The Active Employee Plan makes the Trust Medical Plan available to you as an option for medical coverage. If you select this option you will receive your prescription drug benefits through Kroger Prescription Plans and your vision benefits from VSP. You have the option of receiving dental benefits through Kaiser Permanente OR through the Trust Dental Plan.

The cost of coverage through the Trust Medical Plan may be different than similar coverage through the other options offered in the Active Employee Plan. See Plan Options & Rates for the current cost of coverage.

No benefits are provided for:

1. Any accidental bodily injury that arises out of or in the course of any employment for wage or profit or with an employer for which you could receive benefits under any workers' compensation law or occupational disease law, or you receive any settlement from a workers' compensation carrier.

2. Any illness for which you could receive benefits under any workers' compensation law or occupational disease law, or you receive any settlement from a workers' compensation carrier.

3. Losses that are due to war or any act of war, whether declared or undeclared.

4. Charges incurred or disability claimed while you are not under the direct care of a physician.

5. Preexisting Condition Limitation for New Employees or Dependents. A new employee is one who has not been eligible for coverage through the Harrison Trust in any of the previous 12 consecutive months.

The Plan will pay only a limited amount of up to $4,000 toward covered charges, services or supplies for a new employee or a new employee's dependents for a preexisting condition during the fist six months you or your dependents are covered by the Plan.

A preexisting condition is a condition that was diagnosed or treated or which medication was prescribed or taken in the three months before coverage began.

The six-month waiting period for full coverage of a preexisting condition can be reduced or eliminated if you had previous health and welfare coverage before becoming covered by this Plan. To eliminate or reduce the six-month waiting period, provide the Plan Administrator with a written certificate of prior health and welfare coverage. This certificate can be obtained from your previous employer or health insurance company. The six-month waiting period for preexisting conditions will be reduced by one month for each month of prior health and welfare coverage you had under the prior plan so long as there is not a gap of more than 63 days between when your coverage under the prior health and welfare plan ended and when the coverage under this Plan began.

6. Yearly limitation on Chiropractic and Naturopathic services: 26 visits per calendar year maximum for Chiropractic services and 26 visits per calendar year maximum for Naturopathic services. The number of visits for which you will receive benefit payment will be reduced if these services are used to meet part or all of your calendar year deductible.

7. Acupuncture services provided by an M.D., D.O., or Licensed Acupuncturist. Benefits are limited to 26 visits per calendar year. Services are payable at 70% of reasonable and customary charges (80% if preferred provider), payment not to exceed $50 per visit.

8. Diabetic Training: One session or one treatment plan per lifetime.

9. Charges for any medical or vision care incurred prior to the effective date of your coverage under this Plan.

10. Experimental or Investigational Services. Treatment, procedures, equipment, drugs, devices or supplies (hereinafter called "services") that are, in the Board of Trustees' judgment, experimental or investigational. Services are considered experimental or investigational if:

a. They require, but have not received, approval of the U.S. Food & Drug Administration;

b. They have not been the subject of a favorable study published in peer review medical literature. Peer review medical literature means a U.S. scientific publication that requires that manuscripts be submitted to acknowledged experts inside and outside the editorial office before publication for their considered opinions or recommendations regarding publication of the manuscript; or

c. They are determined by the Board of Trustees, after consultation with medical advisors, to be in research status and not accepted as a proper course of treatment.

11. Telephone consultations, missed appointments and completion of claim forms.

12. Mental retardation, learning disabilities.

13. Emergency Care or Urgent Care Facilities: If you receive treatment from a hospital emergency room for a non-life threatening illness or injury when an urgent care facility was available to treat the illness or injury, you must pay the first $150 for the emergency room visit. This $150 payment is in addition to any deductible that must be met under the Active Employee Plan.

14. Viagra is limited to three pills per week.

1. Charges that are, after professional medical review, deemed not medically necessary to the care or treatment of an injury or illness. Any final review will be based on professional medical opinion.

2. Charges that would not have been made if no plan existed.

3. Charges that you are not legally obliged to pay.

4. Charges that are in excess of the reasonable and customary charges for services and material.

5. Charges for treatment by a doctor that is not within the scope of his or her license.

6. Charges for which benefits are not provided in this Plan.

7. Charges for dental services or supplies for treatment of the teeth, gums, or alveolar processes. Except the Plan will pay for:

a. Hospital charges if you are a bed patient; or

b. Any dental charges covered under the Medical Benefits portion of this Plan.

8. Charges for eye glass lenses or contact lenses and the fitting of them. Except the Plan will pay for charges covered under the Medical Benefits portion of the Plan following cataract surgery.

9. Charges for confinement in a Skilled Nursing Facility, unless such confinement:

a. Starts within 14 days after you have been confined for at least three days in a hospital for which room and board charges were paid;

b. Is for treatment of the illness causing the hospital confinement;

c. Is one during which a doctor visits at least once every 30 days; and

d. Is not routine custodial-type care.

10. Charges for any treatment for cosmetic purposes or for cosmetic surgery. Except that, the Plan will pay for reconstructive treatment or surgery of one of the following:

a. Solely due to an accidental bodily injury if the injury occurred while covered by the Plan;

b. Solely due to surgical removal of all or a part of the breast tissue as the result of an illness; or

c. Solely due to a birth defect if covered by the Plan on the date of birth.

11. Charges for services of a person who usually lives in the same household as you, or who is a member of your immediate family.

12. Charges for services or supplies furnished by an agency of the United States Government or foreign government agency, unless excluding them is prohibited by law.

13. TMJ - Temporomandibular Joint Syndrome: Charges for necessary care and treatment of temporomandibular join syndrome and associated myofacial pain are limited to a maximum benefit payment of $3,000 Lifetime Outpatient Care and $10,000 Lifetime for Surgeons' charges for surgical care. hospital charges associated with surgical care are payable as any other illness.

14. Payment for corrective shoes or arch supports.

15. In-hospital medical or surgical care for conditions that do not generally require hospitalization.

16. Services and supplies for weight loss or obesity.

17. Non-medical self-help or training, such as programs for weight control, and general fitness or exercise programs.

18. Pregnancy-related expenses that are not a covered medical expense under this Plan.

19. Drugs and medicines that can be obtained without a doctor's prescription.

20. Counseling or treatment in the absence of illness, including individual or family counseling or treatment for marital, behavioral, family, occupational, religious or educational problems, or treatment of "normal" transitional response to stress. There may, however, be limited coverage under the Employee Assistance Program.

21. Services related to sex change procedures.

22. Psychological enrichment or self-help programs for mentally healthy individuals, including assertiveness training, image therapy, sensory movement groups, and sensitivity training.

23. Family Planning: Services and supplies for artificial insemination, in-vitro fertilization, or surgery to reverse elective sterilization are not covered.

24. Radial Keratotomy is not covered.

25. Charges for services or purchases before covered by the Plan: The charges for services or purchases will be deemed to have been incurred on the date the services were performed or the date the purchases occurred.

26. All charges not specifically listed as covered charges are not covered.

27. Contraceptives for the Employee's children are not covered.