WELFARE SUMMARY PLAN DESCRIPTION - RETIRED MEMBERS

IMPORTANT CONTACT INFORMATION

IMPORTANT BENEFIT INFORMATION

SCHEDULE OF BENEFITS

NON-MEDICARE ELIGIBILE RETIREES' ELIGIBILITY FOR BENEFITS

MEDICARE ELIGIBLE RETIREES' ELIGIBILITY FOR BENEFITS

ENROLLMENT PROCEDURES

CONTINUATION OF HEALTH BENEFITS

COMPREHENSIVE MAJOR MEDICAL BENEFIT (FOR NON-MEDICARE ELIGIBLE RETIREES ONLY)

WELLNESS EXPENSE BENEFIT (RETIREE AND SPOUSE ONLY)

DENTAL BENEFITS (RETIREES AND DEPENDENTS)

OPTICAL BENEFITS (RETIREES AND DEPENDENTS)

HEARING AID BENEFIT (RETIREES AND DEPENDENTS)

PRESCRIPTION DRUG BENEFITS (RETIREES AND DEPENDENTS)

DEATH BENEFIT (RETIREES ONLY)

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS (RETIREES ONLY)

GENERAL EXCLUSIONS AND LIMITATIONS

HOW TO FILE A CLAIM

COORDINATION OF BENEFITS

HOW MEDICARE AFFECTS MEDICAL BENEFITS UNDER THE PLAN

REIMBURSEMENT POLICIES AND PROCEDURES

IMPORTANT INFORMATION ABOUT THE PLAN

STATEMENT OF RIGHTS UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA)

YOUR PRIVACY RIGHTS UNDER THE PLAN

DEFINITIONS

APPENDIX A: DURABLE MEDICAL EQUIPMENT AND SUPPLIES