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Caterpillar Inc. Retiree Group Insurance Plan Summary Plan Description * * *

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Caterpillar Inc. Retiree Group Insurance Plan Summary Plan Description * * * Caterpillar Inc. Retiree Group Insurance Plan Summary Plan Description * * * For Certain Caterpillar Inc. Retirees and Former Employees (January 1, 1992 – March 6, 2011) (UAW - Central) (January 1, 1999 and After) (UAW – Dallas, TX and Kansas City, MO) This Summary Plan Description (“SPD”) describes the benefits for certain retirees and other former employees of Caterpillar Inc. who were represented by the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) and its affiliated locals 145, 751, 786, 974, 1415, 1989, 2096 and 2406 during their employment and who retired or otherwise terminated employment between January 1, 1992 and March 6, 2011. This SPD also describes the benefits of retirees and former employees who were represented by the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) and its affiliated locals 119 and 710 during their employment and who retired or otherwise terminated employment on or after January 1, 1999. 7622542 Caterpillar: Confidential Green TABLE OF CONTENTS INTRODUCTION........................................................................................................................................................................1 ABOUT THIS DOCUMENT ...............................................................................................................................................1 OFFICIAL PLAN DOCUMENT OVERVIEW....................................................................................................................1 SPECIAL NOTE REGARDING MEDICARE .....................................................................................................................2 SPECIAL NOTE REGARDING HIRE DATES AND RETIREMENT DATES .................................................................2 CONTACT THE ADMINISTRATOR .................................................................................................................................2 ELIGIBILITY ..............................................................................................................................................................................3 ELIGIBILITY FOR THE PLAN ..........................................................................................................................................3 Same-Sex Domestic Partners .........................................................................................................................................4 Dual Coverage ...............................................................................................................................................................5 Qualified Medical Child Support Order (“QMCSO”) ...................................................................................................5 Disabled Children ..........................................................................................................................................................5 HEALTH INSURANCE BENEFITS ..........................................................................................................................................7 AN INTRODUCTION TO YOUR BENEFITS ....................................................................................................................7 PARTICIPATION ................................................................................................................................................................7 How to Enroll.................................................................................................................................................................7 Changing Your Coverage ..............................................................................................................................................9 Cost Of Coverage ......................................................................................................................................................... 11 How Long Coverage Continues ................................................................................................................................... 11 Survivors’ Coverage .................................................................................................................................................... 11 Continuation Of Benefits (COBRA) ............................................................................................................................ 11 Other Events Ending Your Coverage ........................................................................................................................... 15 Coordination of Benefits .............................................................................................................................................. 15 MEDICAL BENEFITS .............................................................................................................................................................. 21 OVERVIEW OF MEDICAL BENEFITS ........................................................................................................................... 21 ELIGIBILITY FOR MEDICAL BENEFITS ...................................................................................................................... 21 WHAT’S COVERED – BENEFITS ................................................................................................................................... 21 Accessing Benefits ....................................................................................................................................................... 21 Identification Card (“ID Card”) ................................................................................................................................... 22 Eligible Expenses ......................................................................................................................................................... 22 Notification Requirements ........................................................................................................................................... 22 Benefits at a Glance ..................................................................................................................................................... 23 Benefit Information ...................................................................................................................................................... 24 WHAT’S NOT COVERED – EXCLUSIONS ................................................................................................................... 42 The Use of Section Headings ....................................................................................................................................... 42 Plan Exclusions ............................................................................................................................................................ 42 DESCRIPTION OF NETWORK AND NON-NETWORK BENEFITS (RESIDE IN A CATERPILLAR NETWORK AREA)................................................................................................................................ 48 Network Benefits ......................................................................................................................................................... 48 Non-Network Benefits ................................................................................................................................................. 50 Emergency Room Health Services .............................................................................................................................. 50 DESCRIPTION OF NETWORK AND NON-NETWORK BENEFITS (RESIDE IN A UNITEDHEALTHCARE NETWORK AREA) ................................................................................................................. 51 Network Benefits ......................................................................................................................................................... 51 Non-Network Benefits ................................................................................................................................................. 52 Emergency Room Health Services .............................................................................................................................. 52 OBTAINING BENEFITS (RESIDE OUTSIDE A NETWORK AREA) ........................................................................... 53 If You Obtain Services from a Network Provider ........................................................................................................ 53 Designated Providers and Other Providers .................................................................................................................. 53 Emergency Room Health Services .............................................................................................................................. 54 YEBB3311 i Caterpillar: Confidential Green PRESCRIPTION DRUG BENEFITS ........................................................................................................................................ 55 ELIGIBILITY FOR PRESCRIPTION DRUG BENEFITS ................................................................................................ 55 OVERVIEW OF PRESCRIPTION DRUG BENEFITS ..................................................................................................... 55
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