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To Learn More, visit MyOKCFFBenefits.com 2

22017 Benefits Enrollment

Table of Contents ……………………….....…..2 Introduction ……………………………………..3 Flexible Spending Accounts…………………...4 Eligibility Information .…………………………..5 MyOKCFFBenefits.com ………………………..6 How to Enroll in Benefits…....…..……………...7 Health Care Reform Changes …………….......8

Benefit Plans

Medical Plan Comparisons (Actives)…………10 Medical Plan Comparisons (Retirees)………..11 Blue Cross Dental Plan ............................ …...12 VSP Vision Plan ....................................... …...13 Hartford Basic Life Insurance ................... …...14 Hartford Voluntary Life Insurance ............. …...15 Central United Cancer Plan ..................... …...16 Central United Accident Plan ................... …...18 Cincinnati Life Voluntary Insurance .......... …...21 Cigna Lump Sum Heart/Stroke Plan ........ …...22 Cigna Lump Sum Cancer Plan………….……..23 Rates……….…………………………..………...24

Required Notices

HIPAA Rights & Privacy Practices……......34 Woman’s & Dependent Health Rights ..….39 Continuation of Coverage (COBRA) ....... .41 Medicaid & CHIP Notification .................. .43 Medicare Disclosure………………………..45 Health Insurance Marketplace…………….46 Benefit Resource Directory ……..………...47

Table of Contents

Every reasonable effort has been made for the information provided in this booklet to be accurate. It is intended to provide the employees of OKCFF an overview of the coverages offered. It is in no way a guarantee or offer of coverage. Each carrier has the ability to underwrite based on its contract with OKCFF or its employees. Each carrier’s contract, underwriting and policies will supersede this document. Please be aware that each carrier may have exclusions or limitations and you must consult your summary plan description and / or policies for details.

The Health Insurance Portability and Accountability Act (HIPAA) requires that your health insurance plan limit the release of your health information to the minimum necessary required for your care. If you have questions about your claims, contact your insurance carrier first. If, after contacting the insurance carrier, you need a representative of the Employee Benefits Division to assist you with any claim issues, you may be required to provide written authorization to release information related to your claim. OKCFF advises you that the HIPAA Privacy Notice is available at www.MyOKCFFBenefits.com


Dear Firefighter,

Oklahoma City Fire Fighters Health & Welfare VEBA Trust has put together the following guide to help you understand the benefits offered in 2017. We recognize the importance of benefits for you and your family, which is why we take the time to carefully select providers who offer quality benefits for 2017.

OOklahoma City Fire Fighters

We encourage you to review the following Benefit Guide prior to completing enrollment and refer to it often for benefits questions. There are several tools available to help guide you through the enrollment process. These include this Benefit Guide, an informative benefits website www.MyOKCFFBenefits.com, which provides all of your important benefit information and our web-based Employee Benefits Portal.

Everyone will use the secure Benefits Portal on MyOKCFFBenefits.com for benefits enrollment, and we’ve made it easy for you. In addition to all of the benefits reference documents you might need and a brief overview of each plan, the system will guide you step-by-step through the enrollment process. You will log on to the enrollment system through the link Enroll Now at MyOKCFFBenefits.com.

Thank you in advance for taking the time to review this benefit guide. If you have any questions regarding the benefits outlined in this guide or your current benefits, please contact Patti Bolin at (405) 232-9543 or via email at [email protected], Monday - Thursday, 8 a.m. - 5 p.m. CST.

Your 2017 Benefit Offerings

BCBS HMO Plan

BCBS PPO Plan

BCBS HCA Plan (HRA)

BCBS Medicare Advantage Plan

BCBS Medicare Supplement Plan F

BCBS Dental Plan

VSP Voluntary Vision Plan

The Hartford Basic Life The Hartford Supplemental Life Cincinnati Life Voluntary Term Life Central United Cancer Plan Central United Personal Accident Plan Cigna Lump Sum Cancer Plan Cigna Lump Sum Heart / Stroke Plan


Flexible Spending Accounts (FSA) are a great cost savings tool to help with common medical and /or dependent care expenses not covered by your insurance. You can elect a portion of your pay to be deducted, on a pre-tax basis, from each paycheck to use for reimbursements of qualified out-of-pocket expenses throughout the plan year.

FFlexible Spending Accounts

Flexible Spending Account Savings Example

FSA Fund Availability

Health FSA Your full annual election is available to you on January 1st of the plan year.

Dependent Day Care FSA Unlike the Health FSA, the entire elected amount is not available on the first day of the plan year, but rather as contributions are received and services have been provided.

Healthcare Flexible Spending Account A Health FSA allows you to allocate money on a pre-tax basis to reimburse yourself for qualified medical expenses for you and your family. Qualified expenses include anything from copayments, medical deductibles, prescriptions and much more.

Healthcare Flexible Spending Account

Minimum Annual Deposit: $120 Maximum Annual Deposit: $2,550 Carryover Provision—The Internal Revenue Service (IRS) gives employers the ability to allow Health FSA participants to carry over up to $500 of unused contributions from one plan year to the next. This carryover amount may then be used to reimburse eligible medical expenses incurred anytime during the next plan year. Dependent Day Care FSA A Dependent Day Care FSA allows you to allocate money on a pre-tax basis to reimburse yourself for dependent care services such as after school care and dependent day care centers. Minimum Annual Deposit: $240 Maximum Annual Deposit: $5,000 Regardless of whether you participate in the Dependent Day Care FSA under Section 125 or claim the credit on your income tax, you must provide the IRS with the name, address and taxpayer identification number (TIN) or Social Security number of your dependent care provider(s) by completing either Schedule 2 of Form 1040A or Form 2441 and attaching it to your annual income tax return. Be sure that you follow the current instructions given by the IRS for preparing your annual income tax return. Failure to provide this information to the IRS could result in loss of the pre-tax exemption for your dependent care expenses.

IMPORTANT Even though you may elect your annual

contribution during your VEBA Enrollment Process, you MUST contact the City Benefits Department to authorize your elections through American Fidelity. Electing contributions through

VEBA does NOT setup your account. You can email your annual election to the city at [email protected]


PPlan Eligibility

Eligibility is determined by the requirements stated in the appropriate plan document or insurance policy for the year in question. Since the plans are subject to change, eligibility may also change. If you change coverage from one plan to another, you and your dependent(s) must meet the requirements of the new plan selected.

Eligibility

Employees and their eligible dependents are eligible for Oklahoma City Fire Fighters Health & Welfare VEBA Trust's benefits on the First of the month following 30 days of employment. Eligible dependents include the employee's spouse and children (under age 26).

Eligibility Information

Adding Dependents

You must add all dependents to your enrollment that you intend to cover under any benefit. If you are adding dependents to your benefit plans outside of annual open enrollment or your new hire enrollment, you must provide the following verification documentations to The Local within 30 days of Qualifying Event.

Qualifying Events

Other than the annual Open Enrollment Period, you cannot make changes to your coverage during the year unless you experience a change in family status, such as:

1. Loss or gain of coverage through your spouse (Retirees cannot add spouse through a qualifying event)

2. Loss of eligibility of a covered dependent 3. Death of your covered spouse or child 4. Birth or adoption of a child 5. Marriage, divorce, or legal separation

Dependent Required Documentation

Spouse Marriage License

Domestic Partner Domestic Partner Affidavit, Copy of Joint Tax Return or Bank Acct.

Natural Children Birth Certificate

Step Children Birth Certificate and Marriage License showing both parents’ names

Dependent Child(ren): Legal guardian, adopted or foster

Birth Certificate, Final Court Order of legal guardianship with judge’s signature and/or final adoption decree with judge’s signature


Where can I get more information about my benefits?

Important phone numbers

Carrier information

Provider & facility searches

Employee benefit news

Important documents

Videos about specific benefits

MyOKCFFBenefits.com

Have you ever had trouble locating information about your benefits? What about trying to remember how to find a participating doctor or dentist? Not to worry, with

MyOKCFFBenefits.com you are just an internet connection away...


Important Enrollment Information Steps to Enroll Online:

1. Go to www.myOKCFFBenefits.com

2. Click on the ENROLL button

3. To access the system, you will enter your USERNAME, which is the 1st 6 letters of your last name, 1st initial of your first name, and last 4 digits of your social security number (all lowercase).

4. The first time you access the system, you will use you SOCIALSECURIY NUMBER as your temporary PASSWORD: xxxxxxxxx. The system will then prompt you to create your own password. Please write this down as you will need it to get back into the system throughout the plan year.

5. If you need assistance logging in or have forgot-ten your password, you can email BenefitHelp at [email protected].

What You Need to Do Enroll in Benefits.

1. Review the benefits available and determine which plans best meet your needs.

2. Review the family members you want covered. During your enrollment period, you are verifying that your dependents meet OKCFF’s benefit eligibility requirement. You may be required to provide supporting documentation.

3. Ensure all your personal information such as address, phone, email, etc. are updated and correct.

HHow to Enroll in Benefits


Flat Dollar Year 2015 $325 $162.50 2% 2016 $695 $347.50 2.5%

HHealth Care Reform Changes

The Patient Protection and Affordable Care Act, (also known as Health Care Reform or the Affordable Care Act), was enacted on March 23, 2010, and has been amended many times already. In its current form, the law has resulted in a steady stream of regulations and guidance, as various governmental entities clarified employers’ requirements under the law over the past three years. The aspect of the legislation that will affect you as an individual is known as the Individual Mandate. Most Americans are re-quired to purchase health insurance coverage that meets a certain minimum standard. If such coverage is not purchased, individuals will pay an additional tax on his or her personal income tax return.

As your employer, we continue to implement provisions to comply with the requirements of the health care reform law. This summary focuses on the changes that affect you as an individual, as well as, changes in the benefit programs we offer in 2017.

We encourage you to pay careful attention to your health care benefits so you can keep up with the changes.

Essential Health Benefits Maximum Out-of-Pocket Limits The Affordable Care Act (ACA) establishes a maximum annual out-of-pocket amount for in-network Essential Health Benefits (EHBs).

The categories of essential health benefits are:

Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive services and chronic disease management Pediatric services, including oral and vision care

What coverage must I carry to avoid paying a penalty?

Nearly all Americans are required to carry “minimum essential coverage” or pay a penalty. Most employer sponsored group health insurance qualifies as minimum essential coverage, as do governmental coverage (like Medicare, Medicaid, CHIP and TRICARE), retiree coverage, COBRA coverage and individual policies.

The coverage we offer you qualifies as minimum essential coverage. If you decide not to take our coverage, the penalty amount applies if you go without minimum essential coverage for at least nine months (you cannot have a gap in coverage for more than a continuous three-month period). The penalty assessed when you file your taxes will be the greater of a flat dollar amount or a percentage of income.

The impact of Health Care Reform requires you to take action. Enroll yourself in minimal essential coverage or pay a penalty.


Do I have to take the coverage my employer offers me?

No. But you should be aware that in most cases, the election you make is considered irrevocable and cannot be reversed if you change your mind. If you decide not to take employer-sponsored coverage, you should purchase coverage elsewhere, such as through a health insurance exchange, discussed next.

In some cases you could experience either a HIPAA special enrollment right or qualifying event that would allow you to enroll in our coverage midyear. Examples might include if you get married, have a baby or adopt a child midyear, qualify for premium assistance through CHIP or lose coverage (through Medicaid or another employer sponsored plan). Importantly, not paying premiums for an individual policy or having a change in financial condition will not allow you to join our plan midyear. Ask your Employee Benefits representative for more information about this. In all cases, we are not permitted to retaliate against you for choosing to enroll in coverage somewhere other than our plan.

Where can I get coverage if I don’t want my employer’s coverage?

The federal government and states set up online public health insurance exchanges. You may hear these referred to as marketplaces. There are also many private exchanges and marketplaces. Some states have already created marketplaces.

Importantly, the public exchanges set up and administered by the federal government and the states are the only avenue for qualifying employees to receive assistance with paying premiums and reducing other cost-sharing normally associated with health insurance (including deductibles, co-payments and co-insurance) in the form of advance tax credits and subsidies.

These are not available in private exchanges. Income parameters and other eligibility requirements apply to qualify for a tax credit or subsidy. To qualify for subsidies, an employee must have household income of between 100 percent and 400 percent of the federal poverty line. Plus, the cost of health insurance premiums must exceed 9.56 percent of household income.

What should I consider when deciding whether to enrolling coverage offered through my employer versus an exchange?

Employer-sponsored coverage is generally subsidized by the employer offering the coverage. This means the cost to you is most likely less than it would be if you purchased it on your own. In many cases, the amount of the employer contribution is more than the federal subsidy or tax credit that you would qualify for through a public exchange. Another reason to consider keeping employer-sponsored coverage is the tax implications of paying for coverage on your own. Coverage purchased through a public exchange cannot be paid on a pre-tax basis. However, paying for coverage offered through your employer can be done on a pre-tax basis. Depending on the amount of premiums paid and your individual effective tax rate, you may see a significant savings in your taxes by paying for employer-sponsored coverage on a pre-tax basis. Finally, allowing us, as your employer, to handle the design choices and narrow down the network of providers, as well as issue the required tax filings, can relieve you of many of the tasks that are inherent when purchasing coverage on your own.

HHealth Care Reform Changes


MMedical Plan Comparisons

ACTIVE EMPLOYEES Blue Lincs HMO

Blue Choice HCA

Blue Choice PPO

Deductible

Individual (In-Network / Out of Network) Family (In-Network / Out of Network)

$0 $0

* $2,000 / $3,000 * $4,000 / $6,000

$250 / $300 $500 / $900

Out of Pocket Maximum


$2,000 $4,000

$3,000 / $6,000 $6,000 / $8,000

$5,100 $10,200

Coinsurance (In-Network / Out of Network) 80% 80% / 60% 90% / 70%

Office Visits / Services

Primary Care Physician Specialist

$20 copay $20 copay

Deductible + Coinsurance Deductible + Coinsurance

$15 copay $15 copay

Emergency Room $75 copay

Deductible + Coinsurance $50 copay + coinsurance

Prescription Drug Benefit

Deductible

Generic

Preferred Brand

Non-Preferred Bran

Specialty

NA

$15

$45

$75

$150

NA

$10

$30

$50

$150

NA

$15

$30

$30

$150

Monthly Wellness Rates**

Employee Only

Employee + Spouse

Employee + Child(ren)

Employee + Family

$128.69

$226.71

$201.53

$440.89

$33.09

$169.18

$151.72

$253.74

$144.08

$255.39

$226.64

$430.79

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage

will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.

Your Medical Benefits Summary

* VEBA pays the first $1,000 toward Individual Deductible and the first $2,000 toward the Family Deductible.

** Non-Wellness Rates ADD $25


MMedical Plan Comparisons

RETIREES Blue Lincs HMO

Blue Choice HCA

Blue Choice PPO

Deductible


$0 $0

* $2,000 / $3,000 * $4,000 / $6,000

$250 / $300 $500 / $900

Out of Pocket Maximum


$2,000 $4,000

$3,000 / $6,000 $6,000 / $8,000

$5,100 $10,200

Coinsurance (In-Network / Out of Network) 80% 80% / 60% 90% / 70%

Office Visits / Services

Primary Care Physician Specialist

$20 copay $20 copay

Deductible + Coinsurance Deductible + Coinsurance

$15 copay $15 copay

Emergency Room $75 copay Deductible + Coinsurance $50 copay + coinsurance

Prescription Drug Benefit

Deductible

Generic

Preferred Brand

Non-Preferred Bran

Specialty

NA

$15

$45

$75

$150

NA

$10

$30

$50

$150

NA

$15

$30

$30

$150

Monthly Wellness Rates**

Employee Only

Employee + Spouse

Employee + Child(ren)

Employee + Family

$356.93

$736.17

$638.75

$1,206.25

$290.76

$590.97

$513.45

$966.54

$356.28

$727.03

$631.29

$1,190.87



Your Medical Benefits Summary

* VEBA pays the first $1,000 toward Individual Deductible and the first $2,000 toward the Family Deductible.

** Non-Wellness Rates ADD $25


DDental Plans

Benefits Benefits

$1,500 $1,500 $2,000 $2,000

100%

100%

100%

100%

Sealants

Labs and Tests

100%

100%

100%

100%

80% 80% 90% 90%

Anesthesia

80%

80%

90%

90%

Root canal therapy Retrograde filling Root amputa on / hemisec on

80%

80%

90%

90%

Periodontal scaling and root planning Full mouth debridement

80%

80%

90%

90%

80% 80% 90% 90%

50% 50% 60% 60%

Bridges and dentures

50%

50%

60%

60%

50% 50% 50% 50%

$1,500 $1,500 $1,500 $1,500

Your Dental Benefits Summary




VVoluntary Vision Plan NEW BENEFIT

Co-Pays

Exam $10

Materials $25

Contact Lens Fi ng $60

(standard & specialty)

Save with VSP Coverage Without VSP Coverage

With VSP Coverage

Eye-Exam $163 $10 Frame Single Vision Lenses

$150 $ 90

$25

Photochromic Adap ve Lenses $109 $70 An -Reflec ve Coa ng $113 $69 Member-Only Annual Contribu on N/A $65.40 Total $625 $239.40

Get up to $110 back Members can save big with VSP exclusive mail-in rebates on eligible popular contact lens brands from Bausch + Lomb and CooperVision.

$500 savings on LASIK Members can save up to $500 on LASIK at NVision Eye Centers and TLC Laser Eye Centers.

Save up to $2,500 With Exclusive Member Extras, members can save more than $2,500 with special offers and rebates through VSP and other leading industry partners.

Services / Frequency

Exam 12 months

Frame 24 months

Contact Lens Fi ng 12 months

Lenses & Contact Lenses

12 months

Your VSP Vision Benefits Summary

High Quality Vision Care. You’ll get the best care from a VSP provider, including a WellVision Exam, the most comprehensive exam designed to detect eye and health condi ons.

Choice of Providers. The decision is yours to make. Choose a VSP doctor, a par cipa ng retail chain, or any out-of-network provider.

Great Eyewear. It’s easy to find the perfect frame at a price that fits your budget.

Average Annual Savings with a VSP Provider: $385.60

Benefit Descrip on Copay Frequency

Your Coverage with a VSP Provider


Oklahoma City Fire Fighters provides basic life insurance to help protect the employee’s family in the event of a death. The employee is also eligible to purchase additional life insurance for himself / herself, and dependent life insurance for a spouse and/or dependent children. The Hartford is OKCFF’s administrator for Group Term Life insurance plan benefits. Eligible Classes for Coverage All Full-Time Active Employees who are citizens or legal residents of the United Sates, its territories and protectorates, excluding temporary, leased or seasonal Employees. Class 1 All Full-Time Active Members of Local 157 Oklahoma City Fire Fighters Class 2 All Retirees on or after 1/1/03 who were members of Local 157 Oklahoma City Fire Fighters Full-Time Employment Eligible members must work at least 32 hours weekly Eligibility Waiting Period for Coverage The first day of the month following 30 days of employment.

Employee Benefit OKCFF provides $15,000 in basic life insurance at no additional cost.

Retiree Benefit OKCFF provides $10,000 in basic life insurance at no additional cost.

BBasic Life Insurance

Benefit Reduction Life Insurance Benefits will be reduced by the percentage indicated in the table below. This reduction will be effective on the date You attain ages shown below. The reduction will apply to the Amount of Life Insurance in force immediately prior to the Anniversary Date.

Reductions also apply if: 1. You become covered under The Policy; or 2. Your coverage increases on or after the date You attain age 65.

Your Age % Reduc on

65 35%

70 55%

75 70%

80 80%

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that

describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.

Your Basic Life Insurance Summary

Controlling provisions are provided in the policy, and this


SSupplemental Term Life

Class 2: Retirees Maximum Amount: 50% of the Supplemental Amount of Life Insurance You had as an Active Employee, not to exceed a maximum of $25,000.

Oklahoma City Fire Fighters offers you ability to purchase additional supplemental life insurance for you and your spouse, offered through The Hartford. Eligible Classes for Coverage All Full-Time Active Employees who are citizens or legal residents of the United Sates, its territories and protectorates, excluding temporary, leased or seasonal Employees. Eligibility Waiting Period for Coverage The first day of the month following 30 days of employment. Class 1 All Full-Time Active Members of Local 157

Oklahoma City Fire Fighters Class 2 All Retirees on or after 1/1/03 who were members

of Local 157 Oklahoma City Fire Fighters Supplemental Dependent Life Insurance Class 1 All Full-time Active Members of Local 157

Oklahoma City Fire Fighters choosing Dependent Option 1

Class 2 All Retirees of Local 157 Oklahoma City Fire Fighters choosing Dependent Option 1

Class 3 All Full-time Active Members of Local 157 Oklahoma City Fire Fighters choosing Dependent Option 2

Class 4 All Retirees of Local 157 Oklahoma City Fire Fighters choosing Dependent Option 2

Class 5 All Full-time Active Members of Local 157

Oklahoma City Fire Fighters choosing Dependent Option 3

Class 6 All Retirees of Local 157 Oklahoma City Fire

Fighters choosing Dependent Option 3 Class 1: Active Employees Guaranteed Issue Amount: $20,000, subject to a maximum of $50,000 and a minimum of $10,000. Maximum Amount: $10,000, subject to a maximum of $100,000 and a minimum of $10,000

Supplemental Amount of Dependent Life Insurance

Op on 1: Spouse Dependent Children: Age 14 day(s) but under age 6 month(s) Dependent Children: Age 6 month(s) but under age 21 year(s)

Maximum Amount $15,000 $1,000

$5,000



$4,000



$2,000

Benefit Reduction The amount of Spouse Supplemental coverage may never exceed 100% of the Supplemental Amount of Life Insurance in force for the Employee

Your Age % Reduc on Your Spouse

65 35% 35%

70 55% 55%

75 70% 70%

80 80% 80%

Your Supplemental Life Insurance Summary

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.


BENEFIT PACKAGE OPTIONS Low Plan High Plan

Immunotherapy, Radiation, Chemotherapy Pays actual charges, maximum $5,000 per month

Pays actual charges, maximum $10,000 per month

Cancer Screening Test Pays $50 per calendar year

Pays $100 per calendar year

First Occurrence Benefit (Rider) Pays $2,500 Pays $10,000

Daily Hospital Confinement Benefit Pays $150 per day

Pays $300 per day

Surgical Benefit Pays maximum per surgery

$3,000

Pays maximum per surgery

$4,000

CCancer Care Plus Your Cancer Care Plus Benefits Summary

HOSPITAL AND OTHER FACILITY BENEFITS

Prescribed Drugs and Medications Actual charges up to maximum of 20% of the Daily Hospital Confinement Benefit

Physician's Attendance $50 per day

Ambulance $250 per trip 3 trips per year

Private Duty Nurse Service $150 per day

Extended Benefits $1,000 per day

Government or Charity Hospital $200 per day

Extended Care Facility $100 for each day confined to a maximum of 70 days

Hospice Care $100 per day

TRANSPORTATION BENEFITS

Transportation and Lodging for Bone Marrow Donors Actual charges to $2,500 for medical expenses related to transplant. Actual charges for round trip coach fare on common carrier or personal auto allowance of $0.50 per mile max 700 miles. Actual charges to $75 per day lodging and meal expense.

Transportation for Non-Local Treatment Requiring Hospital Confinement

Actual charges for round trip coach fare on common carrier or personal auto allowance of $0.50 per mile max 700 miles.

Transportation and Lodging for Non-Local Treatment Not Requiring Hospital Confinement

Actual charges for round trip coach fare on common carrier or personal auto allowance of $0.50 per mile max 700 miles. Maximum of $1,500 per calendar year.

Adult Companion Transportation and Lodging Actual charges for one adult companion to be near a covered person who is hospital confined in a non-local hospital. Max of $2,500 per confinement. Actual charges to $50 per day for lodging. Actual charges for round trip coach fare on common carrier or personal auto allowance of $0.50 per mile max 700 miles.


NNEW Cancer Care Plus

SURGICAL BENEFITS

Anesthesia Pays 25% of the surgical benefit amount

Additional Surgical Opinions $200 each opinion

Artificial Limb and Prosthesis Actual charges up to $1,500

Outpatient Surgery Benefit Pays $375 per operation for drugs, medicines and lab tests Pays a maximum of 150% of surgery shown in surgical

schedule

Skin Cancer Pays $150 per calendar year. Maximum benefit of $600

Breast Reconstruction / Breast Prosthesis Pays actual charges. Except in OK, lifetime maximum of $5,000

Bone Marrow Transplant for Cancer Pays actual charges, lifetime maximum of $10,000. Surgical Benefits

OTHER BENEFITS

Experimental Treatment Pays actual charges, to a lifetime maximum of $10,000

Physical, Occupational or Speech Therapy $50 each session to a lifetime maximum of $1,500

Outpatient Positive Diagnostic Test $250 for a diagnostic test

Blood and Blood Plasma Pays actual charges, to a maximum of $5,000 per calendar year

Home Health Care Services Pays $60 per day at home services, 180 days max per calendar year. Pays $150 per day at home private duty

nursing, 15 days max per calendar year. Pays $50 per day at home physician visits, 15 days max per calendar year.

Hairpiece Benefit Pays $100

Rental or Purchase of Durable Medical Equipment Pays actual charges, maximum $1,000 per calendar year.

Professional Mental Health Consultation $50 per session. Lifetime maximum of $250

Tutor $25 per 60 minute. Lifetime maximum of 50 sessions.

OPTIONAL RIDERS (AT ADDITIONAL COST)

Intensive Care Rider Benefit for Step Down Unit

Pays $600 per day Pays $300 per day

Critical Care Benefit Rider

Benefit For Heart Disease Benefit for Heart Attack / Stroke

Pays actual charges to a lifetime maximum of $2,500 Pays actual charges to a lifetime maximum of $5,000



Your Cancer Care Plus Benefits Summary


PPersonal Accident Plan

Benefit Description One-Unit Two-Unit

Air Ambulance Air transportation within 48 hours1. Once per Covered Accident.

$500

$500

Ambulance

Ground transportation within 90 days. Once per Covered Accident.

$100

$100

Accidental Death Within 90 days1 of covered accident, and

caused by resulting injury/ injuries.2 $25,000 Employee $10,000 Spouse3

$5,000 Child

$50,000 Employee $20,000 Spouse3

$10,000 Child

Accidental Death (Via Common Carrier)

Death must occur within 90 days1 of covered accident while fare-paying passenger on a common carrier (plane, bus, train).2

Accidental Benefit will be

doubled

Accidental Benefit will be

doubled

Emergency Room Treatment

Treatment sought within 72 hours1 of Covered Accident.

$200

$200

Hospital Admission Confined within 180 days. Once

per Covered Accident. (minimum of 20 hours)

$500

$1,000

Hospital Confinement

Confined within 180 days. Maximum of 90 days.

$100 per day

$200 per day

Hospital Intensive Care Unit

Within 30 days of Covered Accident. Maximum of 15 days.

$200 per day

$400 per day

Major Diagnostic Exams Angiogram, CT and CTA scan; MRI, MRA or EEG as result of a Covered Accident.

$100 per calendar

year

$200 per calendar

year

Physicians Office / Urgent Care

Within 60 days of Covered Accident. Once per Covered Accident.

$50

$50

Blood, Plasma & Platelets

Transfusion, administration, cross- matching, typing and processing required within 90 days of a Covered Accident. Once per Covered Accident.

$300 primary insured $200 spouse3/dep child

$300 primary insured $200 spouse3/dep child

Your 24 Hour Accident Benefits Summary

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made

available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.


Benefit Description One-Unit Two-Unit

Burn

Treated within 72 hours1 of a Covered Accident.

Once per Covered Accident.

*Spouse2 and Child

$375/150* for 2nd degree burns on at least 36% of the

body

$750/300* for 3rd degree burns on at least 1% but less

than 20% of the body

$5,000/2,000* for 3rd degree burns on 20% or more of the

body

$750/300* for 2nd degree burns on at least 36% of the

body

$1,500/600* for 3rd degree burns on at least 1% but less

than 20% of the body

$10,000/4,000* for 3rd degree burns on 20% or more of the

body

Emergency Dental Work

Once per Covered Accident regardless of teeth involved.

$150 repairs with crown $50 for extraction

$300 repairs with crown $100 for extraction

Dislocation (separated joint)

Diagnosed within 90 days, correction with anesthesia by Physician and corrected by Open (surgical) or Closed (non-surgical) reduction.

$50 - $2,000 (policy contains complete schedule)

$100 - $4,000 (policy contains complete

schedule)

Fracture (broken bone)

Fractures requiring Surgical or Non- Surgical reduction within 90 days of Covered Accident.

$25 - $2,500 (any Insured) (policy contains

complete schedule)

$50 - $5,000 (any Insured) (policy contains

complete schedule)

Gunshot Wounds

Unintentional wound requiring confinement within 24 hours and surgery within 72 hours after the injury. Primary insured only.

$500

$500

Laceration Lacerations requiring repair by a physician

within 72 hours of a Covered Accident.1 $50 - $400

based on length of lacerations, $100 - $800

based on length of lacerations,

Lodging Companion Lodging when Insured is

confined to a hospital more than 100 miles from home. Maximum of 30 days

$100 per night

$100 per night

Eye Injury Treated by a physician within 90 days of

Covered Accident. Must require surgery or removal of a foreign object.

$200

$200

Knee Cartilage - Torn

Treated by a physician within 60 days of Covered Accident. Must be repaired within 180 days.

$500 arthroscopic surgery

$100 for exploratory surgery

$1,000 arthroscopic surgery


Transportation Round trip when hospital confined and distance is more than 100 miles round trip from residence. Three round trips per Covered Accident.

$300 round trip

$300 round trip

Surgery

Within 72 hours after a Covered Accident to repair internal injuries caused by the Covered Accident. Except in VA, hernia repair not covered. Once per Covered Accident.

$1,000 for thoracic, open ab-dominal


$1,000 for thoracic, open abdominal


NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made

available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.



Benefit Description Amount

Epidural Pain Management

Payable when a Covered Person is prescribed, receives and incurs a charge for an epidural administered for pain management in a hospital or a physician’s office for Off-the-Job Injuries sustained in a Covered Accident. This benefit is not payable for an epidural administered during a surgical procedure.

$100 paid no more than twice per Covered Accident, per

Covered Person.

Physical Therapy

Payable when a Covered Person receives emergency treatment for Off-the-Job Injuries sustained in a Covered Accident and later a physician advises the Covered Person to seek treatment from a licensed physical therapist. Physical therapy must be for Off-the- Job Injuries sustained in a Covered Accident and must start within 30 days of the Covered Accident or discharge from hospital. The treatment must take place within six months after the accident.

$35 per treatment per day, to a maximum of ten treatments per Covered Accident, per Covered

Person.

Rehabilitation Unit

Payable when a Covered Person is admitted for a Hospital Confinement and is transferred to a bed in a rehabilitation unit of a hospital for treatment of Off-the-Job Injuries sustained in a Covered Accident and a charge is incurred. The Rehabilitation Unit Benefit will not be payable for the same day(s) that the Accident Hospital Confinement Benefit is paid. The highest eligible benefit will be paid. No lifetime maximum.

$150 per day, limited to 30 days for each Covered Person per

period of Hospital Confinement and limited to a calendar year

maximum of 60 days.

Prosthesis

Payable when a Covered Person requires use of a prosthetic device as a result of Off-the-Job Injuries sustained in a Covered Accident. This benefit is not payable for repair or replacement of prosthetic devices, hearing aids, wigs, or dental aids, to include false teeth.

$750 once per Covered Accident, per Covered

Person.

Accidental Dismemberment

We will pay the applicable lump sum benefit indicated in the policy for dismemberment. Dismemberment must occur as a result of Off-the-Job Injuries sustained in a Covered Accident and must occur within 90 days of the accident.2 Only the highest single benefit per Covered Person will be paid for dismemberment. Benefits will be paid only once per Covered Person, per Covered Accident. If death and dismemberment result from the same accident, only the Accidental Death Benefit will be paid. Loss of use does not constitute dismemberment, except for the eye injuries resulting in at least 80% of vision that is permanently lost. See schedule in policy.

$625 - $40,000

Appliances

Payable when a Covered Person receives a medical appliance, prescribed by a physician, as an aid in personal locomotion for Off-the-Job Injuries sustained in a Covered Accident. Benefits are payable for the following types of appliances: a wheelchair, a leg brace, a back brace, a walker, and/or a pair of crutches.

$125 per Covered Accident,

per Covered Person.

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will

be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.



VVoluntary Term Life

NOTE: This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will

be made available to you that describes the benefits in greater details. Should there be a difference between this summary and the contract, the contract will govern.

Additional Term Life Insurance

These Policies Include:

Guarantee Issue Death Benefit of up to $100,000 Coverage for you, your spouse and your children Two Terms to Choose From: 10 Year or 20 Year Level Term You Own The Policy– Coverage is Portable

Cincinnati Life’s term life insurance policies are designed to enhance your group life coverage by offering additional

financial protection for your family during your working years. Premiums are guaranteed for the first 10 or 20 years of the policy, depending on the term you choose. After the end of the term period, premiums will increase annually through age 100.

Your insurance needs may change in the future. That’s why your term life insurance policy provides you with an option to convert, without evidence of insurability, to one of Cincinnati Life’ s currently marketed, individual, permanent life insurance policies.

UP TO Coverage for you and your spouse

You may apply for a term life insurance policy on you and your spouse. Available issue ages for Term 10 are 18-70. Available issue ages for Term 20 are 18-60.

GUARANTEE ISSUE AVAILABLE UP TO

$100,000

Children’s Term Rider

You can cover your children, stepchildren and legally adopted children when attached to either your policy or your spouse’s policy. One premium covers all children, each with a death benefit of $10,000

You own the policy

Cincinnati Life’s Term 10 and Term 20 life insurance policies provide individual coverage. You are the owner of the policy and you can take it with you if you leave your employer.

Do You Need More Than $100,000 of Coverage? You can purchase additional life insurance above the $100,000 with Cincinnati Life’s Termsetter Term Life Insurance policy. This plan is fully underwritten, but features:

10 or 20 Year Level Terms

Available Death Benefit from $100,000 to $1,000,000

Guaranteed Level Premium & Death Benefit

Guaranteed Renewable to age 99


CCigna Heart / Stroke Plan

The costs associated with an unexpected heart attack, stroke or other heart-related surgery can be overwhelming. With our Flexible Choice Heart Attack & Stroke Insurance Policy, you can receive a percentage of a $10,000 lump sum benefit, should you receive a diagnosis or procedure for one of the qualifying events listed below, subject to the maximum benefit amount.

Heart Attack & Stroke Restoration

The extra coverage provided by this rider will pay a percentage of your selected benefit amount should you suffer subsequent heart attacks, strokes or require a heart transplant (not to exceed an additional 100% of the selected benefit amount) provided the date of your last diagnosis for a heart attack, stroke or heart transplant was at least two years from your current diagnosis.

The thought of having a heart attack is alarming, but the truth is, it can happen to anyone. Recovery is important. This policy provides a lump sum benefits help you focus on getting well so that you can be 100% you.

Your Heart Attack & Stroke Policy

100%

Heart A ack 100% Heart Transplant 100% Stroke 100% Coronary Artery Bypass Surgery* 25% Aor c Surgery* 25% Heart Valve Replacement/Repair* 25% Angioplasty* 10% Stent* 10%

% of Benefit amount

payable for each event

Max. % of Benefit amount payable Qualifying Events

For example, your guarantee issue benefit amount is $10,000 and you needed an Aortic Surgery, you would receive 25%, or $2,500. If you then suffered a stroke, you would receive the remaining balance amount of $7,500 for a total of 100% of your maximum benefit amount, or $10,000.

100% 75%

25% 0%

Less than 2 2 or more but 5 or more but 10 or more less than 5 less than 10 Years Since Last Heart Attack, Stroke or Heart Transplant



Our Base Policies Provide:

Guarantee Issue lump sum benefit of $10,000 to use any way you like Coverage for you, your spouse and/or your family Issue ages from 18 – 99 Guaranteed Renewable for Life*

No Surprises

The Flexible Choice policy pays regardless of any other insurance you may have, and the benefits are paid directly to you, or your designee, to use any way you like.

$10,000 LUMP SUM BENEFIT GUARANTEEED ISSUE


NNEW BENEFIT Cigna Cancer Plan

Cancer Recurrence Benefit Rider

If you are concerned with a recurring diagnosis of cancer, our Cancer Recurrence Benefit Rider may pay you additional benefits should you receive subsequent diagnoses of cancer. You will receive a percentage of your benefit amount (not to exceed an additional 100% of the selected benefit amount) upon additional diagnoses of cancer provided you have not received advice or treatment for at least two years from the date of your last diagnosis.

Your Cancer Policy

Cancer 100% Carcinoma in Situ

% of Selected Benefit Amount Lump Sum Cancer Coverage

100% 75%

25% 0%

Less than 2 2 or more but 5 or more but 10 or more less than 5 less than 10 Years Without Advice or Treatment

Our Base Policies Provide:

Guarantee Issue lump sum benefit of $10,000 to use any way you like Coverage for you, your spouse and/or your family Issue ages from 18 – 99 Guaranteed Renewable for Life*

No Surprises

The Flexible Choice policy pays regardless of any other insurance you may have, and the benefits are paid directly to you, or your designee, to use any way you like.

$10,000 LUMP SUM BENEFIT GUARANTEEED ISSUE

A cancer diagnosis can occur at anytime regardless of your lifestyle. Lacking the proper cancer coverage to help pay for additional costs associat-with treatment can affect your recovery, so it’s beneficial to plan ahead. With our Flexible Choice Cancer Insurance Policy, you will receive 100% of your guaranteed issue $10,000 lump sum benefit amount, upon diagnosis of any cancer.




22017 Rates

COVERAGE SEMI MONTHLY

COVERAGE MONTHLY

$10,000 LUMP SUM SEMI MONTHLY

$10,000 Lump Sum Benefit

$10.75


COVERAGE MONTHLY


COVERAGE MONTHLY

COVERAGE MONTHLY


$10,000 LUMP SUM SEMI MONTHLY


$11.25

COVERAGE MONTHLY


Active Employees Retirees


22017 Rates 18-64

SEMI-MONTHLY 18-64

MONTHLY 65-69

MONTHLY Low Plan

Low Plan + CC Rider

Low Plan + ICU Rider

Low Plan + ICU & CC Rider

High Plan

High Plan + CC Rider

High Plan + ICU Rider

High Plan + ICU & CC Rider


Low Plan

$21.17

High Plan

COVERAGE MONTHLY

Low Plan

$42.33

High Plan

$51.00


Disability Rider

COVERAGE MONTHLY

Disability Rider

COVERAGE MONTHLY

Retiree + Spouse $0.00

COVERAGE MONTHLY

Retiree or Spouse Only $11.08

Retiree + Spouse


VVoluntary Term Life Non-Smoker Semi-Monthly Rates

10 YEAR LEVEL TERM RATES

Age $10,000 $25,000 $50,000 $75,000 $100,000 18 $2.73 $4.42 $6.11 $7.79 19 $2.75 $4.46 $6.17 $7.88 20 $2.77 $4.50 $6.23 $7.96 21 $2.81 $4.59 $6.36 $8.13 22 $2.86 $4.67 $6.48 $8.29 23 $2.94 $4.84 $6.73 $8.63 24 $3.02 $5.00 $6.98 $8.96 25 $3.15 $5.25 $7.36 $9.46 26 $3.18 $5.31 $7.45 $9.59 27 $3.21 $5.38 $7.54 $9.71 28 $3.24 $5.44 $7.64 $9.84 29 $3.27 $5.50 $7.73 $9.96 30 $3.30 $5.56 $7.83 $10.09 31 $3.34 $5.63 $7.92 $10.21 32 $3.37 $5.69 $8.01 $10.34 33 $3.40 $5.75 $8.11 $10.46 34 $3.44 $5.84 $8.23 $10.63 35 $3.47 $5.90 $8.33 $10.75 36 $3.66 $6.27 $8.89 $11.50 37 $3.87 $6.69 $9.51 $12.34 38 $4.09 $7.13 $10.17 $13.21 39 $4.31 $7.59 $10.86 $14.13 40 $4.58 $8.11 $11.64 $15.17 41 $4.85 $8.65 $12.45 $16.25 42 $5.15 $9.25 $13.36 $17.46 43 $5.46 $9.88 $14.29 $18.71 44 $5.80 $10.56 $15.32 $20.09 45 $6.18 $11.31 $16.45 $21.58 46 $6.70 $12.36 $18.01 $23.67 47 $7.26 $13.48 $19.70 $25.92 48 $7.89 $14.73 $21.57 $28.42 49 $8.59 $16.13 $23.67 $31.21 50 $4.36 $9.35 $17.65 $25.95 $34.25 51 $4.70 $10.18 $19.31 $28.45 $37.58 52 $5.06 $11.10 $21.15 $31.20 $41.25 53 $5.47 $12.11 $23.17 $34.23 $45.29 54 $5.91 $13.22 $25.40 $37.57 $49.75 55 $6.41 $14.45 $27.86 $41.26 $54.67 56 $6.94 $15.78 $30.52 $45.26 $60.00 57 $7.52 $17.24 $33.44 $49.64 $65.83 58 $8.17 $18.86 $36.67 $54.48 $72.29 59 $8.88 $20.63 $40.21 $59.79 $79.37 60 $9.66 $22.57 $44.10 $65.64 $87.17 61 $10.51 $24.71 $48.38 $72.04 $95.71 62 $11.45 $27.06 $53.08 $79.10 $105.12 63 $12.49 $29.65 $58.25 $86.85 $115.46 64 $13.62 $32.49 $63.94 $95.38 $126.83 65 $14.87 $35.62 $70.19 $104.76 $139.33 66 $16.29 $39.16 $77.27 $115.38 $153.50 67 $17.85 $43.06 $85.08 $127.10 $169.12 68 $19.57 $47.37 $93.69 $140.01 $186.33 69 $21.47 $52.10 $103.17 $154.23 $205.29 70 $23.56 $57.33 $113.62 $169.91 $226.20


VVoluntary Term Life

Age $10,000 $25,000 $50,000 $75,000 $100,000 18 $5.46 $8.83 $12.21 $15.58 19 $5.50 $8.92 $12.33 $15.75 20 $5.54 $9.00 $12.46 $15.92 21 $5.62 $9.17 $12.71 $16.25 22 $5.71 $9.33 $12.96 $16.58 23 $5.87 $9.67 $13.46 $17.25 24 $6.04 $10.00 $13.96 $17.92 25 $6.29 $10.50 $14.71 $18.92 26 $6.35 $10.62 $14.90 $19.17 27 $6.42 $10.75 $15.08 $19.42 28 $6.48 $10.87 $15.27 $19.67 29 $6.54 $11.00 $15.46 $19.92 30 $6.60 $11.12 $15.65 $20.17 31 $6.67 $11.25 $15.83 $20.42 32 $6.73 $11.37 $16.02 $20.67 33 $6.79 $11.50 $16.21 $20.92 34 $6.87 $11.67 $16.46 $21.25 35 $6.94 $11.79 $16.65 $21.50 36 $7.31 $12.54 $17.77 $23.00 37 $7.73 $13.37 $19.02 $24.67 38 $8.17 $14.25 $20.33 $26.42 39 $8.62 $15.17 $21.71 $28.25 40 $9.15 $16.21 $23.27 $30.33 41 $9.69 $17.29 $24.89 $32.50 42 $10.29 $18.50 $26.71 $34.92 43 $10.92 $19.75 $28.58 $37.42 44 $11.60 $21.12 $30.64 $40.17 45 $12.35 $22.62 $32.89 $43.16 46 $13.40 $24.71 $36.02 $47.33 47 $14.52 $26.96 $39.39 $51.83 48 $15.77 $29.46 $43.14 $56.83 49 $17.17 $32.25 $47.33 $62.41 50 $8.72 $18.69 $35.29 $51.89 $68.50 51 $9.39 $20.35 $38.62 $56.89 $75.16 52 $10.12 $22.19 $42.29 $62.39 $82.50 53 $10.93 $24.21 $46.33 $68.46 $90.58 54 $11.82 $26.44 $50.79 $75.14 $99.50 55 $12.81 $28.89 $55.71 $82.52 $109.33 56 $13.87 $31.56 $61.04 $90.52 $120.00 57 $15.04 $34.48 $66.87 $99.27 $131.66 58 $16.33 $37.71 $73.33 $108.95 $144.58 59 $17.75 $41.25 $80.41 $119.58 $158.74 60 $19.31 $45.14 $88.20 $131.27 $174.33 61 $21.02 $49.41 $96.75 $144.08 $191.41 62 $22.90 $54.12 $106.16 $158.20 $210.24 63 $24.97 $59.29 $116.50 $173.70 $230.91 64 $27.24 $64.98 $127.87 $190.76 $253.66 65 $29.74 $71.23 $140.37 $209.51 $278.66 66 $32.57 $78.31 $154.54 $230.76 $306.99 67 $35.70 $86.12 $170.16 $254.20 $338.24 68 $39.14 $94.73 $187.37 $280.01 $372.65 69 $42.93 $104.20 $206.33 $308.45 $410.57 70 $47.11 $114.66 $227.24 $339.82 $452.40

Non-Smoker Monthly Rates 10 YEAR LEVEL TERM RATES


VVoluntary Term Life Smoker Semi-Monthly Rates


Age $10,000 $25,000 $50,000 $75,000 $100,000 18 $3.89 $6.73 $9.58 $12.42 19 $3.95 $6.86 $9.76 $12.67 20 $4.01 $6.98 $9.95 $12.92 21 $4.10 $7.15 $10.20 $13.25 22 $4.17 $7.29 $10.42 $13.54 23 $4.24 $7.44 $10.64 $13.84 24 $4.31 $7.59 $10.86 $14.13 25 $4.39 $7.73 $11.07 $14.42 26 $4.49 $7.94 $11.39 $14.84 27 $4.59 $8.13 $11.67 $15.21 28 $4.70 $8.36 $12.01 $15.67 29 $4.80 $8.56 $12.32 $16.09 30 $4.92 $8.79 $12.67 $16.54 31 $5.03 $9.02 $13.01 $17.00 32 $5.16 $9.27 $13.39 $17.50 33 $5.27 $9.50 $13.73 $17.96 34 $5.40 $9.75 $14.11 $18.46 35 $5.53 $10.02 $14.51 $19.00 36 $5.92 $10.79 $15.67 $20.54 37 $6.34 $11.63 $16.92 $22.21 38 $6.79 $12.54 $18.29 $24.04 39 $7.28 $13.52 $19.76 $26.00 40 $7.83 $14.61 $21.39 $28.17 41 $8.40 $15.75 $23.11 $30.46 42 $9.03 $17.02 $25.01 $33.00 43 $9.72 $18.40 $27.07 $35.75 44 $10.46 $19.88 $29.29 $38.71 45 $11.27 $21.50 $31.73 $41.96 46 $12.26 $23.48 $34.70 $45.92 47 $13.36 $25.67 $37.98 $50.29 48 $14.55 $28.06 $41.57 $55.08 49 $15.87 $30.69 $45.51 $60.33 50 $7.55 $17.30 $33.56 $49.82 $66.08 51 $8.18 $18.88 $36.71 $54.54 $72.37 52 $8.87 $20.62 $40.19 $59.76 $79.33 53 $9.63 $22.51 $43.98 $65.45 $86.92 54 $10.46 $24.60 $48.15 $71.70 $95.25 55 $11.38 $26.89 $52.73 $78.57 $104.41 56 $12.29 $29.17 $57.29 $85.42 $113.54 57 $13.29 $31.65 $62.25 $92.85 $123.46 58 $14.36 $34.34 $67.65 $100.95 $134.25 59 $15.54 $37.27 $73.50 $109.73 $145.95 60 $16.81 $40.47 $79.90 $119.32 $158.75 61 $18.20 $43.94 $86.83 $129.73 $172.62 62 $19.71 $47.72 $94.39 $141.07 $187.74 63 $21.36 $51.83 $102.62 $153.41 $204.20 64 $23.15 $56.31 $111.58 $166.85 $222.12 65 $25.10 $61.19 $121.33 $181.47 $241.62 66 $27.20 $66.43 $131.81 $197.19 $262.58 67 $29.48 $72.12 $143.21 $214.29 $285.37 68 $31.96 $78.32 $155.60 $232.88 $310.16 69 $34.65 $85.06 $169.08 $253.10 $337.11 70 $37.58 $92.38 $183.72 $275.06 $366.40


VVoluntary Term Life Smoker Monthly Rates


Age $10,000 $25,000 $50,000 $75,000 $100,000 18 $7.77 $13.46 $19.15 $24.83 19 $7.90 $13.71 $19.52 $25.33 20 $8.02 $13.96 $19.90 $25.83 21 $8.19 $14.29 $20.40 $26.50 22 $8.33 $14.58 $20.83 $27.08 23 $8.48 $14.87 $21.27 $27.67 24 $8.62 $15.17 $21.71 $28.25 25 $8.77 $15.46 $22.14 $28.83 26 $8.98 $15.87 $22.77 $29.67 27 $9.17 $16.25 $23.33 $30.42 28 $9.40 $16.71 $24.02 $31.33 29 $9.60 $17.12 $24.64 $32.17 30 $9.83 $17.58 $25.33 $33.08 31 $10.06 $18.04 $26.02 $34.00 32 $10.31 $18.54 $26.77 $35.00 33 $10.54 $19.00 $27.46 $35.92 34 $10.79 $19.50 $28.21 $36.92 35 $11.06 $20.04 $29.02 $38.00 36 $11.83 $21.58 $31.33 $41.08 37 $12.67 $23.25 $33.83 $44.41 38 $13.58 $25.08 $36.58 $48.08 39 $14.56 $27.04 $39.52 $52.00 40 $15.65 $29.21 $42.77 $56.33 41 $16.79 $31.50 $46.21 $60.91 42 $18.06 $34.04 $50.02 $66.00 43 $19.44 $36.79 $54.14 $71.50 44 $20.92 $39.75 $58.58 $77.41 45 $22.54 $43.00 $63.46 $83.91 46 $24.52 $46.96 $69.39 $91.83 47 $26.71 $51.33 $75.96 $100.58 48 $29.10 $56.12 $83.14 $110.16 49 $31.73 $61.37 $91.02 $120.66 50 $15.09 $34.60 $67.12 $99.64 $132.16 51 $16.35 $37.75 $73.41 $109.08 $144.74 52 $17.74 $41.23 $80.37 $119.52 $158.66 53 $19.26 $45.02 $87.95 $130.89 $173.83 54 $20.92 $49.19 $96.29 $143.39 $190.49 55 $22.76 $53.77 $105.45 $157.14 $208.82 56 $24.58 $58.33 $114.58 $170.83 $227.07 57 $26.57 $63.29 $124.50 $185.70 $246.91 58 $28.72 $68.68 $135.29 $201.89 $268.49 59 $31.07 $74.54 $146.99 $219.45 $291.90 60 $33.62 $80.93 $159.79 $238.64 $317.49 61 $36.40 $87.87 $173.66 $259.45 $345.24 62 $39.42 $95.43 $188.78 $282.13 $375.48 63 $42.71 $103.66 $205.24 $306.82 $408.40 64 $46.30 $112.62 $223.16 $333.69 $444.23 65 $50.20 $122.37 $242.66 $362.94 $483.23 66 $54.39 $132.85 $263.61 $394.38 $525.15 67 $58.95 $144.24 $286.41 $428.57 $570.73 68 $63.91 $156.64 $311.20 $465.75 $620.31 69 $69.30 $170.12 $338.15 $506.19 $674.22 70 $75.16 $184.76 $367.44 $550.12 $732.80


VVoluntary Term Life Non-Smoker Semi-Monthly Rates


Age $25,000 $50,000 $75,000 $100,000 18 $3.41 $5.77 $8.14 $10.50 19 $3.41 $5.77 $8.14 $10.50 20 $3.41 $5.77 $8.14 $10.50 21 $3.41 $5.77 $8.14 $10.50 22 $3.41 $5.77 $8.14 $10.50 23 $3.41 $5.77 $8.14 $10.50 24 $3.41 $5.77 $8.14 $10.50 25 $3.41 $5.77 $8.14 $10.50 26 $3.44 $5.84 $8.23 $10.63 27 $3.47 $5.90 $8.33 $10.75 28 $3.50 $5.96 $8.42 $10.88 29 $3.54 $6.04 $8.54 $11.04 30 $3.60 $6.15 $8.70 $11.25 31 $3.67 $6.29 $8.92 $11.54 32 $3.76 $6.48 $9.20 $11.92 33 $3.89 $6.73 $9.58 $12.42 34 $4.04 $7.04 $10.04 $13.04 35 $4.23 $7.42 $10.61 $13.79 36 $4.44 $7.84 $11.23 $14.63 37 $4.64 $8.23 $11.82 $15.42 38 $4.86 $8.67 $12.48 $16.29 39 $5.10 $9.15 $13.20 $17.25 40 $5.37 $9.69 $14.01 $18.34 41 $5.68 $10.31 $14.95 $19.59 42 $6.05 $11.06 $16.07 $21.08 43 $6.49 $11.94 $17.39 $22.83 44 $7.00 $12.96 $18.92 $24.88 45 $7.61 $14.17 $20.73 $27.29 46 $8.10 $15.15 $22.20 $29.25 47 $8.69 $16.34 $23.98 $31.63 48 $9.40 $17.75 $26.11 $34.46 49 $10.20 $19.36 $28.51 $37.67 50 $11.12 $21.19 $31.26 $41.33 51 $12.15 $23.25 $34.36 $45.46 52 $13.30 $25.56 $37.82 $50.08 53 $14.55 $28.06 $41.57 $50.08 54 $15.89 $30.73 $45.57 $60.42 55 $17.27 $33.50 $49.73 $65.96 56 $18.61 $36.17 $53.73 $71.29 57 $19.90 $38.75 $57.60 $76.46 58 $21.30 $41.56 $61.82 $82.08 59 $23.02 $45.00 $66.98 $88.96 60 $25.19 $49.33 $73.48 $97.62


VVoluntary Term Life Non-Smoker Monthly Rates


Age $25,000 $50,000 $75,000 $100,000 18 $6.81 $11.54 $16.27 $21.00 19 $6.81 $11.54 $16.27 $21.00 20 $6.81 $11.54 $16.27 $21.00 21 $6.81 $11.54 $16.27 $21.00 22 $6.81 $11.54 $16.27 $21.00 23 $6.81 $11.54 $16.27 $21.00 24 $6.81 $11.54 $16.27 $21.00 25 $6.81 $11.54 $16.27 $21.00 26 $6.87 $11.67 $16.46 $21.25 27 $6.94 $11.79 $16.65 $21.50 28 $7.00 $11.92 $16.83 $21.75 29 $7.08 $12.08 $17.08 $22.08 30 $7.19 $12.29 $17.40 $22.50 31 $7.33 $12.58 $17.83 $23.08 32 $7.52 $12.96 $18.40 $23.83 33 $7.77 $13.46 $19.15 $24.83 34 $8.08 $14.08 $20.08 $26.08 35 $8.46 $14.83 $21.21 $27.58 36 $8.87 $15.67 $22.46 $29.25 37 $9.27 $16.46 $23.64 $30.83 38 $9.71 $17.33 $24.96 $32.58 39 $10.19 $18.29 $26.39 $34.50 40 $10.73 $19.37 $28.02 $36.67 41 $11.35 $20.62 $29.89 $39.17 42 $12.10 $22.12 $32.14 $42.16 43 $12.98 $23.87 $34.77 $45.66 44 $14.00 $25.92 $37.83 $49.75 45 $15.21 $28.33 $41.46 $54.58 46 $16.19 $30.29 $44.39 $58.50 47 $17.37 $32.67 $47.96 $63.25 48 $18.79 $35.50 $52.21 $68.91 49 $20.40 $38.71 $57.02 $75.33 50 $22.23 $42.37 $62.52 $82.66 51 $24.29 $46.50 $68.71 $90.91 52 $26.60 $51.12 $75.64 $100.16 53 $29.10 $56.12 $83.14 $100.16 54 $31.77 $61.46 $91.14 $120.83 55 $34.54 $67.00 $99.45 $131.91 56 $37.21 $72.33 $107.45 $142.58 57 $39.79 $77.50 $115.20 $152.91 58 $42.60 $83.12 $123.64 $164.16 59 $46.04 $90.00 $133.95 $177.91 60 $50.37 $98.66 $146.95 $195.24


VVoluntary Term Life Smoker Semi-Monthly Rates


Age $10,000 $25,000 $50,000 $75,000 $100,000 18 $3.89 $6.73 $9.58 $12.42 19 $3.95 $6.86 $9.76 $12.67 20 $4.01 $6.98 $9.95 $12.92 21 $4.10 $7.15 $10.20 $13.25 22 $4.17 $7.29 $10.42 $13.54 23 $4.24 $7.44 $10.64 $13.84 24 $4.31 $7.59 $10.86 $14.13 25 $4.39 $7.73 $11.07 $14.42 26 $4.49 $7.94 $11.39 $14.84 27 $4.59 $8.13 $11.67 $15.21 28 $4.70 $8.36 $12.01 $15.67 29 $4.80 $8.56 $12.32 $16.09 30 $4.92 $8.79 $12.67 $16.54 31 $5.03 $9.02 $13.01 $17.00 32 $5.16 $9.27 $13.39 $17.50 33 $5.27 $9.50 $13.73 $17.96 34 $5.40 $9.75 $14.11 $18.46 35 $5.53 $10.02 $14.51 $19.00 36 $5.92 $10.79 $15.67 $20.54 37 $6.34 $11.63 $16.92 $22.21 38 $6.79 $12.54 $18.29 $24.04 39 $7.28 $13.52 $19.76 $26.00 40 $7.83 $14.61 $21.39 $28.17 41 $8.40 $15.75 $23.11 $30.46 42 $9.03 $17.02 $25.01 $33.00 43 $9.72 $18.40 $27.07 $35.75 44 $10.46 $19.88 $29.29 $38.71 45 $11.27 $21.50 $31.73 $41.96 46 $12.26 $23.48 $34.70 $45.92 47 $13.36 $25.67 $37.98 $50.29 48 $14.55 $28.06 $41.57 $55.08 49 $15.87 $30.69 $45.51 $60.33 50 $7.55 $17.30 $33.56 $49.82 $66.08 51 $8.18 $18.88 $36.71 $54.54 $72.37 52 $8.87 $20.62 $40.19 $59.76 $79.33 53 $9.63 $22.51 $43.98 $65.45 $86.92 54 $10.46 $24.60 $48.15 $71.70 $95.25 55 $11.38 $26.89 $52.73 $78.57 $104.41 56 $12.29 $29.17 $57.29 $85.42 $113.54 57 $13.29 $31.65 $62.25 $92.85 $123.46 58 $14.36 $34.34 $67.65 $100.95 $134.25 59 $15.54 $37.27 $73.50 $109.73 $145.95 60 $16.81 $40.47 $79.90 $119.32 $158.75 61 $18.20 $43.94 $86.83 $129.73 $172.62 62 $19.71 $47.72 $94.39 $141.07 $187.74 63 $21.36 $51.83 $102.62 $153.41 $204.20 64 $23.15 $56.31 $111.58 $166.85 $222.12 65 $25.10 $61.19 $121.33 $181.47 $241.62 66 $27.20 $66.43 $131.81 $197.19 $262.58 67 $29.48 $72.12 $143.21 $214.29 $285.37 68 $31.96 $78.32 $155.60 $232.88 $310.16 69 $34.65 $85.06 $169.08 $253.10 $337.11 70 $37.58 $92.38 $183.72 $275.06 $366.40


VVoluntary Term Life Smoker Monthly Rates


Age $25,000 $50,000 $75,000 $100,000 18 $8.94 $15.79 $22.64 $29.50

19 $9.00 $15.92 $22.83 $29.75

20 $9.08 $16.08 $23.08 $30.08

21 $9.21 $16.33 $23.46 $30.58

22 $9.37 $16.67 $23.96 $31.25

23 $9.54 $17.00 $24.46 $31.92

24 $9.75 $17.42 $25.08 $32.75

25 $10.00 $17.92 $25.83 $33.75

26 $10.23 $18.37 $26.52 $34.67

27 $10.46 $18.83 $27.21 $35.58

28 $10.67 $19.25 $27.83 $36.42

29 $10.92 $19.75 $28.58 $37.42

30 $11.19 $20.29 $29.39 $38.50

31 $11.54 $21.00 $30.46 $39.92

32 $11.98 $21.87 $31.77 $41.67

33 $12.52 $22.96 $33.39 $43.83

34 $13.19 $24.29 $35.39 $46.50

35 $14.02 $25.96 $37.89 $49.83

36 $14.92 $27.75 $40.58 $53.41

37 $15.85 $29.62 $43.39 $57.16

38 $16.83 $31.58 $46.33 $61.08

39 $17.90 $33.71 $49.52 $65.33

40 $19.08 $36.08 $53.08 $70.08

41 $20.44 $38.79 $57.14 $75.50

42 $21.98 $41.87 $61.77 $81.66

43 $23.75 $45.41 $67.08 $88.75

44 $25.79 $49.50 $73.21 $96.91

45 $28.12 $54.16 $80.21 $106.25

46 $30.73 $59.37 $88.02 $116.66

47 $33.54 $65.00 $96.45 $127.91

48 $36.58 $71.08 $105.58 $140.08

49 $39.81 $77.54 $115.27 $152.99

50 $43.29 $84.50 $125.70 $166.91

51 $46.96 $91.83 $136.70 $181.58

52 $50.87 $99.66 $148.45 $197.24

53 $54.98 $107.87 $160.76 $213.66

54 $59.31 $116.54 $173.76 $230.99

55 $63.85 $125.62 $187.39 $249.16

56 $69.16 $136.24 $203.33 $270.41

57 $74.89 $147.70 $220.51 $293.32

58 $81.00 $159.91 $238.82 $317.74

59 $87.52 $172.95 $258.39 $343.82

60 $94.43 $186.78 $279.13 $371.49


provide you with certain rights with respect to your protected health information;

provide you with a copy of this Notice of our legal duties and privacy practices with respect to your protected health infor-mation; and

follow the terms of the Notice that is currently in effect.

We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we maintain, as allowed or required by law. If we make any material change to this Notice, we will mail a copy of our revised Notice of Privacy Practice to you within 60 days of such change.

How We May Use and Disclose Health Information About You

Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following are the different ways we may use and disclose your protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.


For Treatment. We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about your prior prescriptions to a pharmacist to determine if prior prescriptions contraindicate a pending prescription.

For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a treatment is experimental, investigational, or medically necessary, or, to determine whether the Plan will cover the treat-ment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information about conducting quality assessment and improvement activities. These activities include underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and, business management and general Plan administrative activities.

To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. To perform these functions or to provide these services, Business Associates will receive, create, maintain, use and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims or to provide support services, such as utilization management, pharmacy benefit management or subrogation, but only after the Business Associate enters a Business Associate Agreement with us.

As Required by Law. We will disclose your protected health information when required to do so by federal, state or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws.

To Avert a Serious Threat to Health or Safety. We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.

To Plan Sponsors. For administering the plan, we may disclose to certain employees of the Company protected health infor-mation. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for employment purposes without your specific authorization.

SPECIAL SITUATIONS. In addition to the above, the following categories describe other possible ways that we may use and disclose your protected health information. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories

Organ and Tissue Donation. If you are an organ donor, we may release your protected health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the armed forces, we may release your protected health information as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.


Workers' Compensation. We may release your protected health information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose your protected health information for public health actions. These actions generally include the following:

- to prevent or control disease, injury, or disability;

- to report births and deaths;

- to report child abuse or neglect;

- to report reactions to medications or problems with products;

- to notify people of recalls of products they may be using;

- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and

- to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make the disclosure if you agree, or when required or authorized by law.

Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tel l you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may disclose your protected health information if asked to do so by a law enforcement official or any of the following:

- in response to a court order, subpoena, warrant, summons or similar process;

- to identify or locate a suspect, fugitive, material witness, or missing person;

- about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim's agreement;

- about a death that we believe may be the result of criminal misconduct; and

- about criminal conduct.

Coroners, Medical Examiners and Funeral Directors. We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities. We may release your protected health information to authorized federal offices for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates. If you are an inmate of a correctional institution or are in the custody of a law enforcement official, we may disclose your protected health information to the correctional institution or law enforcement official if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Research. We may disclose your protected health information to researchers when: (1) the individual identifiers have been removed; or (2) when an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information, and approves the research.


REQUIRED DISCLOSURES

The following is a description of disclosures of your protected health information we are required to make.

Government Audits. We are required to disclose your protected health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.

Disclosures to You. When you request, we are required to disclose to you the portion of your protected health information that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your protected health information if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the protected health information was not disclosed pursuant to your individual authorization.

OTHER DISCLOSURES

Personal Representatives. We will disclose your protected health information to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable believe that: (1) you have been, or may be, subjected to domestic violence, abuse or neglect by such a person; (2) treating such person as your personal representative could endanger you; or (3) in the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.

Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee's spouse and other family members who are covered under the Plan, and includes mail with information on the use of Plan benefits by the employee's spouse and other family members and information on the denial of any Plan benefits to the employee's spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under "Your Rights"), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.

Authorizations. Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your protected health information for marketing; and we will not sell your protected health information, unless you give us a written authorization. You may revoke written authorization at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.

YOUR RIGHTS

You have the following rights with respect to your protected health information:

Right to Inspect and Copy. You have the right to inspect and copy certain protected health information that may be used to make decisions about your health care benefits. To inspect and copy your protected health information, you must submit your request in writing to your employer's privacy officer. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to the Privacy Officer.

Right to Amend. If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for if the information is kept by or for the Plan.


To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

- is not part of the medical information kept by or for the Plan;

- was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

- is not part of the information that you would be permitted to inspect and copy; or

- is already accurate and complete.

If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.

Right to an Accounting of Disclosures. You have the right to request an "accounting" of certain disclosures of your protected health information. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.

To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time of no longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge.

For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on your protected health information that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your protected health information that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had. Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.

Effective February 17, 2010 (or such other date specified as the effective date under applicable law), we will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to the health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out- of-pocket in full.

To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.

Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, make your request in writing to the Plan Administrator. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests if you clearly provide information that the disclosure of all or part of your protected information could endanger you.

Right to Be Notified of a Breach. You have the right to be notified if we (or a Business Associate) discovery a breach of unsecured protected health information.


Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may write to the Plan Administrator to request a written copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this Notice.

Complaints

If you believe your privacy rights under this policy have been violated, you may file a written complaint with the Plan Administrator at the address listed below. Alternatively, you may complain to the Secretary of the U.S. Department of Health and Human Services, generally, within 180 days of when the act or omission complained of occurred.

Note: You will not be penalized or retaliated against for filing a complaint.

Contact Information

If you have any questions about this notice, please contact:

Name of Entity/Sender: Oklahoma City Firefighters Health & Welfare VEBA Trust Contact: VEBA Board Address: 157 NW 6t h, OKC, OK 73102 Phone Number: 405-232-9543 Notice Effective Date: October, 2015

WOMAN’S & DEPENDENT HEALTH RIGHTS

Women's Health and Cancer Rights Act - Janet's Law:

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy was performed;

- Surgery and reconstruction of the other breast to produce a symmetrical appearance;

- Prostheses; and

- Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the above deductible and coinsurance apply. If you have questions, please contact your insurance representative.

Newborns’ and Mothers' Health Protection Act (NMHPA)

Group health plan and health insurance issuer generally may not, under Federal Law, restrict benefit for any hospital length of stay about childbirth for the mother or newborn child to 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 issuers may not, under Federal law, require that a provider obtain authorization for prescribing a length of stay not more than 48 hours or 96 hours.

Dependents to Age 26

Due to a change in the laws governing your employers Group Health Plan, your children generally can be covered under the Plan until they attain age of 26, regardless of their student or marital status and regardless of whether your home is their principal place of abode or whether you support them.


The dependents are eligible for coverage regardless of eligibility on another employer group health plan.

Genetic Information Nondiscrimination Act (GINA)

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. Genetic information as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

Newborn’s and Mother's Health Protection Act

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay about childbirth for the mother or newborn child to 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 issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not more than 48 hours (or 96 hours).

Mental Health Parity Act

Per the Mental Health Parity Act of 1996, the lifetime maximum and annual maximum dollar limits for mental health benefits under your employers Group Health Plan are equal to the lifetime maximum and annual maximum dollar limits for medical and surgical benefits under this plan. However, mental health benefits may be limited to a maximum number of treatment days per year or series per lifetime.

Michelle's Law

Michelle's Law requires group health plans to provide continued coverage for dependent children who are covered under our group health plan as a student if they lose their student status because they take a medically necessary leave of absence from school. This law will apply to medically necessary leaves that begin on or after January 1, 2010. This continuation of coverage is described below.

If your child is no longer a student, as defined in the plan, because he/she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if, immediately before the first day of the leave of absence, your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions).

For purposes of this continued coverage, a "medically necessary leave of absence" means a leave of absence from a post-secondary educational institution, or any change in enrollment of the child at the institution, that:

1. begins while the child is suffering from a serious illness or injury,

2. is medically necessary, and

3. causes the child to lose student status for purposes of coverage under the plan.

The coverage provided to dependent children during any period of continued coverage:

1. is available for up to one year after the first day of the medically necessary leave of absence, but ends earlier if coverage under the plan would otherwise terminate, and

2. stays the same as if your child had continued to be a covered student and had not taken a medically necessary leave of absence

If the coverage provided by the plan is changed under the plan during this one-year period, the plan will provide the changed coverage for the dependent child for the remainder of the medically necessary leave of absence unless, because of the change, the plan no longer provides coverage for dependent children.


If you believe your child is eligible for this continued coverage, the child's treating physician must provide a written cert ification to the plan stating that your child is suffering from a serious illness or injury and that the leave of absence (or other change in enrollment) is medically necessary.

GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS

Introduction

You are receiving this notice because you have recently become covered under a group health plan (the plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan's Summary Plan Description or contact the Plan Administrator.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your spouse, and your dependent children could become quali-fied beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary, if you lose your coverage under the Plan because either one of the following qualifying events happens:

- Your hours of employment are reduced, or

- Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

- Your spouse dies; - Your spouse's hours of employment are reduced; - Your spouse's employment ends for any reason other than his or her gross misconduct; - Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or - You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualify-ing events happens:

- The parent-employee dies; - The parent-employee's hours of employment are reduced; - The parent-employee's employment ends for any reason other than his or her gross misconduct; - The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); - The parents become divorced or legally separated; or - The child stops being eligible for coverage under the plan as a "dependent child."


When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the Human Resource Department Office.

General Notice of COBRA Continuation Coverage Rights {continued) How is COBRA Coverage Provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified benefi-ciaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his or her employment terminates, COBRA continuation cover-age for his or her spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18- month period of continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred

If You Have Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.)


Keep Your Plan Informed of Address Changes To protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan Contact Information Name of Entity/Sender: Oklahoma City Firefighters Health & Welfare VEBA Trust Contact: VEBA Board Address: 157 NW 6th, OKC, OK 73102 Phone Number: 405-232-9543 MEDICAID AND THE CHLDREN’S HEALTH INSURANCE PROGRAM (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or go online to www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer's health plan is required to permit you and your dependents to enroll in the plan - as long as you and your dependents are eligible, but not already enrolled in the employer's plan. This is called a "special enrollment" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. The coverage provided to dependent children during any period of continued coverage: 1. is available for up to one year after the first day of the medically necessary leave of absence, but ends earlier if coverage under

the plan would otherwise terminate, and 2. stays the same as if your child had continued to be a covered student and had not taken a medically necessary leave of absence. If the coverage provided by the plan is changed under the plan during this one-year period, the plan will provide the changed coverage for the dependent child for the remainder of the medically necessary leave of absence unless, as a result of the change, the plan no longer provides coverage for dependent children. If you believe your child is eligible for this continued coverage, the child' s treating physician must provide a written certification to the plan stating that your child is suffering from a serious illness or injury and that the leave of absence (or other change in enrollment) is medically necessary. Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.


If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a "special enrollment" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at www.askebsa .dol.gov or by calling toll-free 1-866-444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2015. You should contact your State for further information on eligibility-

OKLAHOMA- Medicaid and CHIP

To see if any more States have added a premium assistance program July 31, 2015, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor

Employee Benefits Security Administration

www.dol.gov/ebsa

1-866-444-EBSA (3272)

0MB Control Number 1210-0137 (expires 10/31/2016)

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

www.ems.hhs.gov

1-877-267-2323, Menu Option 4, Ext. 61565


MEDICARE PART D PRESCRIPTION DRUG COVERAGE

Explains the prescription options available to those eligible for Medicare and can help you decide whether or not to enroll in coverage. At the end is information about where you can get help to make decisions about your prescription drug coverage.

Note: If you enroll in one of the Medicare-approved plans which offer prescription drug coverage, you may need to provide a copy of this notice to show you are not required to pay a higher premium amount.

Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may offer more coverage for a higher monthly premium.

Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15 through December 7. Beneficiaries leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.

If you decide to enroll in a Medicare prescription drug plan and elect to drop your medical and prescription drug coverage, be aware that you and your dependents will not be able to get the OKCFF coverage back.

Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan. You should also know that if you drop or lose your coverage with your employer and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least one percent per month for every month that you did not have that coverage. For example, if you go 19 months without coverage, your premium will always be at least 19 percent higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll.

For more information about your options under Medicare, the “Medicare & You” handbook contains more detailed information about Medicare plans that offer prescription drug coverage. If you’re eligible for Medicare coverage, you’ll receive a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans.

For more information about Medicare prescription drug plans:

Visit www.medicare.gov.

Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for the telephone number) Call 1-800-MEDICARE (1-800-633-4227). TTY users, call 1-877-486-2048.

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available.

Information about extra help is available from the Social Security Administration online at www.socialsecurity.gov or by calling 1-800-772-1213 (TTY 1-800-325-0778).


NOTICE OF HEALTH INSURANCE MARKETPLACE

As a result of some key parts of the health care law that took effect in 2014, there are now new ways to buy health insurance: the Health Insurance Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace at www.health care.gov offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings though the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other Employees of your family) is more than 9.69% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

1https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/

Your Responsibility Under Health Care Reform

Individual Mandate. The law now requires that most individuals maintain health insurance coverage or otherwise pay a penalty. If you don’t have medical coverage in 2017, you’ll pay the higher of these two amounts:

2.5% of your yearly household income.

(Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.)

The maximum penalty is the national average premium for a bronze plan.

$695 per person for the year ( $347.50 per child under 18 ).

The maximum penalty per family using this method is $2,085.

Please Note: The above was the 2016 maximum.

In 2017, the maximum may be adjusted to increase on par with the national rate of inflation.

1https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/


BBenefit Resource Directory

BlueCross BlueShield of Oklahoma PPO Plan (Group Number:166720) Mon-Fri, 8 a.m. - 8 p.m. CST 800-942-5837

BlueCross BlueShield of Oklahoma HMO Plan (Group Number:170398) Mon-Fri, 8 a.m. - 8 p.m. CST 800-942-5837

BlueCross BlueShield of Oklahoma HCA Plan (Group Number:170719) Mon-Fri, 8 a.m. - 8 p.m. CST 800-942-5837

BlueCross BlueShield of Oklahoma Dental Plan (Group Number: 170309) (0001 - Actives, 0002 - Retirees) Mon-Fri, 8 a.m. - 8 p.m. CST 888-381-9727

BlueCross BlueShield of Oklahoma Medicare Advantage PPO Plan (Group Number: P0K0001) Mon-Fri, 8 a.m. - 8 p.m. CST 800-942-5837

The Hartford Group Life Insurance (Group Number:677307) Mon-Fri, 7 a.m. - 7 p.m. CST 800-523-2233

AmeriFlex COBRA Administration Mon-Fri, 7:30.am. - 7 p.m. CST 888-868-3539

American Fidelity Assurance Company FSA Account Mon-Fri, 7 a.m. - 7 p.m. CST 800-437-1011

VSP Vision Plan (Group Number:166720) Mon-Fri, 8 a.m. - 8 p.m. CST 800-877-7195

Cincinnati Life Insurance Company Voluntary Term Life Insurance Mon-Fri, 8 a.m. - 5 p.m. CST 800-752-3419

Central United Life Voluntary Cancer & Accident Mon-Fri, 8 a.m. - 5 p.m. CST 800-752-3419

Cigna Supplemental Solutions Lump Sum Heart/Stroke & Cancer (Group Number: LA0050) Mon-Fri, 8 a.m. - 5 p.m. CST 800-752-3419 Cigna Supplemental Solutions Lump Sum Cancer Plan (Group Number: LA0050) Mon-Fri, 8 a.m. - 5 p.m. CST 800-752-3419

BenefitHelp™ Employee Benefit Advocacy Mon-Thurs, 8.am. - 5 p.m. CST Fri, 8 a.m. - 4 p.m. CST 888-663-1285 www.MyOKCFFBenefits.com

OKCFF Local 157 Benefits Support Patti Bolin 405-232-9543 [email protected] Mon-Thurs, 8 a.m. - 5 p.m. CST

OKCFF Health & Welfare VEBA Trust Address: 157 NW 6th St. Oklahoma City, OK 73102 405-232-9543

800-633-4227 www.medicare.gov

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