The medical benefits portion of this benefit booklet provides that all covered charges, after satisfying the deductible, will be payable at 70% (80% for preferred providers and 80% if there are fewer than two Preferred Provider primary care physicians within a 30 mile radius of your primary residence) of the reasonable and customary covered charges. Your out-of-pocket maximum, excluding the deductible, is $2,000, or $6,000 per family during a calendar year. After the out-of-pocket maximum has been met, all covered charges (other than those for dental, orthodontia, vision, and chemical dependency) will be paid at 100% of the reasonable and customary charges for the remainder of the calendar year.

Any covered charges incurred during the last three months of the calendar year and applied to the deductible will apply toward the deductible in the next calendar year.

If a single accident causes injuries to two or more members of a family unit, a single deductible will apply to the family for covered charges incurred during that calendar year and resulting from such injuries. In no event will a lesser amount be paid than would be payable if this single deductible did not apply.

An annual deductible of $250 per person or a maximum of $750 per family will be charged for covered charges occurring during a calendar year

Chemical dependency charges are not included in the out-of-pocket expense maximum. There is a separate maximum and specific allowances for the treatment of chemical dependency.

A benefit period ends on the earliest of the following:

1. The last day of the calendar year in which it was established; or
   
2. The day coverage provided under this Plan ends; or
   
3. The day the maximum benefit is paid.
   

2. Semi-private room and board and routine nursing for confinement in a skilled nursing facility (not to exceed the average semi-private room rate). Services must commence within 14 days after discharge of three or more days in an acute care hospital.

3. Intensive nursing care for each day of confinement in a hospital as follows:

a. For those hospitals that make a separate charge for intensive nursing care, the hospital's specific charge for intensive nursing care is covered;

b. For those hospitals that make a combined charge for room and board and intensive nursing care, the part of the combined charge that is in excess of the hospital's prevailing semi-private room and board rate will be the covered charge for intensive nursing care.

4. Medical services and supplies furnished by the hospital.

5. Anesthetics and their administration.

6. Medical treatment given by or at the direction of a physician, if such treatment is within the scope of the provider.

7. Services of an RN for private duty nursing services in a hospital.

8. Services of an LPN for private duty nursing services in a hospital.

9. Services of a licensed physiotherapist.

10. Charges by a doctor or speech therapist for rehabilitative speech therapy that is necessary because of an illness (other than a functional nervous disorder), or is necessary because of surgery on account of an illness. If the speech therapy is necessary because of a congenital anomaly, surgery to correct the anomaly must have been performed prior to the therapy.

11. X-ray exams (other than dental), lab tests and other diagnostic services.

12. X-ray and radiation therapy.

13. Charges for the repair of sound, natural teeth (including their replacement) required as a result of, and performed within 24 months of, an accidental bodily injury.

14. Transportation within the United States and Canada to and/or from a hospital or care center will be a covered charge if medically necessary and recommended by your attending physician.

15. Medical supplies as follows:

a. Drugs that require a written prescription from a doctor and that must be dispensed by a licensed pharmacist or doctor;

b. Blood and other fluids to be injected into the circulatory system;

c. Lens, each eye, immediately following and because of cataract surgery only;

d. Casts, splints, trusses, braces, crutches and surgical dressings;

e. Purchase or rental of hospital-type equipment for kidney dialysis for your personal and exclusive use. The total purchase price considered will be on a monthly prorata basis during the first 24 months of ownership, but only so long as dialysis treatment continues to be medically necessary. Also covered are all charges for supplies, materials and repairs necessary for the proper operation of such equipment and also reasonable and necessary expenses for the training of a person to operate and maintain the equipment for your sole benefit. No benefits are paid on or after the day you are entitled to benefits under Medicare;

f. Rental of hospital-type medical equipment up to purchase price for other than kidney dialysis, including wheelchair, hospital bed, equipment for the treatment of respiratory paralysis, and equipment for the use of oxygen; and

g. Purchase of durable medical equipment (hospital-type medical equipment), if approved, will be prorated over 12 months beginning with date of purchase.

16. Smoking Cessation: The Plan covers prescription stop-smoking aids the same as any other prescription drug. Coverage is provided only if the item requires a prescription from your doctor, and it must be dispensed by a licensed pharmacist or doctor.

17. Maternity Expenses (retirees and spouses only): Retirees and spouses are covered for maternity expenses on the same basis as for any other illness, whether or not the pregnancy commences while you are covered under this Plan. Coverage must be in effect at the time of delivery. Benefits are not available for maternity related expenses for your pregnant child, even if the child is covered under the Plan.

18. Immunizations.

19. Well Baby Care: This benefit is not subject to the deductible. This benefit provides for well baby visits during the first three years of your child's life. In addition, medically necessary immunizations are covered for your child.

20. Birthing Center: The Plan covers charges made for services and supplies furnished by a birthing center for prenatal care, delivery of a child or children and postpartum care rendered within 24 hours after delivery.

21. Benefit for Donors: The Plan covers the medical services incurred by a donor in connection with a covered transplant when you are the recipient of the transplant.

22. Childbirth: Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child for less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case, plans and insurance companies may not, under federal law, require a provider to obtain authorization from the Plan or the insurance company for prescribing a length of stay not in excess of 48 hours (or 96 hours).

23. Breast Reconstruction: If, following a mastectomy, you elect breast reconstruction in connection with such mastectomy, the following charges will be covered:

a. Reconstruction of the breast on which the mastectomy has been performed;

b. Surgery and reconstruction of the other breast to produce symmetric appearance;

c. Coverage for prostheses and physical complications of all stages of mastectomy, including lymphedemas in a manner determined in consultation between you and your attending physician; and

d. This benefit is subject to the annual deductible and copayments.

24. Formula and related supplies if the formula is supplying 100 percent of the individual’s nutritional intake; for example, the individual must be fed through a tube.

25. Bariatric surgical procedures including gastric-bypass and laproscopic procedures but only if the surgery is preapproved in writing by a medical review agency selected by the Board of Trustees using its most stringent medical necessity review criteria. The medical review agency currently used by the Board of Trustees is Qualis Health in Seattle, Washington.

No benefits are provided for:

1. Any accidental bodily injury or illness 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. Losses that are due to war or any act of war, whether declared or undeclared.

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

4. Preexisting Condition Limitation for new retirees or dependents. A new retiree 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 retiree or a new retiree's dependents for a preexisting condition during the first six months you or your dependents are covered by the Plan.

A preexisting condition is a condition that was diagnosed or treated or for 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: Twenty-six visits per calendar year maximum for chiropractic services and 26 visits per calendar year maximum for naturopathic services.

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% for a preferred provider and 80% if there are fewer than two Preferred Provider primary care physicians within a 30 mile radius of your primary residence), payment will not exceed $50 per visit.

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

9. Charges for services or purchases incurred prior to the effective date of your coverage under this 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.

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 this Plan.

14. Viagra is limited to three pills per week.

The Following Charges For Medical Benefits Are Not Covered:

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 materials.

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 the 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;

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.

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 joint 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 except for surgical procedures that are allowed under the section Covered Charges, paragraph 24.

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 the 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 a retiree's children are not covered.

If you, the case manager and Plan Administrator agree on care not covered by the Benefit Booklet that can reasonably be expected to offer a cost effective result without a sacrifice to the quality of your care, the Plan Administrator and/or the Board of Trustees will have the right to allow the care even though the care is not covered by the Benefit Booklet.