The Summary Plan Description explains when the Plan will pay or reimburse all or a portion of Covered Expenses.

EFFECTIVE DATE: January 1, 1998

NAME OF PLAN: Palmer Chiropractic University System Foundation Employee Health Plan

NAME AND ADDRESS OF PPO NETWORK:
Genesis HealthPlan
2238 Jersey Ridge Road 
Davenport, IA 52803
(319) 421-3000
1-800-323-1321
www.genesishealth.com

Trinity PHO
1701-30th St., Suite 3
Rock Island, IL 61201
(309) 786-1932
1-888-278-8742
 www.trinityqc.com

EMPLOYER I.D. NUMBER: 42-6081293

PLAN NUMBER: 501

TYPE OF BENEFIT PROVIDED: Medical and Dental Expenses

FUNDING OF THE PLAN: Palmer Chiropractic University System Foundation and Employee Contributions

FISCAL YEAR OF THE PLAN: Begins January 1st and ends December 31st.

NAMED FIDUCIARY AND PLAN ADMINISTRATOR:
The Named Fiduciary and Plan Administrator is Palmer Chiropractic University System Foundation, who will have the authority to control and manage the operation and administration of the Plan. The Named Administrator may delegate responsibilities for the operation and administration of the Plan. The Company will have the authority to amend the Plan, to determine its policies, to appoint and remove supervisors, fix their compensation (if any), and exercise general administrative authority over them. The Administrator has the sole authority and responsibility to review and make final decisions on all claims to benefit hereunder.

CONTRIBUTIONS TO THE PLAN:
The amount of contributions to the Plan are to be made on the following basis:

The Company will from time to time evaluate the costs of the Plan and determine the amount to be contributed by the Company and the amount to be contributed by each Covered Employee.

Notwithstanding any other provision of the Plan, the Company's obligation to pay claims otherwise allowable under the terms of the Plan will be limited to its obligation to make contributions to the Plan. Payment of said claims in accordance with these procedures will discharge completely the Company's obligation with respect to such payments.

In the event that the Company terminates the Plan, then as of the effective date of termination, the Company and Covered Employees will have no further obligation to make additional contributions to the Plan.

PLAN MODIFICATION AND AMENDMENTS:
Subject to any negotiated agreements, the Company may modify, amend, or discontinue the Plan without the consent of the Covered Employees. Any changes made shall be binding on each Covered Employee and on any other Covered Persons. This right to make amendments shall extend to amending the coverage (if any) granted to Retirees covered under the Plan, including the right to terminate such coverage (if any) entirely.

TERMINATION OF PLAN:
The Company reserves the right at any time to terminate the Plan by a written instrument to that effect. All previous contributions by the Company will continue to be issued for the purpose of paying benefits under the provisions of this Plan with respect to claims arising before such termination, or will be used for the purpose of providing similar health benefits to Covered Employees, until all contributions are exhausted.

PLAN IS NOT A CONTRACT:
The Plan Document constitutes the entire Plan. The Plan will not be deemed to constitute a contract of employment or give any Covered Employee of the Company the right to be retained in the service of the Company or to interfere with the right of the Company to discharge or otherwise terminate the employment of any Covered Employee.

CLAIM PROCEDURE:
In accordance with Section 503 of ERISA, the Company will provide adequate notice in writing to any Covered Employees whose claim for benefits under this Plan has been denied; setting forth the specific reasons for such denial and written in a manner calculated to be understood by the Covered Employee. Further, the Company will afford a reasonable opportunity to any Covered Employee, whose claim for benefits has been denied, for a full and fair review of the decision denying the claim by the person designated by the Company for that purpose.

PROTECTION AGAINST CREDITORS:
No benefit payment under this Plan will be subject in any way to alienation, sale, transfer, pledge, attachment, garnishment, execution, or encumbrance of any kind, and any attempt to accomplish the same will be void.

If the Company finds that such an attempt has been made with respect to any payment due, the Company in its sole discretion may terminate the interest of such Covered Employee or former Covered Employee in such payment, and in such case will apply the amount of such payment to or for the benefit of such Covered Employee or former Covered Employee, his spouse, parent, adult child, guardian of a minor child, brother or sister, or other relative of a dependent of such Covered Employee or former Covered Employee, as the Company may determine, and any such application will be a complete discharge of all liability with respect to such benefit payment.

INDEMNIFICATION OF EMPLOYEES:
Except as otherwise provided in ERISA, no director, officer, or Employee of the Company or of the Claims Processor will incur any personal liability for the breach of any responsibility, obligation, or duty in connection with any act done or omitted to be done in good faith in the administration or management of the Plan and will be indemnified and held harmless by the Company from and against any such personal liability, including all expenses reasonably incurred in his defense if the Company fails to provide such defense. The Company may purchase insurance to cover the potential liability of directors, officers, and Employees serving in a fiduciary capacity with respect to the Plan, and the Plan, itself, at its expense, may insure itself against loss by misdeeds or omissions of Plan Fiduciaries, provided such insurance permits recourse by the insurer against such Fiduciaries. The Company may also purchase insurance to cover the exposure of its directors, officers, and Employees by reason of such right of recourse.

Effective Date of Plan: January 1, 1998

Eligible Class: All regular Employees of Palmer Chiropractic University System Foundation working an average of 32 hours or more per week. This shall also include temporary Employees whose assignment is intended to exceed 90 days and are working an average of 32 hours or more per week. Employees hired on a 100% commission basis are not considered regular Employees of Palmer Chiropractic University System Foundation.

Required Period of Service: An Employee shall be eligible on the first day of eligible employment for medical and dental benefits.

Individual $250
Family $750 (All Family Members Combined)

Note: The Deductible will not apply to Copayments, Pre-Admission Testing, Outpatient Surgery and Second Surgical Opinions.

Individual $1,000
Family $2,000

Individual $2,000
Family $4,000

Participating Providers: 90%

Non-Participating Providers with authorized referral: 90%

Non-Participating Providers: 70%

Prescription Drugs: 80%

Outpatient Treatment of Mental/Nervous & Substance Abuse (Non-Participating Providers): 50%

COINSURANCE PERCENTAGE (Deductible is Waived. Subject to the Usual, Customary and Reasonable Fee):

Pre-admission Testing: 100%

Second Surgical Opinion: 100%

If two or more Covered Persons of the same family are injured in the same accident, only one individual Deductible is applied for all Eligible Expenses incurred by those persons for that accident. The common accident Deductible is included as part of the Individual and Family Deductibles shown in the Medical Schedule of Benefits.

Also, any Eligible Expenses incurred by the Covered Person in the last three months of a calendar year used to meet the Deductible for that year will count toward the Deductible for the next year.

Allocation and Apportionment of BenefitsThe Company reserves the right to allocate the Deductible amount to the first Eligible Expenses received in the calendar year and to apportion the benefits to the Covered Person and any assignees. Such allocation and apportionment shall be conclusive and shall be binding upon the Covered Person and all assignees.

Coinsurance
Coinsurance means the Plan pays a portion of your Eligible Expenses after the Deductible is satisfied, as shown in the Medical Schedule of Benefits. The Plan pays benefits at Coinsurance levels for Eligible Expenses incurred during the rest of the same calendar year.

Copayment
Copayments are dollar amounts that the covered person must pay before the Plan pays. A copayment is a smaller amount of money that is paid each time a particular service is used. Typically, there may be copayments on some services and other sevices will not have any copayments.

Plan Payment Schedule
All Eligible Expenses received from a Participating Provider are based on the PPO Network reimbursement schedule. All Eligible Expenses received from a Non-Participating Provider are based on the Usual, Customary and Reasonable fee for the geographic area where the services or supplies are received. When using a Non-Participating Provider, a Covered Person is responsible for paying any difference if the billed charges exceed the Usual, Customary and Reasonable Fee. (See Definition of Usual, Customary and Reasonable in the Definitions Section). Additional amounts paid do not count toward meeting the Deductible or Out-Of-Pocket Maximum.

Hospital Room & Board Limitation
Semi-Private Rate; if a facility does not have semi-private rooms, the limit is 90% of the facility's lowest private room rate.

Intensive Care Unit/Coronary Care Unit Limitation
Actual ICU or CCU rate.

Extended Care Facility Room & Board
Average semi-private rate and limited to 365days in a Covered Person's lifetime.

Maximum Lifetime Benefit- $5,000,000

Maximum Lifetime Benefit – $10,000

Maximum Lifetime Benefit - $25,000
Substance Abuse
(Inpatient & Outpatient Combined)

Maximum Calendar Year Benefit - 24 visits
Chiropractic Adjustment

Maximum Calendar Year Benefit - 30 days
Substance Abuse (Inpatient)

Maximum Calendar Year Benefit - 30 visits or $5,000
Substance Abuse (Outpatient)

MAIL ORDER PRESCRIPTION DRUG PROGRAM
A maintenance Prescription Drug Program is administered by an independent Pharmacy Benefits Manager. You will pay the appropriate copay, as stated below, for each prescription or refill. Standard exclusions apply. Mail Order packets are available in the Human Resources Department.

Mail Order: 90 Day Supply* $15 copayment, per prescription

*Except for Controlled Substances as governed by law.

Class I - Preventive Services 100%, no deductible
Class II - Basic Services 80%, after deductible
Class III - Major Services 50%, after deductible
Class IV - Orthodontic Services 50%, after deductible

Individual Deductible $25
(for Basic, Major & Orthodontic Services)

Family Deductible $75 (All family members combined)
(Basic, Major & Orthodontic Services)

Calendar Year Maximum Benefit $1,500 per individual
(Preventive, Basic and Major Services Combined)

Your Participating Provider Organization (PPO) Network is shown on your medical identification card. You may seek care from any Provider you wish. However, when you obtain medical care from a Participating Provider, additional benefits are available to you. The program is easy to use. Advantages when you use Participating Providers include:

1. Payment is sent directly to that Provider; and

2. They accept the PPO network allowed amount as the most they collect for covered services, less any Deductible or Copay/Coinsurance that the Covered Person is required to pay.

Participating Provider Organization (PPO) means a network of Physicians, Hospitals and other health care facilities.

Participating Provider means a Physician, Hospital, or other health care facility who is in the PPO network.

Copay (Copayment) means the amount of money you must pay, if applicable, after which the Plan will provide coverage. Copays do not apply to your Deductible or Out-Of-Pocket Maximum unless stated in your Medical Schedule of Benefits.

Coinsurance means the amount of money you must pay, after which the Plan will provide coverage. The coinsurance you pay does apply to your Out-Of-Pocket Maximum unless stated in your Schedule of Benefits.

How the Program Works
The Plan may be different for services and treatment rendered by a Participating Provider. See the Medical Schedule of Benefits for the differences between the Participating and Non-Participating Provider benefits.

In addition to providing a network of providers, the PPO Network administers the following Medical Management Services regardless of whether you are utilizing a Participating or Non-Participating Provider:

Pre-Admission Certification: A program for authorizing Hospital admissions prior to the time of service.

Pre-Procedure Review: A program for reviewing recommended procedures, by making sure you are in the right setting and identifying possible treatment alternatives.

Please read the information in this section closely. This section will explain:

1. Pre-Admission Certification of Planned Hospital Admissions and Procedures
2. Pre-Procedure Review
3. Referral Authorization
4. Continued Stay Review/Discharge Planning
5. Medical Management Services

PRE-ADMISSION CERTIFICATION - PLANNED HOSPITAL ADMISSIONS AND PROCEDURES

Your health plan requires Pre-Admission Certification of all planned (non-emergent) Hospital admissions and planned inpatient procedures.

If you are using a Participating Provider, your Participating Provider has agreed to perform these activities for you.

If you are using a Non-Participating Provider, you are required to notify the PPO Network prior to any planned Hospital admission or procedure. When possible, please have the following information available when calling for Pre-Admission Certification:

                    3. Patient's Name

Once this information is received the admitting Physician will be contacted to obtain additional medical information.

Note: The attending Physician does not have to obtain precertification from the plan for prescribing a maternity length of stay that is 48 hours or less for a vaginal delivery or 96 hours or less for a Caesarian delivery.

If you are receiving services from a Non-Participating Provider with an Authorized Referral please make sure that the service recommended, i.e., inpatient admission or procedure is included in your Referral Authorization. If your referral does not include authorization for the services recommended, you must receive additional authorization. For additional authorizations, contact your Participating Provider who initiated the referral on your behalf. He/she will contact the PPO Network to request the additional authorization on your behalf.

EMERGENCY ADMISSIONS
If you or a Covered Dependent are unexpectedly admitted to a Hospital, either locally or out of the area, you are required to contact the PPO Network within 48 hours of the admission. This helps the professional staff begin managing your health care needs in a timely manner to help you get the most from your benefit plan. The phone number is listed on the back of your Identification Card.

EXCEPTIONS FOR CERTAIN NON-NETWORK PROVIDERS
The Plan will pay in accordance with the PPO Network level of benefits for covered expenses incurred for related Non-PPO Network radiology, anesthesiology, pathology, and Emergency physicians’ services rendered in a PPO Network hospital.

PRE-PROCEDURE REVIEW
The procedures listed below when performed on an elective or scheduled basis should receive Pre-Procedure Review, regardless of the type of setting where the procedure is performed. Many of the following procedures can be performed safely in the outpatient setting as well as in the hospital setting and many times there are alternative forms of treatment available.

If you are using a Participating Provider, you are not responsible for obtaining the Pre-Procedure Review. Your Participating Provider has agreed to perform these activities on your behalf.

If you are using a Non-Participating Provider, you are encouraged to contact the PPO Network prior to any planned procedures. Please have the following information available when calling for Pre-Procedure Review:

1. Employee's Name

2. Employee's Social Security Number

3. Patient's Name

4. Date of Admission/Procedure

5. Facility Name

6. Physician's Name and Phone Number

7. Reason for admission or procedure to be performed

Adenoidectomy (removal of adenoids)
Arthroscopy of the Knee
Bunionectomy, with or without Osteotomy
Cardiac Catheterization
Cardiac Pacemaker Insertion
Carotid Endarterectomy
Carpal Tunnel Release
Cataract Extraction with or without Intraocular Lens Implantations
Cholecystectomy with or without Bile Duct Exploration
Colonoscopy
Coronary Angiography
Coronary Bypass Procedure (Open Heart)
Coronary Transluminal Angioplasty
Elective Esophagogastroduodenoscopy
Endoscopic Retrograde Choledochopancreatography (ERCP)
Fusion, Cervical Spine
Fusion, Lumbar Spine
Gastric Surgery for Clinically Severe Obesity
Hemorrhoidectomy, Internal and/or External
Hip Arthroplasty, total
Hysterectomy, Abdominal
Hysterectomy, Vaginal
Knee Arthroplasty, total
Laminectomy, Cervical
Laminectomy, Lumber
Lithotripsy/Extra Corporeal Shock Wave (ESWL)
Oophorectomy, Salpingectomy, Salpingo-oophorectomy
Prostatectomy, Trans-Urethral
Radiofrequency Intracardiac Electropysiological Procedure
Nasal Septoplasty
Thyroidectomy, Subtotal & Total
Tonsillectomy
Tympanotomy Tube Insertion
Ulcer Surgery
Varicose Vein Excision & Ligation

REFERRAL TO A NON-PARTICIPATING PROVIDER FROM A PARTICIPATING PROVIDER
Your Plan recognizes that a Covered Person may occasionally require services that are not available from a Participating Provider. When this occurs, your Participating Provider will request a referral authorization from the PPO Network. Request for referrals to Non-Participating Providers are generally approved if the service requested is medically necessary and not available from a Participating Provider. The goal is to make sure that you receive cost efficient care in the most appropriate setting.

Both you and your Participating Provider will receive a written approval or denial letter. If your referral request is approved, the PPO Network staff will notify the Non-Participating Provider of the specific services. Please take your approval letter with you to the Non-Participating Provider in case you are asked to present it.

Referrals authorize specific services within a specific time frame according to each patient's unique health care needs. If the Non-Participating Provider requests additional care or services that were not authorized, contact your referring Participating Provider. Your Participating Provider will work with the Non-Participating Provider and the PPO Network Medical Director to determine the most appropriate treatment and place of service. If additional services are determined to be appropriate, an additional referral authorization letter will be issued.

CONTINUED STAY REVIEW
The PPO Network will perform utilization review for all patients who are hospitalized. The review process will monitor the appropriateness, quality and efficiency of health care services you receive during your Inpatient confinement. This process will also assist us in identifying patients who will benefit from post Hospital services such as skilled home nursing visits, equipment needed in the home and community services which may be available.

The PPO Network Case Manager will work with your Physician, you or your family to determine what the most appropriate treatment plan is. If it is not clear why care at the current level should continue, the Case Manager will discuss your case with the Medical Director or Physician Consultant. If more information is necessary, the Case Manager or Physician Consultant may contact your attending Physician.

MEDICAL MANAGEMENT SERVICES
Before you receive treatment for certain services, supplies or procedures, you are encouraged to contact the PPO Network. Medical Management Services is a special service the PPO Network offers you. The program helps determine if a proposed treatment plan is medically necessary and a benefit of this Plan.

PLEASE NOTE: It is in your best interest to determine what is covered before you receive certain services. The following is a list of the most common services that you are encouraged to contact the PPO Network regarding.

Bone Growth Stimulator.
Cardiac Rehabilitation Services-- 30 sessions (Phase I & II only, Phase III not covered).
Cornea Surgery
Cosmetic Surgery
Diabetic Education Program (outpatient).
Electrical Stimulation of the Spine (Dorsal Column Stimulator).
Growth Hormones--please note: growth hormones will not be covered under any circumstances for males over 5 feet 6 inches and females over 5 feet 2 inches.
Insulin Infusion Pump.
Motorized Wheelchair including chairs with three or four wheels.
Speech Therapy.
Surgery to Correct Funneled or Hollowed Chest (Pectus Excavatum Surgery).
Transplants:
a. Bone Marrow/Stem Cell Infusions
b. Heart
c. Heart and Lung
d. Pancreas
e. Kidney
f. Kidney/Pancreas
g. Single Lung
h. Liver
Uvulopalatopharyngoplasty to reduce sleep apnea.
Beta Seron (medication for patients with Multiple Sclerosis).
Immunosuppressant Therapy (drugs used following transplants).

Other services that you are encouraged to notify the PPO Network prior to receipt are:

Durable Medical Equipment costing greater than $100.
Supplies not routinely provided in the Physician's office.
Home care services including but not limited to skilled nursing visits and hospice.
Any type of extended care, including skilled care such as a nursing home. You are not covered for custodial care.

Once the PPO Network is notified of the request, they will verify with your Physician that he/she did order the service/equipment. The Medical Management staff will evaluate the request to determine medical necessity, appropriateness and cost effectiveness of the service and if the requested service/equipment is covered benefit under your Plan.

If you are using a Participating Provider, your Participating Provider has agreed to perform this activity on your behalf for the service/equipment.

If you are using a Non-Participating Provider you are encouraged to contact the PPO Network prior to receiving the service/equipment.

Upon receipt of proof of loss, the Plan will pay the coinsurance percentage listed in the Medical Schedule of Benefits of the Eligible Expenses incurred in each calendar year (unless otherwise stated in the Plan) which are in excess of the Deductible, up to the stated Out-of-Pocket Maximum in the Medical Schedule of Benefits. All Eligible Expenses incurred in the calendar year in excess of the limitation will be paid at 100%. The amount payable in no event shall exceed the Maximum Lifetime Benefit stated in the Medical Schedule of Benefits.

COVERED MEDICAL EXPENSES
In order to be eligible for benefits under this provision, expenses actually incurred by a Covered Person must meet all of the following requirements:

1. They are administered or ordered by a Physician; and

2. They are medically necessary for the diagnosis and treatment of an Illness or Injury unless otherwise specifically excluded as an Eligible Expense; and

3. They are not excluded under any provision or section of this Plan.

COVERED EXPENSES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
Covered medical expenses are the following expenses listed below that are incurred while coverage is in force. If, however, any of the listed expenses are excluded from coverage because of a reason described in the Major Medical Exclusions and Limitations section, those expenses will not be considered covered medical expenses.

HOSPITAL EXPENSES
Charges made by a Hospital for its own behalf for:

1. Daily room and board and general nursing services, or confinement in an Intensive Care Unit, not to exceed the applicable maximum limits shown in the Medical Schedule of Benefits. Charges made by a Hospital having only private rooms will be paid at 90% of the average semi-private room rate for the area or actual charge, whichever is less.

2. Necessary services and supplies, other than room and board, furnished by the Hospital, including but not limited to Inpatient miscellaneous service and supplies, outpatient Hospital treatments for chronic conditions, emergency room use, physical therapy treatments, hemodialysis, and x-ray and linear therapy, and necessary drugs.

OUTPATIENT SURGICAL FACILITY BENEFIT
Charges made by an Outpatient Surgical Facility are Eligible Expenses. Coverage is provided for miscellaneous services and supplies rendered by the facility on its own behalf. This includes charges made by a Physician for services rendered while you are at the facility, for x-rays and lab tests, and for radiology and pathology. These charges are covered whether billed directly by the facility or separately by the Physician.

OUTPATIENT X-RAY AND LAB BENEFIT
Charges for x-ray and diagnostic lab procedures. Charges for radiology and pathology to interpret the tests or studies are included. This benefit also covers x-ray, radium, and radioactive isotope therapy when you are not Hospital confined.

SURGERY BENEFIT
Physician surgery charges, including post-operative care, are payable wherever surgery is performed. The Plan covers services rendered by an assistant surgeon, but limits the assistant surgeon's maximum allowable charge to a percentage of the maximum allowable charge for the surgical procedure as defined in the guidelines published in the Federal Register. (These guidelines are also followed by Medicare). Charges to administer anesthesia are also covered.

This benefit covers charges incurred for a second surgical opinion. If the second opinion differs from your Physician's opinion, the charges for a third opinion are also covered. The Physician giving the opinion must be a specialist for your condition and not be financially associated with your Physician and not be performing the surgery.

When multiple surgical procedures are done at the same time, Eligible Expenses include the maximum allowable charge for the first or major procedure. For each additional procedure the maximum allowable charges will be a percentage of the maximum allowable charge for that procedure as defined in the guidelines published in the Federal Register. (These guidelines are also followed by Medicare). No benefit is payable for incidental surgical procedures, such as an appendectomy performed during gall bladder surgery.

The Surgery Benefit covers transplants. Pre-Procedure Review is recommended. Covered transplant surgeries included but are not limited to: cornea, artery or vein, kidney, kidney/pancreas, heart, heart/lung, lung, bone replacement, allogenic bone marrow, autologous bone marrow, stem cell infusion and liver. If the organ is donated from a living person or cadaveric donor, the Plan will pay for the covered expenses incurred by that donor, but only if that person has no coverage for this type of expense under any type of insurance or government program. Eligible Expenses do not include transplant of an artificial organ.

Eligible charges under this Surgery Benefit include heart valve replacement, implantable prosthetic lenses for cataracts, prosthetic bypass or replacement vessels.

EXTENDED CARE FACILITY EXPENSES
Charges made by an Extended Care Facility for the following services and supplies furnished by the facility during a convalescent confinement, limited to the number of days as stated in the Medical Schedule of Benefits:

1. Room and board, (one-half of the maximum allowable charge for a semi-private room in the Hospital from which the Covered Person was transferred) including any charges made by the facility as a condition of occupancy or on a regular daily or weekly basis, such as general nursing services.

2. Medical services customarily provided by the Extended Care Facility, with the exception of private-duty or special nursing services and Physician fees.

3. Drugs, biologicals, solutions, dressings and casts furnished for use during the convalescent period, but no other supplies.

HOME HEALTH CARE EXPENSES
Home Health Care Expenses are those Eligible Expenses by a home health care agency for services provided in accordance with a Home Health Care Plan. Such expenses include:

1. Part-time or intermittent nursing care by a registered graduate nurse (R.N.), or by a licensed practical nurse (L.P.N.), a vocational nurse, or public health nurse who is under the direct supervision of a registered nurse;

2. Home health aides;

3. Medical supplies drug and medicines prescribed by a Physician, and laboratory services provided by or on behalf of a Hospital, but only to the extent that they would have been covered under this Plan if the Covered Person had remained in the Hospital.

Specifically excluded from coverage under this benefit are the following:

1. Services and supplies not included in the Home Health Care Plan.

2. Services of a person who ordinarily resides in the home of the Covered Person, or is a close relative of the Covered Person.

HOSPICE EXPENSES
Hospice care is an Eligible Expense when provided in lieu of all other care to treat a terminal illness. A terminal Illness is an Illness which a Covered Person has six months or less to live. Hospice care must be furnished in a licensed facility or in the home. The Physician must certify the care, and the care must be agreed upon by the Physician and the agency and meet the Covered Person's medical and social needs. Charges made by a Hospice include:

1. Nursing care by a registered graduate nurse, or by a licensed practical nurse, a vocational nurse or a public health nurse who is under the direct supervision of a registered nurse up to eight (8) hours a day.

2. Physical therapy and speech therapy when rendered by a licensed therapist.

3. Medical supplies, including drugs and biological and the use of medical appliances.

4. Physician services.

5. Services, supplies, and treatments deemed medically necessary and ordered by a licensed Physician.

6. Bereavement services. This term means those supportive services provided in the counseling session with the family unit to assist them in coping with the death of the terminally ill patient. The period of bereavement begins on the death of the terminally ill patient and ends 12 months after it began.

Not covered are private or special duty nursing, care other than for pain control or to manage acute or chronic symptoms; funeral arrangements; financial or legal counseling; companion, homemaker or housekeeping services; voluntary services that are otherwise free, and counseling by your church pastor or minister.

PHYSICIAN SERVICES
The Plan will allow Physician charges according to Usual, Customary, and Reasonable guidelines for medical care and/or surgical treatments, including office or home visits, Hospital inpatient or outpatient care, clinic care and surgical opinion consultations.

COVERED EXPENSES IN OR OUT OF THE HOSPITAL

1. Fees of registered graduate nurses (R.N.'s), licensed practical nurses (L.P.N.'s) or licensed vocational nurse (L.V.N.) for private-duty nursing when medically necessary; limited to 30 days per calendar year.

2. Charges for the treatment or services rendered by a licensed physical therapist, speech therapist or occupational therapist when ordered by the Covered Person's attending Physician. Services and treatment must be rendered for acute, traumatic Injury or physical functional defect caused by an Illness or Injury.

Services not covered are: Programs, treatment, and services relating to community re-entry, transitional living, residential, school-based or vocational programs.

3. Charges for medically necessary professional ambulance service to and from the nearest facility where emergency care or treatment is rendered, or to the nearest facility equipped to furnish necessary medical treatment if not available at a local Hospital, when such ambulance service is the only means of transporting the Covered Person due to his medical condition. Subject to prior approval, when an Injury or Illness requires special care not available at a local Hospital, the benefit covers ambulance transfers to the nearest Hospital that can provide the care.

4. Charges for x-rays, microscopic tests, and laboratory tests.

5. Charges for radiation therapy or treatment, and chemotherapy.

6. Charges for the processing and administration of blood or blood components, but not for the cost of the actual blood or blood components if replaced.

7. Charges for oxygen and other gases, and their administration.

8. Charges for electrocardiograms, electroencephalograms, pneumoencephalograms, basal metabolism tests, allergy tests, or similar well-established diagnostic tests generally approved by Physicians throughout the United States.

9. Charges for the cost and administration of anesthesia.

10. Charges for dressings, sutures, casts, splints, trusses, crutches, braces, or other necessary medical supplies, with the exception of dental braces, corrective shoes, or arch supports.

11. Charges for the rental of a wheelchair, hospital bed, iron lung, or other durable medical equipment required for temporary therapeutic use, or the purchase of this equipment if economically justified, whichever is less. It is recommended that the Covered Person pre-approve the purchase.

12. Charges for the initial purchase of artificial limbs, eyes or larynx. Replacement of same will be covered if the appliance being replaced is no longer serviceable or due to pathological change. If repair of an appliance is more economical and the same result is achieved, the Plan will pay for repairs only.

13. Charges for hemodialysis as an Inpatient or at an Outpatient dialysis center.

14. Hospital and Physician charges for the routine care of a newborn child until the initial hospital discharge according to the eligibility provisions of the Plan.

15. Charges in relation to elective sterilization or abortion and related charges.

16. Charges for allergens and allergy injections received in a Physician's office.

17. Medical eye exams (excluding routine exams/refractions).

18. Charges for Dental work or treatment due to accidental Injury to sound natural teeth or to the jaw. Injury as a result of chewing or biting will not be considered an accidental Injury. This will not in any event be deemed to include charges for treatment for the repair or replacement of a denture.

19. Charges for Dental work or treatment while the Covered Person is confined to the Hospital. Such confinement must be ordered by a Physician because the life or health of the Covered Person will be placed in danger if such surgery is done while the Covered Person is not confined to the Hospital. This is limited to charges for cutting procedures for diseases or the extraction of impacted teeth.

20. Charges for outpatient cardiac rehabilitation programs to provide supervised monitored exercise sessions following heart surgery or a heart attack.

21. Charges for maternity related expenses for any Covered Person will be considered the same as any other Illness.

22. Charges for a glucometer will be eligible when medically indicated or in connection with the following:

A. Pregnancy
B. Brittle Diabetic
C. Renal Involvement
D. Peripheral Vascular Disease
E. Long-term gastrointestinal disorders that would affect absorption

23. Charges for services involving manual manipulation of the musculoskeletal system on an unlimited basis for acute, chronic, and preventive care, including maintenance care.

24. Charges for the treatment of Substance Abuse, and Mental and Nervous Disorders in the most current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, including but not limited to anorexia nervosa, bulimia, schizophrenia, panic disorder, attention deficit disorder, bipolar disorder, and depressive disorders, e.g., manic depression. Subject to amounts payable as stated in the Medical Schedule of Benefits. Services must be rendered or supervised by a Physician, masters level psychologist, or social worker and/or substance abuse counselors who are licensed in the state in which they are practicing.

25. Charges for the initial contact lenses or eyeglasses after cataract surgery, if they are prescribed your Physician and the surgery is performed while you are covered under this Plan.

26. Charges for catheters, colostomy bags, rings and belts, flotation pads, needles and syringes when prescribed by your Physician.

27. Charges for treatment at an Urgent Care Center for accidental Injury or Illness is covered the same as an office visit.

28. Charges for prescription drugs and medicines which bear the legend, "Caution, Federal Law prohibits dispensing without a prescription.

29. Charges for routine physical exams, and related services, including but not limited to, x-ray and lab expenses, routine injection of drugs and immunizations, audiometric examinations mammograms and pap tests. Subject to the calendar year maximum benefit as stated in the Medical Schedule of Benefits.

30. Charges for emergency services for medical care received while you are outside the United States.

31. Charges for Diabetic Self-Management Education programs. No benefits will be paid for:

A. Incurred while confined to a Hospital or other covered institution;
B. Not made or ordered by a Physician;
C. For Diabetic Self-Management Education programs whose sole or primary purpose is weight reduction; and
D. Made by a provider of health care services for items which are not in the scope of the provider's license.

32. Charges for scheduled delivery for childbirth at an accredited birth clinic.

33. Charges for the diagnosis and treatment of male or female infertility. This includes but not limited to drug induced stimulation of ovulation, artificial insemination, or in vitro fertilization or forms of in vitro fertilization. Any infertility procedures that are currently considered as investigational will not be covered.

Benefits are never available for the collection of donor semen (sperm) or oocytes (eggs); services of a surrogate; freezing of sperm, oocytes, or embryos; reversal of sterilization.

34. Charges for services in connection with surgical treatment of morbid obesity and/or panniculectomy will be considered Eligible Expenses, subject to the following conditions:

A. A second concurring surgical opinion is required prior to the surgical procedure; and
B. Pre-Procedure Review by the PPO Network is required.

A. Body weight must be at least 100 pounds over optimal weight.
B. The condition of morbid obesity must be of at least a five (5) year duration immediately prior to the date surgical treatment is sought.
C. The patient may be requested to have psychiatric evaluation to obtain a psychiatric opinion as to psychiatric stability.
D. Non-surgical methods of weight reduction must have been attempted under a Physician's supervision for at least a three (3) year period immediately prior to the date surgical treatment is sought.
E. The patient must also have other medical complications secondary to the obesity (such as hypertension, diabetes, serious venostasis, hyperlipemia, etc.) and these conditions must be expected to be relieved or improved by weight loss.

35. Charges for routine mammograms, in excess of the Routine Physical Examination benefits, subject to the following schedule:

A. One baseline mammogram for women who are age thirty-five and less than forty;

B. A mammogram for women who are age forty and less than age fifty every two years or more frequently based on the Physician's recommendations;

36. Charges for reconstructive surgery following a mastectomy for:

1. Reconstruction of the breast on which the mastectomy has been performed.
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance.
3. Prostheses and physical complications during all stages of mastectomy, including lymphedemas.

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

The following exclusions and limitations apply to expenses incurred by all Covered Persons:

1. Charges incurred prior to the effective date of coverage under the Plan, or after coverage is terminated, unless an Extension of Benefits applies.

2. Charges incurred as a result of war or any act of war, whether declared or undeclared, or caused during service in the armed forces of any country.

3. No benefits or expenses will be paid or reimbursed to or for any Covered Person for any Injury, Illness, Occupational Disease, or other loss which arises out of an in the course of employment, and for which the Covered Person is reimbursed or entitled to reimbursement under any federal or state law, including a workers' compensation law or similar law. However, this exclusion will not apply in the case of a self-employed individual if the law does not require the Covered Person to obtain coverage under a workers' compensation law or similar law, and that individual chooses not to purchase such coverage.

4. Charges incurred while confined in a Hospital owned or operated by the United States Government or any agency thereof, or charges for services, treatments or supplies furnished by the United States Government or any Agency thereof, unless such benefits are mandated under federal law or regulation.

5. Charges incurred for which the Covered Person is not, in the absence of this coverage, legally obligated to pay, or for which a charge would not ordinarily be made in the absence of this coverage.

6. Charges incurred due to an Illness or Injury resulting from the Covered Person's voluntary participation in a civil or criminal battery or felony or participation in a riot or civil disturbance.

7. Charges incurred as the result of a court order.

8. Charges related to attempted suicide or intentional self-inflicted Injury or Illness while sane or insane.

9. Charges incurred for services or supplies which constitute personal comfort or beautification items, for television or telephone use, or in connection with custodial care, education or training, or expenses actually incurred by other persons, except as specifically shown as a Eligible Expense elsewhere in the Plan.

10. Charges incurred in connection with the care or treatment of, or surgery performed for, a cosmetic procedure. This exclusion shall not apply when such treatment is rendered to correct a condition resulting from an accidental Injury or an Illness sustained while coverage is in effect, or when rendered to correct a congenital anomaly (i.e., a birth defect) for a Covered Dependent, if said individual was born while the Employee had Dependent coverage under this Plan. Pre-Procedure Review is recommended.

11. Charges incurred in connection with services and supplies which are not necessary for treatment of the Injury or Illness, or are in excess of Reasonable and Customary charges, or are not recommended and approved by a Physician, unless specifically shown as a Eligible Expense elsewhere in the Plan.

12. Charges for services, supplies or treatment not recognized by the American Medical Association as generally accepted and medically necessary for the diagnosis and/or treatment of an active Illness or Injury; or charges for procedures, surgical or otherwise, which are specifically listed by the American Medical Association as having no medical value.

13. Charges for services rendered by a Physician, nurse, or licensed therapist if such Physician, nurse, or licensed therapist is a close relative of the Covered Person, or resides in the same household of the Covered Person.

14. Charges incurred outside the United States if the Covered Person traveled to such a location for the sole purpose of obtaining medical services, drugs, or supplies.

15. Charges for hospitalization when such confinement occurs primarily for physiotherapy, hydrotherapy, convalescent or rest care.

16. Charges for Physician fees for any treatment which is not rendered by or in the physical presence of a Physician.

17. Charges incurred in connection with eye refractions or the purchase or fitting of eyeglasses, contact lenses, radial keratotomy, corneal modulation, refractive keratoplasty or any similar procedure, vision therapy including eye exercises.

18. Charges related to impotency testing and treatment including all services, supplies and medications unless directly related to a medical condition as the result of a surgical procedure.

19. Charges for birth control methods, devices, supplies or pills.

20. Charges for professional nursing services if rendered by other than a registered graduate nurse (R.N.), licensed practical nurse (L.P.N.) or licensed vocational nurse (L.V.N.).

21. Charges for experimental procedures, drugs, or research studies, or for any services or supplies not considered legal in the United States or not recognized by the American Medical Association or the American College of Surgeons and/or the United States Food & Drug Administration.

22. Charges related to counseling for persons suffering from gender identification problems and services, or supplies related to gender transformation procedures; and sex change operation or complications from that surgery.

23. Charges for services or supplies for recreational or educational therapy or forms of non-medical self-help or self-cure, biofeedback or relaxation therapy.

24. Charges for the reversal of a sterilization procedure; or for penile prosthesis/implants and any charges relating thereto.

25. Charges for services or supplies for marital, family, general counseling and advice, or other counseling or training service or sex therapy. (These services may be available through your EAP).

26. Charges for mammoplasty, purchase of breast prothesis, except following a medically necessary mastectomy.

27. Charges for hypnotherapy, biofeedback, myo-functional therapy or sleep therapy.

28. Charges for custodial care, services or supplies to assist in daily living needs not necessary to recover from an Injury or Illness; private duty services of a health care provider. Programs, treatment, and services relating to community re-entry, transitional living, residential, school-based or vocation programs.

29. Charges for the diagnosis and treatment (including but not limited to orthopedic shoes, shoe supports, shoe inserts, strapping, and other supportive devices) for:

A. Weak, strained, unstable or flat feet;
B. Any tarsalgia, metatarsalgia or bunion; except for operations which involve the exposure of bones, tendons or ligaments;
C. Toenails, other than removal of nail matrix or root; or
D. Superficial lesions of the feet, such as corns, calluses and hyperkeratoses.

30. Charges for the purchase or rental of air conditioners, humidifiers, dehumidifiers, air purifiers, whirlpool, water bed, exercise equipment, ultraviolet lighting and other such equipment.

31. Charges for developmental and neuroeducational testing or treatment; hearing therapy or therapy for learning disability, communication delay, perceptual disorders, sensory deficit, mental retardation and related conditions; and other special therapy not specifically included as a covered expense elsewhere in the Plan.

32. Charges for inpatient concurrent services of Physicians, unless there is a clinical necessity for supplemental skills and the two or more Physicians attend the patient for separate conditions during the same Hospital admission.

33. Charges for Dental treatment resulting from chewing injuries, dental implants, and Preventive, Basic, Major or Orthodontic dental treatment; non-surgical treatment of Temporomandibular Joint Dysfunction (TMJ) disorders and (all other craniomandibular disorders) or injections other than those made directly in the Temporomandibular Joint.

34. Charges for drugs and medicines not prescribed by a Physician or that are not required to have a written prescription; vitamins, fluorides, and nutritional supplements.

35. Charges for physician phone consultations.

36. Charges for services and supplies rendered to treat hair loss or to promote hair growth, including but not limited to hair transplants and wigs.

37. Charges for diet, health, exercise or smoking cessation programs, health club dues or weight reduction programs.

38. Charges for any expense, demand or other obligation resulting from or arising out of tax or similar assessment, interest, or penalties (federal or state) which are or would have been levied on any charges or fees.

39. Charges for expenses for which no benefit is specifically described in this booklet or in an amendment attached to this booklet.

Subject to the Dental Limitations and Exclusions of the Plan, reasonable charges incurred for the following Dental Expenses will be covered in accordance with the percentage of coverage and maximums in the Dental Schedule of Benefits.

COVERED DENTAL EXPENSES
The term "Covered Dental Expenses" means the expenses incurred by or on behalf of a Covered Person for charges made by a Dentist for the performance of Dental services provided for in the Dental Schedule of Benefits when the Dental service is performed by or under the direction of a Dentist, is essential for the necessary care of the teeth, and begins while the Covered Person is covered for Dental Benefits. If the actual performance of a Dental service begins on a date other than the date the service was recommended or determined to be necessary, the Dental service will be considered to begin on the date the actual performance of the service begins. Covered Dental Expenses do not include any expenses that are in excess of the reasonable and customary amount.

Pre-Treatment Review is recommended on all charges that will result in a payment of $200 or more. Ask your dentist office to submit a Pre-Treatment Estimate of the anticipated services. The charges will be calculated based on the estimate and you will receive notification of the anticipated payment. Please remember that this is only an estimate, payment will be based on actual services rendered and utilization of your dental calendar year maximum.

If a Covered Person should change Dentists in the middle of a particular course of treatment, no more will be paid than would have been paid if the individual had stayed with the same Dentist until treatment was completed unless prior approval is received from the Claims Administrator.

During a course of treatment, a Covered Person and/or his Dentist may decide to use services or procedures that are not customarily provided. The amount payable will be based upon the procedure that is consistent with sound professional Dental practice.

CLASS I (PREVENTIVE SERVICES)

1. Oral examinations, limited to two (2) each calendar year.

2. Prophylaxis, (other than Periodontal) limited to two (2) each calendar year.

3. Topical Fluoride, limited to one (1) application each calendar year and limited to Dependent Children to age 14.

4. Sealants, limited to two (2) treatments per tooth and limited to Dependent Children to age 16.

5. Dental x-rays:
A. Complete mouth (single or multiple films), but no more than once every thirty-six (36) months.

B. Bitewing x-rays, but no more than two (2) times in any calendar year.

C. Extraoral x-rays (limited to two (2) films in any calendar year).

D. TMJ x-rays.

E. Cephalometric Film Series.

6. Emergency exams and treatment for relief of pain.

7. Space Maintainers including all adjustments within six (6) months of insertion. Limited to Dependent Children to age 14.

8. Biopsy and exam of oral tissue.

1. Oral surgery:

A. Simple Extraction.

C. Root Recovery (surgical removal of residual root).

D. Removal of a Dentigerous or Edentulous Cyst.

E. Incision and Drainage of an Abscess.

F. General Anesthesia - paid as a separate procedure only when required for complex oral surgical procedures, as determined the Claims Administrator, for which benefits are payable under Dental Benefits.

G. Prescription Drugs, if prescribed for a Dental condition.

H. Surgical Exposure of Impacted Tooth to Aid Eruption.

I. Alveoplasty (surgical preparation of ridge for dentures).

J. Frenulectomy.

K. Oral Anterior Fistula Closure.

2. Periodontics:

A. Initial Diagnostic Consultation (limited to one (1) consultation in any calendar year).

B. One of the following procedures per area of the mouth in any calendar year:

C. Periodontal Occlusal Adjustment, if done with Periodontal Surgery.

D. Periodontal Appliance (limited to one (1) appliance in any three (3) calendar years).

E. Periodontal Scaling and Root Planing, full mouth.

F. Periodontal Prophylaxis, including scaling and root replaning (limited to a total of any two (2) periodontal or other prophylaxis treatments in any calendar year).

3. Endodontics:

4. Restorative Dentistry (amalgam, stainless-steel crowns, synthetic porcelain and plastic fillings. Multiple restorations on the same surface will be considered as a single restoration. Mesial-lingual, distal-lingual, mesial-buccal, and distal-buccal restorations on anterior teeth will be considered a single restoration):

A. Acid Etch for Restoration, not including restoration.
B. Pin Retention, if done in conjunction with an amalgam or composite restoration.
C. Re-cement Inlays, Crowns, Space Maintainers, Bridges.
D. Crown Build-up, if done for endodontically treated teeth which require crowns.
E. Repair of Crowns - replace broken facing with other facing.
F. Laminates.
G. Repairs (other than relining) and Adjustments to Dentures (limited to repairs or adjustments done more than one year after the initial insertion).

5. Non-surgical treatment of Temporomandibular Joint Disorders (and all other craniomandibular disorders):

A. Initial diagnostic consultation and exam.
B. Temporomandibular repositioning appliance and adjustments.
C. Injections, other than injections made directly into the Temporomandibular Joint. D. Medications.

1. Restorations:
A. Gold Foil.
B. Inlays and onlays, if tooth cannot be restored by amalgam or composite fillings.
C. Crowns and abutments, if tooth cannot be restore by a filling (limited to plastic or stainless steel crowns for Dependent Children to age 16)
D. Post and cores, if tooth as had root canal therapy.

2. Bridges and Dentures:
A. Full Dentures, complete or immediate, upper or lower.
B. Partial Dentures, including two clasps and rests.
C. Additional Clasps and Rests.
D. Relining Dentures (limited to relining done more than one year after the initial insertion and one relinement in any two (2) calendar years).
E. Fixed Bridges:
F. Stress Breaker.

Note:
1. Temporary restorations and appliances and one (1) year follow-up care for the services listed will be considered as part of the final service rather than as a separate service.

2. Installment of fixed bridges, partial dentures and full dentures for the first time will be covered only if proof is given that:

A. The work needed is due to extraction of an injured or diseased natural tooth and is finished within twelve months of the date the tooth was extracted; and

B. The tooth is extracted while the person is insured for these benefits; and

C. The work includes replacing the extracted tooth.

A bridge or denture is considered to be installed for the first time if it does not replace any existing bridge or denture.

3. Replacement of, or addition to, fixed bridges and partial dentures will be covered only if proof is give that:

A. The work needed is due to the extraction of an injured or diseased natural tooth which occurs while the person is insured for these benefits; and the work is finished within twelve (12) months of the date of the extraction; or

B. The existing prosthesis cannot be made fit for use and the replacement is made after the later of:

1. Ten (10) years after the date the existing prosthesis is installed; and
2. Two (2) years after the date the person became insured for these benefits.

3. Replacement of full dentures will be covered only if proof is given that the existing prosthesis cannot be made fit for use and the replacement is made after the later of:

A. Ten (10) years after the date the existing prosthesis is installed; and

B. Two (2) years after the date the person became insured for these benefits.

4. The Dental Plan will provide a standard cast chrome or acrylic denture. If in the construction of the denture the patient and the Dentist decide on personalized restorations or employ specialized restorations or employ specialized techniques as opposed to standard procedures, the Plan will allow an appropriate amount for the standard denture toward such treatment and the patient must bear the difference in cost.

5. Crowns, inlays and gold restorations will be made only after five (5) years have elapsed following any prior provisions of crowns, inlays or gold restorations.

6. Crowns, inlays and gold restorations will be provided only when teeth cannot be restored adequately by using amalgam, porcelain, plastic or composite restorations.

7. Prosthodontic appliances will be replaced only after five (5) years have elapsed following any prior provision of such appliances. Replacement will be made of a prosthodontic appliance not provided under the Plan only if it is unsatisfactory and cannot be made satisfactory.

8. The cost of restorations required to replace missing teeth will be covered if procedures, appliances or restorations necessary to increase vertical dimension and/or restore or maintain the occlusion are considered optional, and the cost is the responsibility of the patient. Such procedures include, but are not limited to, equilibration, periodontal splinting, restoration of tooth structure lost from attrition, and restoration for malalignment of teeth.

Class IV (Orthodontia)
Treatment, diagnostic exam, x-rays and records necessary for proper alignment of teeth for dependent child(ren) to age 19. The maximum benefit payable is shown in the Dental Schedule of Benefits. Payments are calculated over the lifetime of the appliance and then paid on a quarterly basis.

1. Procedures that are not included in the classes of eligible Dental Expenses as described in this Plan, that are not necessary, or are not the treatment customarily recognized by the Dentist's field of specialty as essential to treating the condition.

2. Any portion of a service charge that is in excess of the allowable charge.

3. Congenital malformations.

4. Cosmetic procedures.

5. Implants; replacement of lost or stolen appliances; replacement of orthodontic retainers; myofunctional therapy; athletic mouthguards; precision or semi-precision attachment denture duplication; treatment of fractures; treatment of cysts; orthognatic surgery.

6. Oral hygiene instruction; plaque control; completion of claim forms; acid etch; missed appointments and infection control;

7. Hospital expenses and related anesthetic expenses.

8. Services incurred before coverage for the class of eligible Dental services is in effect, except as specifically provided.

9. Services not completed by the end of the month when coverage terminates. This includes, but is not limited to the insertion of crowns, bridges, dentures, inlays, onlays or appliances and any related services or charges.

10. Procedures that are begun but not completed.

11. Any Dental procedures for which benefits are payable under the medical provisions of this Plan.

12. Procedures performed by a Dentist who is a family member, or for whose services there would be no charge without this coverage.

13. For treatment provided without charge.

14. For serviced caused by war or any act of war, whether declared or undeclared, or because of an accident while on full-time active duty in the armed forces of any country.

15. For care and treatment for which you are entitled to, or are eligible for, benefits under any Workers' Compensation Act or similar law.

16. Injection of antibiotic drugs.

EMPLOYEE ELIGIBILITY
All Active Employees of the Employer. An Employee is eligible for coverage under the Plan when:

1. Employed as a regular Employee of Palmer Chiropractic University System Foundation working an average of 32 hours or more per week. This shall also include temporary Employees whose assignment is intended to exceed 90 days and are working an average of 32 hours or more per week. Employees hired on a 100% commission basis are not considered regular Employees of Palmer Chiropractic University System Foundation.

2. Completes the employment Waiting Period as shown in the Plan Summary.

If the Employee is employed by the Company on the effective date of this Plan, the date of eligibility shall be the effective date of the Plan.

If the Employee becomes employed by the Company after the effective date of the Plan, the date of eligibility shall be:

1. After completion of the employment Waiting Period as shown in the Plan Summary, providing he is actively at work and provided written application for such coverage is made within the first 30 days of employment.

EMPLOYEE EFFECTIVE DATE OF COVERAGE
An Employee will be covered under this Plan following the date that the Employee satisfies the Eligibility Requirement, the Actively at Work Requirement and the Enrollment Requirement.

DEPENDENT ELIGIBILITY
Each Employee who makes written request for Dependent coverage hereunder on a form approved by the Company shall, subject to the further provisions of this section, become covered for Dependent coverage as follows:

1. The date he becomes eligible for Employee coverage.

2. The date on which he first acquires a Dependent.

If both husband and wife are employed by the Company and both are eligible for Dependent coverage, either the husband or wife, but not both, may elect Dependent coverage for their eligible Dependents.

DEPENDENT EFFECTIVE DATE OF COVERAGE
A Dependent's coverage will take effect on the day that the Eligibility Requirement is met; the Employee is covered under the Plan; and all Enrollment Requirements are met.

SPECIAL ENROLLMENT PERIOD
If you do not enroll when you are first eligible or at the original enrollment of the group, you will only be eligible to enroll only under a Special Enrollment Period, otherwise you are ineligible for coverage. The Employee is responsible to notify the Employer (Human Resources) of a Special Enrollment Event.

If an Employee declines coverage for himself and/or his Dependents, an Employee and/or his Dependents may be entitled to Special Enrollment in this Plan under the following circumstances, provided the Employee requests enrollment, by completing and submitting all enrollment materials otherwise required for coverage to become effective, within thirty-one (31) days of the Special Enrollment Event.

Special Enrollment Events:

1. Loss of Other Coverage - The Employee was eligible but not enrolled in the Plan, and the Employee had other coverage (including COBRA), which has now expired because of loss of eligibility, loss of an employer contribution, or exhaustion of COBRA continuation coverage.

The Dependent of the Employee was eligible but not enrolled in the Plan, and the Dependent had other coverage (including COBRA), which as now expired because of loss of eligibility, loss of an employer contribution, or exhaustion of COBRA continuation coverage.

Enrollment for the eligible Employee and/or Dependent will be effective on the first day of the first month after the Plan receives a completed request for enrollment.

2. Acquisition of a Dependent - The Employee and/or Dependents were eligible but not enrolled in the Plan and the Employee gained a Dependent through marriage, birth, court order, adoption or placement for adoption.

Enrollment for the eligible Employee and/or Dependents will be effective on the date of the marriage, birth, court order, adoption or placement for adoption.

The definition of Loss of Other Coverage is: loss of eligibility of other coverage including loss as a result of legal separation, divorce, death, termination of employment or reduction in work hours, but does not include failure of the individual to pay premiums, or for cause (such as making a fraudulent claim or an intention misrepresentation of a material fact in connection with the Plan).

An Employee retiring from active employment shall be eligible to continue coverage, providing coverage is in effect on the date of retirement, subject to the following:

1. Employee's date of hire is prior to July, 1995;

2. Employee is at least 55 years of age;

3. Age and years of service are at least:

Age                 Years of Service

55                             20
56                             19
57                             18
58                             17
59                             16
60                             15
61                             14
62                             13
63                             12
64                             11
65                             10

4. Dependents are not eligible for coverage.

RETIREE BENEFITS
The Plan will pay benefits for eligible retirees under the age of 65 according to the Plan’s Coordination of Benefits and Medical Schedule of Benefits provisions as stated elsewhere in this summary.

The Plan will pay benefits for eligible retirees age 65 and older supplementary and secondarily to Medicare benefits, whether or not Medicare has been elected, according to the Plan's Coordination of Benefits and Medical Schedule of Benefits provisions as stated elsewhere in this summary.

Retiree benefits do not include dental coverage.

EMPLOYEE TERMINATION
Employee coverage shall automatically terminate immediately upon the later of the following:

1. The date the Employee terminates employment.

2. The date the Employee ceases to be eligible for coverage.

3. The date on which the Company terminates the Employee's coverage.

4. The date of the Employee's death.

5. The date the Plan is terminated; or with respect to any benefit of the Plan, the date of termination of such benefit.

DEPENDENT TERMINATION
The Dependent coverage shall automatically terminate immediately upon the earliest of the following date:

1. The date in which the Dependent ceases to be an eligible Dependent as defined in the Plan.

2. The date the Employee's coverage under the Plan terminates.

3. The date which the Employee ceases to be eligible for Dependent coverage.

4. The date the Plan is terminated; or with respect to any Dependent benefit of the Plan, the date of termination of such benefit.

5. The date of the Employee's death.

A federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), requires that most employers sponsoring group health plans offer Employees and their families covered under their health plan the opportunity for a temporary extension of health coverage (called "continuation coverage") in certain instances where coverage under the plan would otherwise end. This notice is intended to inform Plan Participants and beneficiaries, in summary fashion, of the rights and obligations under the continuation coverage provisions of COBRA, as amended and reflected in final and proposed regulations published by the Department of the Treasury. This notice is intended to reflect the law and does not grant or take away any rights under the law. Complete instructions on COBRA, as well as election forms and other information, will be provided by the Plan Administrator to Plan Participants who become Qualified Beneficiaries under COBRA.

What is COBRA continuation coverage? If a Qualifying Event occurs, each Qualified Beneficiary (other than a Qualified Beneficiary for whom the Qualifying Event will not result in any immediate or deferred loss of health plan coverage) must be offered an opportunity to elect to receive the group health plan coverage that is provided to similarly situated nonCOBRA beneficiaries (ordinarily, the same coverage that the Qualified Beneficiary had on the day before the Qualifying Event).

Who is a Qualified Beneficiary? In general, a Qualified Beneficiary is:

(i) Any individual who, on the day before a Qualifying Event, is covered under a group health plan by virtue of being on that day either a covered Employee, the Spouse of a covered Employee, or a Dependent child of a covered Employee.

(iv) An individual who was denied or not offered Plan coverage under the Plan under circumstances in which the denial or failure to offer constituted a violation of applicable law, then the individual will be considered to have had the Plan coverage.

What is a Qualifying Event? A Qualifying Event is any of the following where Plan coverage would be terminated except for COBRA continuation:

(i) The death of a covered Employee.

(ii) The termination (other than by reason of the Employee's gross misconduct), or reduction of hours, of a covered Employee's employment.

iii. The divorce or legal separation of a covered Employee from the Employee's spouse.

(v) A Dependent child's ceasing to be a Dependent child of a covered Employee under the requirements of the Plan.

(vi) A proceeding in bankruptcy under Title 11 of the U.S. Code with respect to an Employer from whose employment a covered Employee retired at any time.

If the Qualifying Event causes the covered Employee, or the Spouse or a Dependent child of the covered Employee, to cease to be covered under the Plan under the same terms and conditions as in effect immediately before the Qualifying Event (or in the case of the bankruptcy of the Employer, any substantial elimination of coverage under the Plan occurring within 12 months before or after the date the bankruptcy proceeding commences), the persons losing such coverage become Qualified Beneficiaries under COBRA if all the other conditions of the COBRA law are also met.

The taking of leave under FMLA does not constitute a Qualifying Event. A Qualifying Event occurs, however, if an Employee does not return to employment at the end of the FMLA leave and all other COBRA continuation coverage conditions are present. If a Qualifying Event occurs, it occurs on the last day of FMLA leave and the maximum coverage period is measured from this date.

What is an election period and how long must it last? A group health plan can condition availability of COBRA continuation coverage upon the timely election of such coverage. An election of COBRA continuation coverage is a timely election if it is made during the election period. The election period must begin not later than the date the Qualified Beneficiary would lose coverage on account of the Qualifying Event and must not end before the date that is 60 days after the later of the date the Qualified Beneficiary would lose coverage on account of the Qualifying Event or the date notice is provided to the Qualified Beneficiary of her or his right to elect COBRA continuation coverage.

Is a covered Employee or Qualified Beneficiary responsible for informing the Plan Administrator of the occurrence of a Qualifying Event? In general, the Employer or Plan Administrator must determine when a Qualifying Event has occurred. However, each covered Employee or Qualified Beneficiary is responsible for notifying the Plan Administrator of the occurrence of a Qualifying Event that is either a Dependent child's ceasing to be a Dependent child under the generally applicable requirement of the Plan or a divorce or legal separation of a covered Employee. The Plan is not required to offer the Qualified Beneficiary an opportunity to elect COBRA continuation coverage if the notice is not provided to the Plan Administrator within 60 days after the later of the date of the Qualifying Event or the date the Qualified Beneficiary would lose coverage on account of the Qualifying Event.

Is a waiver before the end of the election period effective to end a qualified beneficiary's election rights?
If, during the election period, a Qualified Beneficiary waives COBRA continuation coverage, the waiver can be revoked at any time before the end of the election period. Revocation of the waiver is an election of COBRA continuation coverage. However, if a waiver is later revoked, coverage need not be provided retroactively (that is, from the date of the loss of coverage until the waiver is revoked). Waivers and revocations of waivers are considered made on the date they are sent to the Employer or plan administrator, as applicable.

When may a Qualified Beneficiary's COBRA continuation coverage be terminated? During the election period, a Qualified Beneficiary may waive COBRA continuation coverage. Except for an interruption of coverage in connection with a waiver, COBRA continuation coverage that has been elected for a Qualified Beneficiary must extend for at least the period beginning on the date of the Qualifying Event and ending not before the earliest of the following dates:

(i) The last day of the maximum required period.

(ii) The first day for which Timely Payment is not made to the Plan with respect to the Qualified Beneficiary.

(iii) The date upon which the Employer ceases to provide any group health plan (including successor plans) coverage to any Employee.

4. The date, after the date of the election, upon which the Qualified Beneficiary first becomes covered under any other group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition, other than such an exclusion or limitation that does not apply to, or is satisfied by, the Qualified Beneficiary.
5. The date, after the date of the election, upon which the Qualified Beneficiary first becomes entitled to Medicare benefits.
6. The Plan can terminate for cause the coverage of a Qualified Beneficiary on the same basis that the Plan terminates for cause the coverage of similarly situated nonCOBRA beneficiaries, for example, for fraud.
7. In the case of an individual who is not a Qualified Beneficiary and who is receiving coverage under the Plan solely because of the individual's relationship to a Qualified Beneficiary, if the Plan's obligation to make COBRA continuation coverage available to the Qualified Beneficiary ceases, the Plan is not obligated to make coverage available to the individual who is not a Qualified Beneficiary.

What are the maximum coverage periods for COBRA continuation coverage? The maximum coverage periods are:

(i) In the case of a Qualifying Event that is a termination of employment or reduction of hours of employment, the maximum coverage period ends 18 months after the Qualifying Event if there is not a disability extension and 29 months after the Qualifying Event if there is a disability extension.

(ii) If a covered Employee becomes entitled to Medicare benefits before experiencing a Qualifying Event that is a termination of employment or reduction of hours of employment, the maximum coverage period for Qualified Beneficiaries other than the covered Employee ends the later of 36 months after the date the covered Employee becomes entitled to Medicare benefits or 18 months (or 29 months, if there is a disability extension) after the date of the covered Employee's termination of employment or reduction of hours of employment.

(iii) In the case of a Qualifying Event that is the bankruptcy of the Employer, the maximum coverage period for a Qualified Beneficiary who is the retired covered Employee ends on the date of the retired covered Employee's death. The maximum coverage period for a Qualified Beneficiary who is the Spouse, surviving Spouse or Dependent child of the retired covered Employee ends on the earlier of the date of the Qualified Beneficiary's death or the date that is 36 months after the death of the retired covered Employee.

(iv) The maximum coverage period for a Qualified Beneficiary who is a child born to or placed for adoption with a covered Employee during a period of COBRA continuation coverage is the maximum coverage period for the Qualifying Event giving rise to the period of COBRA continuation coverage during which the child was born or placed for adoption.

(v) Except as provided above, the maximum coverage period ends 36 months after the Qualifying Event.

Under what circumstances can the maximum coverage period be expanded? If a Qualifying Event that gives rise to an 18-month or 29-month maximum coverage period is followed, within that 18- or 29-month period, by a second Qualifying Event that gives rise to a 36-months maximum coverage period, the original period is expanded to 36 months, but only for individuals who were Qualified Beneficiaries in connection with both Qualifying Events. In no circumstance can the COBRA maximum coverage period be expanded to more than 36 months.

How does a Qualified Beneficiary become entitled to a disability extension? A disability extension will be granted if an individual (whether or not the covered Employee) who is a Qualified Beneficiary in connection with the Qualifying Event that is a termination or reduction of hours of a covered Employee's employment, is determined under Title II or XVI of the Social Security Act to have been disabled at any time during the first 60 days of COBRA continuation coverage and provides notice to the Plan Administrator of the disability determination on a date that is both within 60 days after the date the determination is issued and before the end of the original 18-month maximum coverage period that applies to the Qualifying Event.

Can a group health plan require payment for COBRA continuation coverage? Yes. For any period of COBRA continuation coverage, a group health plan can require the payment of an amount that does not exceed 102% of the applicable premium except the Plan may require the payment of an amount that does not exceed 150% of the applicable premium for any period of COBRA continuation coverage covering a disabled qualified beneficiary if the coverage would not be required to be made available in the absence of a disability extension.

What is Timely Payment for payment for COBRA continuation coverage? Timely Payment means payment that is made to the Plan by the date that is 30 days after the first day of that period. Payment that is made to the Plan by a later date is also considered Timely Payment if either under the terms of the Plan, covered Employees or Qualified Beneficiaries are allowed until that later date to pay for their coverage for the period or under the terms of an arrangement between the Employer and the entity that provides Plan benefits on the Employer's behalf, the Employer is allowed until that later date to pay for coverage of similarly situation nonCOBRA beneficiaries for the period.

The Coordination of Benefits provision applies whether or not a claim is filed under the other plan or plans. If needed, authorization must be given to this Plan to obtain information as to benefits or services available from the other plan or plans, or to recover overpayments. All benefits contained in the Plan Document are subject to this provision.

DEFINITIONS
The term "Plan" as used herein will mean any plan providing benefits or services for or by reason of medical or dental treatment, and such benefits or services are provided by:

1. Group insurance or any other arrangement for coverage of a Covered Person in a group whether on an insured or uninsured basis, including but not limited to:

A. Hospital indemnity benefits; and
B. Hospital reimbursement-type plans which permit the Covered Person to elect indemnity at the time of claims.

2. Hospital or medical service organizations on a group basis, group practice and other group per-payment plans.

3. Hospital or medical service organizations on an individual basis having a provision similar in effect to this provision.

4. A Licensed Health Maintenance Organization (H.M.O.).

5. Any coverage for students which is sponsored by or provided through a school or other educational institution.

6. Any coverage under a governmental program, and any coverage required or provided by any statute.

7. Group automobile insurance.

8. Individual automobile insurance coverage on an automobile leased or owned by the Company.

9. Individual automobile insurance coverage based upon the principles of "No-Fault" coverage.

The term "plan" will be construed separately with respect to each policy, contract, or other arrangement for benefits or services, and separately with respect to that portion of any such policy, contract, or other arrangement which reserves the right to take the benefits or services of other Plans into consideration in determining its benefits and that portion which does not.

The term "allowable expenses" means any necessary item of expense, the charge for which is reasonable, regular and customary, at least a portion of which is covered under at least one of the plans covering the person for whom claim is made. When a plan provides benefits in the form of services rather than cash payments, then the reasonable cash value of each service rendered will be deemed to be both an allowable expense and a benefit paid.

The term "claim determination period" means a calendar year or that portion of a calendar year during which the Covered Person for whom claim is made has been covered under this Plan.

COORDINATION PROCEDURES
Notwithstanding the other provisions of this Plan, benefits that would be payable under this Plan will be reduced so that the sum of benefits and all benefits payable under all other plans will not exceed the total of allowable expenses incurred during any claim determination period with respect to a Covered Person eligible for:

1. Benefits either as an insured person or participant or as a dependent under any other plan which has no provision similar in effect to this provision.

2. Dependent benefits under this Plan if that Covered Person is also eligible for benefits:

A. As an insured person or participant under any other plan, or

B. As a dependent covered under another group plan.

3. Employee benefits under this Plan if that Covered Person is also eligible for benefits as an insured person or participant under any other plan and has been covered continuously for a longer period of time under such other plan.

PAYMENTS
Each plan makes its claim payment according to where it falls in this order, if Medicare is not involved:

1. If a plan contains no provision for Coordination of Benefits, then it pays before all other plans.

2. The plan which covers the claimant as an Employee or named insured (exception cases of retirees or laid-off Employees, see 4 below) pays as though no other plan existed; remaining recognized charges are paid under a plan which covers the claimant as a dependent.

3. If the claimant is a Dependent Child, the plan of the parent whose birthday occurs earlier in the calendar year shall pay first. However, if his parents are divorced, then:

A. The plan of the parent with custody pays first, unless a court order or decree specifies the other parent to have financially responsibility, in which case that parent's plan would pay first.

B. The plan of a stepparent with whom he lives pays second (if applicable).

C. The plan of the parent without custody pays third.

4. In cases where there are benefits available either as a retiree or laid-off Employee, the plan which covers the claimant as a Dependent.

5. If the order set out in 1, 2, 3 or 4 above does not apply in a particular case, then the plan which has covered the claimant for the longest period of time will pay first.

The Company has the right:

1. To obtain or share information with an insurance company or other organization regarding Coordination of Benefits without the claimant's consent.

2. To require that the claimant provide the Company with information on such other plans so that this provision may be implemented.

3. To pay the amount due under this Plan to an insurer or other organization, if this is necessary in the Company's opinion to satisfy the terms of this provision.

RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION
For the purposes of determining the applicability of an implementing the terms of this provision of the Plan or any provision similar purpose of any other plans, the Company may, without the consent of or notice to any person, release to or obtain from any insurance company or other organization or person any information with respect to any person which the Company deems to be necessary for such purposes. Any person claiming benefits under this Plan shall furnish to the Company such information as may be necessary to implement this provision.

FACILITY OF PAYMENT
Whenever payments which should have been made under this Plan in accordance with this provision have been made under any other plan or plans, the Company will have the right, exercisable alone and in its sole discretion, to pay to any insurance company or other organization or person making such other payments any amounts it will determine in order to satisfy the intent of this provision, and amounts so paid will be deemed to be benefits paid under this Plan and to the extent of such payments, the Company will be fully discharged from liability under this Plan.

The benefits that are payable will be charged against any applicable maximum payment or benefit of this Plan rather than the amount payable in the absence of this provision.

EFFECT OF MEDICARE
It is the intent of this Plan to adhere to the laws of DEFRA, TEFRA and COBRA, as currently constituted and as amended from time to time.

If any Covered Person eligible for Medicare fails to enroll therefor, benefits will be paid by the Plan as though he had enrolled.

RIGHT OF RECOVERY
This Plan may pay benefits that should be paid by another benefit plan. In this case this Plan may recover the amount paid from the other benefit plan or the Covered Person. That repayment will count as a valid payment under the other benefit plan.

Further, this Plan may pay benefits that are later found to be greater than the allowable charge. In this case, this Plan may recover the amount of the overpayment from the source to which it was paid.

1. Automatically assigns to the Plan his or her rights against any third party or insurer when this provision applies; and

2. Must repay to the Plan the benefits paid on his or her behalf out of the recovery made from the third party or insurer.

AMOUNT SUBJECT TO SUBROGATION OR REFUND
The Covered Person agrees to recognize the Plan's right to subrogation and reimbursement. These rights provide the Plan with a priority over any funds paid by a third party to a Covered Person relative to the Injury or Sickness, including a priority over any claim for non-Medical or Dental charges, attorney fees, or other costs and expenses. Notwithstanding its priority to funds, the Plan's subrogation and refund rights, as well as the rights assigned to it, are limited to the extent to which the Plan has made, or will make, payments for Medical or Dental charges as well as any costs and fees associated with the enforcement of its rights under the Plan.

When a right of recovery exists, the Covered Person will execute and deliver all required instruments and papers as well as doing whatever else is needed to secure the Plan's right of subrogation as a condition to having the Plan make payments. In addition, the Covered Person will do nothing to prejudice the right of the Plan to subrogate.

DEFINED TERMS
"Recovery" means monies paid to the Covered Person by way of judgment, settlement, or otherwise to compensate for all losses caused by the Injuries or Sickness whether or not said losses reflect Medical or Dental charges covered by the Plan.

"Subrogation" means the Plan's right to pursue the Covered Person's claims for Medical or Dental charges against the other person.

"Refund" means repayment to the Plan for Medical or Dental benefits that it has paid toward care and treatment of the Injury or Sickness.

NOTICE OF CLAIM
It is recommended that written notice of claim be submitted to the Claims Administrator within ninety (90) days after the occurrence. All claims must be filed within three (3) months after the end of the calendar year of the date in which the claim is incurred or payment will be denied.

Failure to furnish proof within the time provided in the Plan will not invalidate or reduce any claim if it will be shown not to have been reasonably possible to furnish such proof and that such proof was furnished as soon as reasonably possible.

Written notice of claim given by or on behalf of the Covered Person to the Claims Administrator, with information sufficient to identify the Covered Person, will be considered notice.

CLAIM FORMS
Claim forms for filing notice of claim may be obtained from office of the Claims Administrator. To obtain claim forms, contact:

Hilb, Rogal and Hamilton of Illinois/Bartlett Agency
2200 - 52nd Avenue
P.O. Box 468
Moline, IL 61266-0468
(309) 764-9666

PROOF OF LOSS
The Plan Administrator will have the right and opportunity to have examined any individual whose Injury or Illness is the basis of a claim hereunder when and as often as it may reasonably require during the pendency of a claim, and also the right and opportunity to make an autopsy in case of death (where such autopsy is not forbidden by law).

FREE CHOICE OF PHYSICIAN
The Covered Person will have free choice of any legally qualified Physician or Surgeon, and the Physician-patient relationship will be maintained.

PAYMENT OF CLAIM
All Plan benefits are payable to the Covered Employee, or subject to any written direction of the Covered Employee. All or a portion of any indemnities provided by the Plan on account of Hospital, nursing, medical or surgical services may, at the Covered Employee's option and unless the Covered Employee requests otherwise in writing not later than the time of filing proof of such loss, be paid directly to the Hospital or person rendering such services; however, if any such benefit remains unpaid at the death of the Covered Employee of if the Covered Person is a minor or is, in the opinion of the Company, legally incapable of giving a valid receipt and discharge for any payment, the Company may, at its option, pay such benefits to any one or more of the following relatives of the Employee: spouse, mother, father, child or children, brother or brothers, sister or sisters. Any payment so made will constitute a complete discharge of the Company's obligation to the extent of such payment, and the Company will not be required to see the application of the money so paid.

CLAIM REVIEW AND APPEAL PROCESS
If you think an error was made in paying your claim, we will be glad to review the claim payment for you. To initiate a review, inform our customer service representative that you would like a claim to be reviewed. He/she will ask you to provide some information about the claim (provider, patient, date of service) and the reason for your question and we will assist you with the claim review.

RIGHTS OF APPEAL
If a claim is partially or totally denied for any reason, the Covered Employee will be given written notice of denial. Written denial will include:

1. Specific reasons for the denial with reference to the Plan provision(s); and

2. A description and need for any other material pertinent to the claim.

If a claim is not processed within 90 days of receipt by the Claims Administrator, a Covered Employee may proceed with an appeal.

REVIEW PROCEDURES
A Covered Employee, or the Covered Employee's representative, may request a review of the claim denial by making written request to the Claims Administrator within 60 days of receipt of the notice of denial.

Written notice for review should:

1. State the reasons the Covered Employee feels the claim should not have been denied; and

2. Include any additional documentation which the Covered Employee believes supports the claim. A Covered Employee may review pertinent documents and submit additional questions or information for consideration.

DECISION ON REVIEW
The Claims Administrator in conjunction with the Plan Administrator will make a full, fair review of the claim and give final written notice of its decision within 60 days (120 days in some circumstances) after the request is received. The written notice on the review will include specific reasons for the decision and include reference to the Plan provisions on which the decision is based. You may send your request for a claim review to:

Hilb, Rogal and Hamilton of Illinois/Bartlett Agency
P.O. Box 468
Moline, IL 61266-0468

ASSIGNMENT
Benefits may not be assigned except by consent of the Company, other than to providers of medical services and according to the provisions set forth in the Plan Document.

RIGHTS OF RECOVERY
Whenever payments have b