Medical and Hospital Coverage

The Fund currently provides employee, dependent and domestic partner hospital and medical coverage through the Empire Health Direct POS program and Prism program. Hospital and medical coverage for domestic partners is provided at the discretion of the Fund’s health care provider, and thus is not guaranteed. Employees may select from one of three plans with different co-pay/deductible and employee contribution options. Employees who elect one of the Fund's hospital and medical coverage will be required to make a contribution per pay period towards the hospital and medical coverage premium. The contribution amount will vary based on the type of plan and coverage (individual or family) selected by the employee. This premium contribution will be deducted from an employee's paycheck on a pre-tax basis through the Fund's Premium Conversion Program, or on an after-tax basis. Employees who do not wish to be covered by the Fund's hospital and medical plan must decline the coverage in writing.

The specific benefits, restrictions and limitations of the coverage are outlined in the health coverage policy booklet that can be obtained from the Personnel & Benefits Administrator. Generally, coverage includes the following:

• For most benefits, Empire hospital and medical coverage offers Fund employees, dependents and domestic partners the choice of using any network provider (including hospitals physicians and other ancillary providers) from the appropriate network, or any non-network provider. Individuals can stay in network for some services and go out of network for others.

• For those who stay in network, any participating provider may be selected. There is no deductible, no co- insurance, a small co-payment (in most cases), and no claim forms to fill out for office visits, referrals, lab tests, x-rays and hospitalization. Some services are available only in-network. In-network mental health coverage is provided by Magellan Behavioral Services.

• For those who go out of network, any physician or hospital can be used. There is an annual deductible. Once the deductible has been paid, Empire will provide a percentage co-insurance coverage of allowed medical expenses based on the plan selected. After out-of-pocket medical expenses have been reached, 100% of allowed medical expenses are covered. Claim forms must be filed to receive payment for covered services.

The Empire Medical Management Program requires a telephone call to obtain “pre- certification” for certain kinds of care including: planned hospital admission or surgery, emergency hospital admissions (call within 48 hours), ambulatory surgery, cardiac rehabilitation, and MRIs. Mental health and alcohol/substance abuse coverage requires pre- certification from Empire’s Behavioral Health Care Management.

Please refer to the descriptive chart and the policy booklet for specific plan details.

There is a waiting period of 30 days before coverage becomes effective, and coverage continues for 30 days following termination of employment.

Note: details of plan benefits are provided for descriptive purposes only.