Atlanta Plumbers & Steamfitters Local 72 Fringe Benefit Funds

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: Active Plan Participants Board of Trustees From: Board of Trustees Union Trustees Date: November 15, 2020 Mr. Jeff Housworth RE: Important Announcement regarding Dependent Coverage Co-Chairman UA Local Union 72

IMPORTANT ANNOUNCEMENT ABOUT YOUR HEALTHCARE Mr. Terry Newsome, Jr. BENEFITS UA Local Union 72

The Board of Trustees of the Atlanta Plumbers & Steamfitters Health and Mr. Steve Newsome Welfare Fund (“the Fund”) has established a special committee to work on UA Local Union 72 improving participants’ experience with using their benefits. The committee Mr. Jarrett Wade has met numerous times over the course of the 2020 plan year and will UA Local Union 72 continue to meet to evaluate and simplify plan rules and requirements, with the objective of providing participants with a more convenient experience. Mr. Alan Tomberlin UA Local Union 72

Dependent Coverage Contribution Requirements Employer Trustees

The Trustees recognize that the initial process that was established for Mr. Jon Sterling collecting dependent coverage contributions has, at times, led to Co-Chairman dissatisfaction from plan participants. The Trustees are pleased to announce Maxair Mechanical, Inc. revised dependent coverage contribution guidelines that have been Mr. Andy Sumpter established to address this challenge. Mechanical Contractors Association of Georgia What’s Changing Mr. Ken Harbour

Cleveland Mechanical Services  Initial Dependent Coverage: When a participant completes the enrollment process to add new dependents, such as a new spouse or new Mr. John McKenney dependent child, eligible dependents will be enrolled in the plan without McKenney’s Inc.

requiring that dependent coverage contributions be received in advance. Mr. James K. Estabrook Lindabury, McCormick, How does this help? Previously, participants had to remit their dependent Estabrook & Cooper, P.C. coverage contributions before their dependents could be covered, which

ADMINISTRATIVE MANAGER:

National Employee Benefits Administrators, Inc. 1.888.365-0072 (Toll Free) • 954.266.6322 • 954.266.2079 (Fax) www.nebainc.com 2010 N.W. 150th Ave, Suite 100 374 Maynard Terrace, S.E., Suite 72 3715 Northside Parkway, Suite 2-495 Pembroke Pines, FL 33028 Atlanta, GA 30316 Atlanta, GA 30327

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

sometimes led to delays in getting new dependents covered. This new process will eliminate these delays.

 Continuing Dependent Coverage: If a participant has an interruption in their dependent coverage contributions, dependent coverage will not be immediately lost.

How does this help? Previously, if the full amount due for each month was not received, dependent coverage was dropped until the participant self-paid the contributions owed. This happened for a variety of reasons, including participants being out of work, participants taking vacation time, deduction errors at participants’ employers, etc.

Under the new requirements, participants will still owe the same amount for the coverage; however, participants will have until December 15th each year to pay any shortages due that have accumulated throughout the year. This new process will eliminate the interruptions in dependent coverage due to missed contributions.

NEBA will continue to provide periodic self-pay statements for dependent contributions owed and the Trustees encourage participants to pay shortages due as soon as possible to avoid accumulating a large self-pay amount due at the end of the year.

Dependent Coverage Contribution Reconciliation for Participants with Dependents

Each year, NEBA will review each participant’s dependent contribution history for the 12-month period beginning November 1 of the prior year through October 31 of the current year, to determine if there are any shortages due. One month of dependent contributions will be owed for each month of dependent coverage that was provided during the current year.

Following this review, NEBA will notify each participant that has a dependent contribution shortage with a statement of amounts due. Participants must submit payment for amounts due no later than December 15th. Dependent coverage will terminate on December 31st for Participants who do not remit the amounts due by December 15th. Dependent coverage that has been terminated due to non-payment may only be reinstated under the limited circumstances outlined on the next page.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Conditions for Re-Enrolling Dependent Children or Spouse After Lapse in Coverage Due to Non-Payment

A participant may re-enroll a Dependent child or spouse after a lapse in coverage due to non-payment of dependent contributions, provided that the Dependent child or Dependent spouse otherwise meets the remaining Plan eligibility requirements as of the enrollment date, and the following conditions are met:  The participant remits payment in full for all outstanding dependent coverage contributions; and,  the participant becomes newly eligible for benefits after a lapse in coverage, pursuant to the reinstatement of eligibility rules; or  the Dependent child or Dependent spouse would otherwise be eligible to enroll during a subsequent open enrollment period; or  the Dependent child or Dependent spouse becomes eligible for a special enrollment right pursuant to the Health Insurance and Portability Act.

Enclosed with this memorandum is a Summary of Material Modifications (SMM) which describes these changes in detail. The SMM should be kept with your Summary Plan Description (SPD). As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – January 1, 2021

This document is a “Summary of Material Modifications” (SMM) which describes changes to the Atlanta Plumbers and Steamfitters Health and Welfare Fund (the “Fund”). This SMM modifies the language found in your Summary Plan Description (SPD). All statements made in this document are subject to the terms and conditions of the Plan Document. If there is a discrepancy between the SPD or this SMM and the Plan Document, the Plan Document will govern. Copies of the SPD and Plan Document are available for review at any time during normal working hours at NEBA’s offices.

Dependent Eligibility

The eligibility rules of the Fund have been revised to reflect the following requirements for dependents.

Dependent Child

A Dependent child of an Employee who becomes eligible for benefits shall become eligible for benefits for each month beginning as of the date upon which the Employee first becomes eligible for benefits and enrolls the Dependent child, if any required contribution is made to the Trust on behalf of the Dependent child for each such month; provided, that if any such required contribution is not paid for any applicable month or months, coverage for the Dependent child shall continue during the month or months for which the required contribution has not been paid.

The total amount of any unpaid monthly contributions for a Plan Year shall be due and payable on or before the December 15 of the year in which the monthly contributions are due. In the event that unpaid monthly contributions are not paid by the applicable December 15, the Dependent child will not be eligible to receive coverage under the Plan for any subsequent Plan Year during which the monthly contributions remain unpaid, and shall not again become eligible to enroll in the Plan until the date upon which the past due contributions are paid in full and either: (A) the Employee again becomes eligible for benefits after a lapse in coverage, pursuant to the reinstatement of eligibility rules; (B) the Dependent child would otherwise be eligible to enroll during a subsequent open enrollment period; or (C) the Dependent child becomes eligible for a special enrollment right pursuant to the Health Insurance and Portability Act; provided, that the Dependent child otherwise meets the remaining Plan eligibility requirements as of the enrollment date.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Dependent Spouse

A Dependent spouse of an Employee, except for an Employee classified as a “residential employee,” who becomes eligible for benefits shall become initially eligible for benefits beginning as of the first day of the third month following a period of twelve (12)-consecutive months or less during which such Employee has worked at least twelve hundred (1,200) hours; provided, that Employer contributions are properly paid to the Fund on behalf of the Employee or, as applicable, reciprocal contributions are received by the Fund for each such month; provided, further, that the Covered Employee enrolls the Dependent spouse and pays to the Trust the required contribution on behalf of the Dependent spouse for each such month.

If any required contribution is not paid by the Covered Employee for any applicable month or months, coverage for the Dependent spouse shall continue during the month or months for which the required contribution has not been paid. The total amount of any unpaid monthly contributions for a Plan Year shall be due and payable on or before the December 15 of the year in which the monthly contributions are due. In the event that unpaid monthly contributions are not paid by the applicable December 15, the Dependent spouse will not be eligible to receive coverage under the Plan for any subsequent Plan Year during which the monthly contributions remain unpaid, and shall not again become eligible to enroll in the Plan until the date upon which the past due contributions are paid in full and either: (A) the Employee again becomes eligible for benefits after a lapse in coverage, pursuant to the reinstatement of eligibility rules; (B) the Dependent spouse would otherwise be eligible to enroll during a subsequent open enrollment period; or (C) the Dependent spouse becomes eligible for a special enrollment right pursuant to the Health Insurance and Portability Act; provided, that the Dependent spouse otherwise meets the remaining Plan eligibility requirements as of the enrollment date. Spouses of Employees classified as ‘residential employees’ are not eligible to participate in the Plan.”

This Summary of Material Modifications should be kept with your Summary Plan Description.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Board of Trustees To: All Plan Participants Union Trustees From: Board of Trustees Date: April 2020 Mr. Jeff Housworth RE: Health & Welfare Benefits Co-Chairman UA Local Union 72

IMPORTANT ANNOUNCEMENTS ABOUT YOUR HEALTH Mr. Terry Newsome, Jr. UA Local Union 72 AND WELFARE BENEFITS Mr. Steve Newsome The Board of Trustees of the Atlanta Plumbers and Steamfitters Health and UA Local Union 72

Welfare Fund (“Fund”) wishes to extend their best wishes for the wellbeing of Mr. Jarrett Wade you and your families during this unprecedented time. In accordance with the UA Local Union 72 Families First Coronavirus Response Act (“FFCRA”), a package of provisions aimed at providing emergency relief and support during the 2020 novel Mr. Alan Tomberlin UA Local Union 72 coronavirus/COVID-19 pandemic, the Board has approved certain changes to your benefit plan. Employer Trustees

Mr. Jon Sterling The following services will be covered without any cost sharing charges (e.g. no Co-Chairman deductible, co-payment, or co-insurance) for the Fund’s eligible participants and Maxair Mechanical, Inc. dependents: Mr. Andy Sumpter Mechanical Contractors 1. Diagnostic tests to detect the coronavirus that are approved or authorized Association of Georgia by the FDA, including the administration of such tests; and Mr. Ken Harbour 2. Items and services furnished to individuals during provider office visits Cleveland Mechanical (whether in-person or via telehealth), urgent care visits, and emergency Services room visits that result in an order for, or the administration of, a test as Mr. John McKenney described above, but only to the extent such items or services relate to the McKenney’s Inc. furnishing or administration of the test or the evaluation of whether the individual needs the test. Mr. James K. Estabrook Lindabury, McCormick, Estabrook & Cooper, P.C.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health & Welfare Benefits Page 2

This provision applies to tests, items and services provided on or after March 18, 2020 through the end of the federal government’s declared emergency period related to COVID-19.

Medically necessary treatment of COVID-19 remains covered under the normal rules of the Plan (including cost sharing and other requirements).

Dependent Coverage Contributions

If you are not currently working and were previously making dependent coverage contributions via payroll deductions, there are several options available to you. You may self pay for the contributions owed via credit card, debit card, check or money order. If you are on the “Out of Work” list at Local 72 or are furloughed, you may withdraw hours from your hour bank to use as payment instead.

If You Are on The Local 72 Out of Work List or Furloughed

• You may submit an hour bank withdrawal form via NEBA’s website, https://www.nebainc.com/send-secure-file/ (preferred). A copy of the form is enclosed.

• You may submit an hour bank withdrawal form via U.S. Mail to the following address. A copy of the form is enclosed.

Atlanta Plumbers & Steamfitters H & W Fund 2010 N.W. 150th Avenue, Suite 100 Pembroke Pines, FL 33028 (Postal service delays may occur)

• You may remit payment by credit or debit card via NEBA’s website, https://os.nebainc.com/atldependent (preferred).

• You may remit payment via check or money order via U.S. Mail to the address listed above. (Postal service delays may occur)

If You Are Not Working, Not on The Local 72 Out of Work List, and Not Furloughed

• You may remit payment by credit or debit card via NEBA’s website, https://os.nebainc.com/atldependent (preferred).

• You may remit payment via check or money order via U.S. Mail to the address listed above. (Postal service delays may occur)

Atlanta Plumbers and Steamfitters Health & Welfare Benefits Page 3

Instructions for Remitting Credit or Debit Card Payments:

1. Visit https://os.nebainc.com/atldependent.

A. Complete all requested information in the fillable form. B. If you are unsure how much you owe, or what coverage period you must pay for, please contact NEBA at: [email protected] or 1-888-365-0072 C. Click Continue to complete checkout.

2. Complete the checkout process.

D. Enter your credit or debit card details. E. Enter your email address to get an email confirmation. F. Check the “I’m not a robot” box. G. Click the “Pay With Your Credit Card” box to complete the transaction.

Atlanta Plumbers and Steamfitters Health & Welfare Benefits Page 4

Instructions for Using the Secure Upload Feature of NEBA’s Website:

1. Visit https://www.nebainc.com/send-secure-file/.

A. Complete the requested information in the fillable form. B. Choose the Atlanta Office from the department drop down list. C. Click the “Choose File” button to select the file you wish to send. This will allow you to select a saved file on your computer, or open your device camera if you are using a smartphone or other mobile device with a camera. D. Click the “Submit” button. Atlanta Plumbers and Steamfitters Health & Welfare Benefits Page 5

As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) with any questions.

NEBA can be reached at:

National Employee Benefits Administrators, Inc. 374 Maynard Terrace SE, Suite 072 Atlanta, GA 30316 Toll Free 888.365.0072 | Fax 404.464.7905

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: All Plan Participants Board of Trustees From: Board of Trustees Date: April 2019 Union Trustees

RE: Dental and Vision Benefits Mr. Jeff Housworth Co-Chairman

UA Local Union 72 IMPORTANT ANNOUNCEMENT ABOUT YOUR HEALTHCARE Mr. Terry Newsome, Jr. BENEFITS UA Local Union 72

This document is a “Summary of Material Modifications” (SMM) which Mr. Steve Newsome describes changes to the Atlanta Plumbers and Steamfitters Health and Welfare UA Local Union 72

Fund (the “Fund”). This SMM modifies the language found in your Summary Mr. Jarrett Wade Plan Description (SPD). All statements made in this document are subject to the UA Local Union 72 terms and conditions of the Plan Document. If there is a discrepancy between the SPD or this SMM and the Plan Document, the Plan Document will govern. Employer Trustees

Mr. Jon Sterling The Board of Trustees of the Atlanta Plumbers and Steamfitters Health and Co-Chairman Welfare Fund is pleased to announce that effective June 1, 2019, dental and Maxair Mechanical, Inc. vision benefits will be reinstated for all eligible plan participants. All enrolled Mr. Gary Fowler participants and dependents will be automatically enrolled in the new dental Mechanical Contractors and vision programs, so no action is required. Association of Georgia

Dental care benefits will be insured by Delta Dental. Vision care benefits will Mr. Ken Harbour be insured by Group Vision Service (GVS). Enclosed are benefit summaries for Cleveland Mechanical Services both plans. Dental and vision ID cards will be mailed to your home in late May. Mr. John McKenney Following are some highlights regarding your new benefits: McKenney’s Inc. Dental Benefits* (Delta Dental) Mr. James K. Estabrook Waiting Periods None Lindabury, McCormick, $50 per person each calendar year Deductible Estabrook & Cooper, P.C. * waived for Diagnostic & Preventative Maximums $1,000 per person each calendar year Diagnostic & Preventative Benefits Exams, cleanings and x-rays covered at 100% Basic Services , Endodontics, Covered at 75% Periodontics, Oral Surgery Major Services & Prosthodontics Covered at 50% * See benefit summary for full details

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Benefit Highlights, continued…

Vision Benefits* (Group Vision Service) Vision Examination- In Network Once Every 12 Months/ $5.00 copay *Includes Dilation as indicated Eyeglass Lenses- In Network Once Every 12 Months/ No copay Frames – In Network Once Every 12 Months/ Covered at 100% up to a $150.00 retail value Contact Lenses – Elective Once Every 12 Months/ Covered at 100% up to $150.00 Allowance Contact Lenses – Medically Necessary Once Every 12 Months/ Covered at 100% up to $250.00 * See benefit summary for full details

As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) with any questions. NEBA can be reached at:

National Employee Benefits Administrators, Inc. 374 Maynard Terrace SE, Suite 072 | Atlanta, GA 30316 Toll Free 888.365.0072 | Fax 404.464.7905

This Summary of Material Modifications should be kept with your Summary Plan Description.

Keep Smiling Delta Dental PPOTM

Save with PPO plan, they will need your information. Prefer to Visit a dentist in the PPO1 network to maximize take a paper or electronic ID card with you? your savings.2 These dentists have agreed to Simply log in to your account, where you can view reduced fees, and you won’t get charged more or print your card with the click of a button. than your expected share of the bill.3 Find a PPO dentist at deltadentalins.com. Coordinate dual coverage If you’re covered under two plans, ask your dental Set up an online account office to include information about both plans Get information about your plan anytime, with your claim, and we’ll handle the rest. anywhere by signing up for an online account at deltadentalins.com. This free service, available Understand transition of care once your coverage kicks in, lets you check Did you start on a dental treatment plan before benefits and eligibility information, find a your PPO coverage kicked in? Generally, multi- network dentist and more. stage procedures are only covered under your current plan if treatment began after your plan’s Check in without an ID card effective date of coverage.4 You can find this date You don’t need a Delta Dental ID card when you by logging in to your online account. visit the dentist. Just provide your name, birth date and enrollee ID or social security number. Newly covered? If your family members are covered under your Visit deltadentalins.com/welcome.

Save with a PPO dentist PPO NON–PPO

1 In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan. 2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid contracted fees. 3 You are responsible for any applicable deductibles, coinsurance, amounts over annual or lifetime maximums and charges for non-covered services. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s maximum contract allowance. 4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may be eligible to continue treatment under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan.

LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.html.

Eligibility Primary enrollee, spouse and eligible dependent children to the end of the month dependent turns age 26 Deductibles $50 per person each calendar year Deductibles waived for Diagnostic Yes & Preventive (D & P)? Maximums $1,000 per person each calendar year D & P counts toward maximum? Yes Basic Benefits Major Benefits Prosthodontics Waiting Period(s) None None None

Benefits and Delta Dental PPO Non-Delta Dental PPO Covered Services* dentists** dentists** Diagnostic & Preventive Services (D & P) 100 % 100 % Exams, cleanings and x-rays Basic Services Fillings, sealants and denture 75 % 75 % repair/relining/rebase Endodontics (root canals) 75 % 75 % Covered Under Basic Services Periodontics (gum treatment) 75 % 75 % Covered Under Basic Services Oral Surgery 75 % 75 % Covered Under Basic Services Major Services Crowns, inlays, onlays and cast 50 % 50 % restorations Prosthodontics 50 % 50 % Bridges and dentures * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists. Delta Dental Insurance Company Customer Service Claims Address 1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809 Alpharetta, GA 30009 Alpharetta, GA 30023-1809 deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.

HLT_DDIC_PPO_2COL_(Rev. 4/11/2019)

This plan provides coverage for a vision examination, eyeglass lenses or contact lenses and frame and a hearing exam with allowances for hearing aids. Vision benefits are available from an extensive national network of participating providers powered by Eye Med Vision Care. You can easily find a conveniently located provider near you. You have a choice of independent optometrists and ophthalmologists, as well as retail locations such as Lens Crafters, Sears Optical, Target Optical and JC Penney Optical and most Pearle Vision Centers. Members will receive additional savings from Network Providers for lens upgrades and additional pair purchases.

NETWORK PROVIDERS - By using a network provider, you minimize your out-of-pocket costs and receive the benefit of our paperless claims processing. Network Providers verify your eligibility and obtain all the necessary information to validate your level of coverage. You simply pay your copayment and any remaining balance for non-covered services or materials at the time of your appointment. In addition, Network Providers offer you discount pricing which is significantly below retail. You receive substantial savings of 15%-40% or more on most additional pair purchases, conventional contact lenses, lens treatments, specialized lenses and various accessory items. Out of Network Benefits** – If you choose to go to a non-network provider, you must pay the provider his or her full charges at the time of service. Members will be responsible for submitting a claim for reimbursement for the amount indicated in the member reimbursement schedule. Member Out-of-Network Benefits from a Network Provider* Copay Benefit Schedule **

Vision Examination – includes dilation as indicated Once Every 12 Months* $ 5.00 Vision Examination Up to $32.00 Lenses • Single Vision Up to $30.00 Eyeglass Lenses - single vision, bifocal, or trifocal in standard/basic plastic • Bifocal Up to $45.00 w/Standard Scratch Resistance and Polycarbonate Lenses for dependent Once Every 12 Months* $ 0.00 • Trifocal Up to $75.00 children under 19 • Standard Scratch Up to $12.00

• Polys Child Up to $32.00

Frame – covered in full up to a $ 150.00 retail value. Members receive 20% off balance for selection costing more than the plan allowance. Once Every 12 Months* N/A Frame Up to $66.00 Glasses available through glasses.com Contact Lenses - in lieu of spectacle lenses (does not include fitting and

follow-up) Elective Contact

• Elective – Disposable or Conventional, covered in full up to $ 150.00 Lenses (in lieu of Up to $120.00 Allowance. Conventional lenses: members receive 15% discount off Once Every 12 Months* N/A spectacle lenses)

balance over plan allowance.

Contacts available through contactsdirect.com Medically Necessary Up to $200.00 • Medically Necessary – Covered in full up to $ 250.00 Contact Lenses * Benefits are available 12 months from last date of service *In-network services and materials may be subject to a copayment at the time of service. **Out-of- Network amounts are maximum reimbursable amounts paid to members after the claim is filed. Co-pays don’t apply to the out of network reimbursement

Additional Savings Program Member Lens Options Other Options/Services Member Pricing Pricing Other Lens Add-Ons and Tint (solid & gradient) $15.00 20% off Retail Services

UV Coating $15.00 Complete Pair Purchases *** 40% off Retail

Standard Scratch Resistance* Covered Conventional Contact Lenses 15% off Retail 877-606-3742

Please contact EPIC to utilize the hearing aid discount Standard Contact Lens Fitting Standard Polycarbonate Adult $40.00 $40.00 plan & Follow-up

Standard Polycarbonate Premium Contact Lens Fitting 10% discount Children* Covered & Follow-up Fixed fee schedule *Covered by plan benefit. ** Standard/Premium Progressive Standard Anti-Reflective $45.00 EPIC Hearing Savings Plan lenses are not covered benefits – however when upgrading in on hearing aids conjunction with your funded benefit the bifocal lens amount will be applied. Members are responsible for the lens copayment Standard Progressive Lens** $65.00 Photo chromatic Lenses 20% discount and any additional charges. (bifocal co-pay + $65 + 80% of retail less $120 *** Discount applies on complete pair purchase once 20% off funded benefit is used. Premium Progressive Lenses** Retinal Imaging $39.00 Retail

Vision Limitations & Exclusions

Fees charged by a provider for services other than a covered benefit must be paid in full by the insured to the provider. Such fees or materials are not covered under the policy. Benefit allowances provide no remaining balance for future use within the same benefit frequency. No benefits will be paid for services or materials connected with/or charges arising from

• Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseiikonic lenses; medical and/or surgical treatment of the eye, eyes or supporting structures • Any corrective eyewear, required by a policyholder as a condition of employment, safety eyewear, services provided as a result of any Worker’s Compensation law, or similar legislation or required by any governmental agency or program whether federal, state or subdivision thereof • Plano (non-prescription) lenses; non-prescription sunglasses • Two pair of glasses in lieu of bifocal • Services or materials provided by another group benefit plan providing vision care • Services rendered after the date an insured ceases to be covered under the policy, except when vision materials ordered before coverage ended are delivered and the services rendered to the insured are within 31 days from the date of such order • Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit frequency when vision materials would next become available. • Certain frame brands in which the manufacturer imposes a no-discount policy • Covered benefits may not be used in conjunction with coupons or other provider discount offers • If an Insured and the Insured Spouse are both Insured by the plan, one Insured party may request to be a Dependent spouse of the other. A Dependent child may not be covered by more than one Insured.

Visit the GVS web site to “Locate a Provider” or “View your Benefits” and learn more about our Additional Savings Program

Web Site – www.gvsmd.com - click “Members” to locate a provider or view your benefits

Customer Service and IVR – at 866-265-4626 Call customer service to ask about your benefits or to locate a provider.

Call Center Hours Access 7Days 7:30 a.m. to 11:00 p.m. EST-Monday – Saturday a Week 11:00 a.m. to 8:00 p.m. EST - Sunday

Locating a Provider Network Providers 1. Find network provider at www.gvsmd.com click on “Providers”. 2. Schedule an exam with the provider of your choice. When scheduling your appointment inform the provider that you are a GVS/EyeMed member and provide your name and date of birth (DOB). The provider will verify your eligibility and plan benefits prior to your appointment. 3. If you have already made an appointment show your ID card at the time of service or provide your name and DOB for quick verification of eligibility and plan coverage. 4. Members will be responsible to pay the provider at the time of service for any applicable copayment /costs that exceed the plan coverage. Out-of-Network Providers 1. Visit non-network provider 2. Members are required to pay the entire amount for exam and eyewear at the time of service. 3. Members must obtain an OON claim form from the GVS website at www.gvsmd.com. (click “Members”). 4. Members must submit OON claim form and provider receipt to the Claims Address indicated on the form. 5. Member will be reimbursed based on OON benefits indicated in their benefit summary.

Personalized Member Website Access For Members to Access their Benefits: You must first register on the GVS website – www.gvsmd.com

1. Under the MEMBER tab select VIEW YOUR BENEFITS 2. Welcome to the GVS Member - Click here to Login/Register 3. Select Register for an account 4. When you enter the Member Site to Register for an Account - USE the LAST FOUR DIGITS of your social security number and pick your own user ID. 5. Site will send an Email confirmation and password selection

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Board of Trustees Summary of Material Modifications – January 1, 2019 Union Trustees

This document is a “Summary of Material Modifications” (SMM) which Mr. Jeff Housworth Co-Chairman describes changes to the Atlanta Plumbers and Steamfitters Health and UA Local Union 72 Welfare Fund (the “Fund”). This SMM modifies the language found in your Summary Plan Description (SPD). All statements made in this document are Mr. Terry Newsome, Jr. subject to the terms and conditions of the Plan Document. If there is a UA Local Union 72 discrepancy between the SPD or this SMM and the Plan Document, the Plan Mr. Steve Newsome Document will govern. Copies of the SPD and Plan Document are available for UA Local Union 72 review at any time during normal working hours at the Plan’s office. Mr. Jarrett Wade

UA Local Union 72  Effective January 1, 2019, the weekly benefit available through the Fund’s Loss of Time Benefit is $300 per week for any period in which Mr. Greg Stephens you are temporarily Totally Disabled. This weekly benefit will continue UA Local Union 72

to be subject to Federal FICA tax withholdings. See the chart below for Employer Trustees additional details about the Short Term Disability Benefit. Mr. Jon Sterling Co-Chairman Benefit Description Benefit Available Maxair Mechanical, Inc.

Total Benefit Duration Available 36 weeks Mr. Gary Fowler Total Monetary Benefit Available $300 per week Mechanical Contractors Association of Georgia

Mr. Ken Harbour Cleveland Mechanical If you have any questions, please contact National Employee Benefits Services

Administrators, Inc. at (888) 365-0072. Mr. John McKenney McKenney’s Inc.

Mr. James K. Estabrook Lindabury, McCormick,

Estabrook & Cooper P.C. ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: All Plan Participants Except Helpers, Tradesmen and Pipe Tradesmen Board of Trustees From: Board of Trustees Date: January 29, 2018 Union Trustees RE: Benefit Changes Mr. Jeff Housworth Co-Chairman As a member of Plumbers, Pipefitters, & HVACR Technicians Local 72 (“Local UA Local Union 72 72”) you receive health care benefits through the Atlanta Plumbers and Mr. Terry Newsome, Jr. Steamfitters Health and Welfare Fund (“the Fund”). The Fund is run by a group UA Local Union 72 of people called the Board of Trustees; the Trustees include Local 72 Mr. Steve Newsome representatives and representatives from employers that employ Local 72 UA Local Union 72 members (“Contributing Employers”). Mr. Jarrett Wade Over the last two years, the Board of Trustees has issued a number of UA Local Union 72 communications indicating that changes are necessary in order to bring the Mr. Greg Stephens Fund’s expenses in line with income. The Trustees have been working diligently UA Local Union 72 towards achieving a balanced budget for the Fund in order to protect its long term financial health and provide you with the best benefits available using the Employer Trustees monies paid into the Fund. Mr. Jon Sterling Co-Chairman Last year, changes were made to increase income to the Fund in a balanced Maxair Mechanical, Inc. way, without placing all of the burden of change on one group or entity. Local 72, Contributing Employers and Participants all came together to be part of the Mr. Gary Fowler solution. Participants began contributing towards dependent coverage; Mechanical Contractors Contributing Employers increased the Health & Welfare Fund contribution by Association of Georgia $1.39 per hour; Local 72 reallocated contributions from the Pipe Fund and the Mr. Ken Harbour Joint Apprenticeship and Training Trust Fund; the Mechanical Contractors Cleveland Mechanical Association reallocated contributions from the MIC Management Fund. Services

Increasing income to the Fund is half of the equation in establishing a balanced Mr. John McKenney budget. This year, the Trustees must focus on plan design changes that are McKenney’s Inc. necessary to reduce plan expenses and bring them in line with income. The Mr. James K. Estabrook following pages describe the benefit changes which will be effective April 1, Lindabury, McCormick, 2018. Please carefully review this notice and contact NEBA with any questions. Estabrook & Cooper, P.C. Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – April 1, 2018 This document is a “Summary of Material Modifications” (SMM) which describes changes to the Atlanta Plumbers and Steamfitters Health and Welfare Fund (the “Fund”). This SMM modifies the language found in your Summary Plan Description (SPD). All statements made in this document are subject to the terms and conditions of the Plan Document. If there is a discrepancy between the SPD or this SMM and the Plan Document, the Plan Document will govern. As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions. Copies of the SPD and Plan Document are available for review at any time during normal working hours at NEBA’s offices.

Benefit Changes Applicable to the Non-Residential Plan effective April 1, 2018:

Out of Pocket Maximum $7,350 per covered individual The Out of Pocket Maximum will be adjusted annually to match the Federal $14,700 per family limit set by the U.S. Department of Health and Human Services. Medical and Prescription Drug benefits fall under one combined Out of Pocket maximum.

Deductible $1,200 per covered individual Medical and Rx benefits fall under one combined deductible. $3,600 per family

Physician Office Visit to Treat Illness or Injury $50 copay for Office Evaluation Also applies to office visits to Urgent Care centers and Convenience Care centers. Does not apply to chiropractors.

LiveHealth Online $0 Copay LiveHealth Online is a 24/7 service that connects members with board- No Cost to You certified doctors through a two-way, live video chat from their smartphone, tablet or computer with a webcam. Members can get medical advice, a diagnosis and even a prescription.

Medical Benefits Coinsurance 30%

Prescription Drug Benefits Coinsurance 15% for Generic drugs See OptumRx Formulary to determine which category your prescription drug 35% for Preferred drugs falls under. 50% for Non-Preferred drugs

Emergency Room $500 Specific Deductible per Visit *Also subject to Plan Deductible PLAN CHANGES WHAT DO THEY MEAN?

What is an Out of Pocket maximum? The Out of Pocket maximum is a financial protection for you that is built in to your plan. This is the maximum amount you will have to pay in deductibles, copays and coinsurance for your covered in-network claims. Once you have met this maximum, the plan will pay 100% of your covered in-network claims.

You earn credit towards meeting your Out of Pocket maximum each time you incur covered expenses with your in-network healthcare providers. For example, if you receive services at a hospital and incur a $100 charge towards your deductible, when your claim is processed, the plan will credit you with meeting $100 towards your Out of Pocket maximum. Medical and Prescription drug expenses count towards your Out of Pocket maximum.

Effective April 1, 2018, your Out of Pocket maximum will be $7,350 per covered Individual or $14,700 per Family.

What will my deductible be? You must pay all the costs up to the deductible amount before the plan begins to pay for covered services you use. Your deductible is waived for some services. Your deductible counts towards your Out of Pocket Maximum and applies to both medical and prescription drug benefits.

Effective April 1, 2018, your deductible will be $1,200 per covered individual, or $3,600 per family. Your deductible does not apply to wellness visits or physicians’ office evaluation charges ( other than a chiropractor).

What will I pay for a primary care or specialist doctor’s office visit to treat an injury or illness? A set office visit copay allows you to plan and budget for doctors’ visits. Instead of paying a percentage of an unknown charge, you will know exactly how much you have to pay with an office visit copay benefit. (Labs and other services performed during the office visit are subject to your deductible and coinsurance).

Effective April 1, 2018, your copay for visiting an in-network primary care doctor or

specialist to treat an illness or injury will be $50. Your deductible will not apply to doctors’ visits. *Not applicable to chiropractors. Continued…

PLAN CHANGES WHAT DO THEY MEAN?

What will I pay for other medical services? After you meet your deductible, the plan covers a percentage of your claims and you cover the remaining percentage, called your coinsurance. Your coinsurance counts towards your Out of Pocket Maximum.

Effective April 1, 2018, your coinsurance percentage will be 30% for services subject

to coinsurance.

What will I pay for prescription drugs? After you have met your deductible, the plan covers a percentage of your prescription drug claims and you cover the remaining percentage, called your coinsurance. Your coinsurance level depends on the classification of your prescription drug as either Generic, Preferred or Non-Preferred. See your Optum Rx Formulary to determine your drug’s classification. Your deductible and coinsurance count towards your Out of Pocket Maximum.

Effective April 1, 2018, your coinsurance for prescription drugs will depend on what type of medication you are receiving. Generic Medication…………………..15% Coinsurance Preferred Medication…………………35% Coinsurance Non-Preferred Medication…………50% Coinsurance

What if I have an Emergency? The Board of Trustees wants you to receive the most appropriate care for your situation. Sometimes that means going to a hospital Emergency Room; however, consider this: the average hospital Emergency Room claim is about ten times costlier than an Urgent Care center claim.

Effective April 1, 2018, your additional deductible for visiting a hospital Emergency Room will be $500. You can save money by using an Urgent Care Center, Retail Health Clinic, or LiveHealth Online.

PLAN CHANGES WHAT DO THEY MEAN?

The wait times are usually much shorter than at an ER and you can avoid the $500 specific deductible that applies to each ER visit. LiveHealth Online® Easy, fast doctor visits. All from the comfort of your own computer or mobile device.

Talk to a doctor today, tonight, anytime — 365 days a year. Just enroll at livehealthonline.com or on the free mobile app.

31709GAMENBGA Rev. 07/14 Now you can get the health care you need without all the hassle Have a health question? Under the weather? With LiveHealth Online, you don’t have to schedule an appointment, drive to the doctor’s ofﬁ ce, and then wait for your appointment. In fact, you don’t even have to leave your home or ofﬁ ce. Doctors can answer questions, make a diagnosis, and even prescribe basic medications when needed.*

With LiveHealth Online, you get: Available at no cost to eligible Participants of  Immediate doctor visits through live video. the Atlanta Plumbers &  Your choice of U.S. board-certiﬁ ed doctors. Steamfitters Health Download  Help at a cost of only $49 per visit, subject to and Welfare Fund deductible and coinsurance. effective April 1, the app now!  Private, secure and convenient online visits. 2018!

What are the qualiﬁ cations of the doctors you consult via apple.com LiveHealth Online?

 U.S. board-certiﬁ ed.

 Average 15 years practicing medicine.

 Mostly primary care physicians.

 Specially trained for online visits.

When can you use LiveHealth Online?

As always, you should call 911 with any emergency. Otherwise, you can use play.google.com/store LiveHealth Online whenever you have a health concern and don’t want to wait. Doctors are available 24 hours a day, seven days a week, 365 days a year. Some of the most common uses include:

 Cold and ﬂ u symptoms such as a cough, fever and headaches

 Allergies

 Sinus infections

 Family health questions

Start a conversation now.

Just enroll for free at livehealthonline.com or on the app, and you’re ready to see a doctor.

*As legally permitted in certain states. LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Blue Cross and Blue Shield of Georgia. Blue Cross and Blue Shield of Georgia, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: All Plan Participants Board of Trustees From: Board of Trustees Union Trustees Date: April 25, 2017 RE: Important Announcement regarding Dependent Coverage Mr. Jeff Housworth Co-Chairman As a member of Plumbers, Pipefitters, & HVACR Technicians Local 72 (“Local UA Local Union 72

72”) you receive health care benefits through the Atlanta Plumbers and Mr. Terry Newsome, Jr. Steamfitters Health and Welfare Fund (“the Fund”). The Fund is run by a group UA Local Union 72 of people called the Board of Trustees; the Trustees include Local 72 representatives and representatives from employers that employ Local 72 Mr. Steve Newsome members (“Contributing Employers”). UA Local Union 72

Mr. Terry Sinyard On an ongoing basis, the Board of Trustees monitors the financial status of the UA Local Union 72 Fund; their focus is to provide you with the best benefits available using the monies paid into the Fund. Over the last year and a half, the Board of Trustees Mr. Greg Stephens has issued a number of communications indicating that changes are necessary UA Local Union 72 in order to bring the Fund’s expenses in line with income. The Trustees have Employer Trustees been working diligently towards achieving a balanced budget for the Fund in order to protect its long term financial health. Mr. Jon Sterling Co-Chairman The Trustees have considered and continue to consider many different ways Maxair Mechanical, Inc. to increase income and reduce expenses in a balanced way, without placing all of the burden of change on one group or entity. The Trustees believe that this Mr. Gary Fowler Mechanical Contractors problem is one that can only be solved together, with participation and Association of Georgia compromise from all parties. Local 72, Contributing Employers and Participants must all be part of the solution. Mr. Ken Harbour Cleveland Mechanical The following pages describe how the Fund’s eligibility rules are changing with Services respect to dependent coverage. In order to maintain coverage for Mr. John McKenney dependents, your action will be required. Please carefully review this McKenney’s Inc. memorandum and Summary of Material Modifications (SMM) and contact NEBA with any questions. Mr. Grant Willis Willis Mechanical, Inc.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

These important steps are being taken with the sole focus of preserving the financial integrity of the Fund so that valuable benefits can continue to be provided to you now and in the future.

Active Employees and Non-Bargaining Unit Employees

• Spousal coverage will continue to be available to non-bargaining unit employees and bargaining unit employees working in a classification under the Collective Bargaining Agreement (CBA) which requires Health and Welfare Fund contributions at a rate that is at least equal to the Journeyman Health and Welfare contribution rate. Coverage for dependent children will continue to be available to non-bargaining unit employees and bargaining unit employees working in all classifications. Please refer to your Collective Bargaining Agreement for specific contribution rates.

• As of the date of this memo, CBA classifications with a Health and Welfare contribution rate at least equal to the Journeyman Health and Welfare contribution rate include: • 1st - 5th year Apprentice • Foreman, Crew Foreman, & General Foreman • Mechanical Equipment Serviceman • Provisional Journeyman • Journeyman • Tradesman (Not Including Pipe Tradesman)

• Spousal coverage is no longer available to employees working in a CBA classification which requires Health and Welfare Fund contributions at a rate that is less than the Journeyman Health and Welfare contribution rate. This coverage was eliminated effective April 1, 2017 and notice was provided in a memo dated January 31, 2017. As of April 1, 2017, these classifications include Helper, Pipe Tradesman and Residential. Please refer to your Collective Bargaining Agreement for specific contribution rates.

• Eligible employees working in a classification that permits spousal coverage must determine whether or not they wish to elect spousal coverage. Employees should consider all coverage options available for their spouse, such as coverage through his/her employer or the Healthcare Marketplace. Loss of coverage under the Atlanta Plumbers and Steamfitters Health and Welfare Fund may trigger special enrollment rights for spouses who have lost coverage, which would allow them to enroll in another group health plan or in a plan available through the Healthcare Marketplace at Healthcare.gov.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

• Each employee who elects to cover his/her spouse as a dependent must make a weekly contribution of $25, effective the first payroll period in June 2017. First Year Apprentices are exempt from this contribution requirement. Contribution payments will be collected by Contributing Employers via payroll deductions. Contribution rates are set by the Board of Trustees and may be modified periodically.

• Each employee who elects to cover his/her dependent child(ren) must make a contribution for coverage. First Year Apprentices are exempt from this contribution requirement.

• The contribution requirements for dependent child(ren) coverage vary. First Year Apprentices are exempt from this contribution requirement.

o The dependent child(ren) contribution rate for employees working in a classification under the Collective Bargaining Agreement (CBA) which requires Health and Welfare Fund contributions at a rate that is at least equal to the Journeyman Health and Welfare contribution rate has been set at $5 per week, effective the first payroll period in June 2017. This rate is for all dependent children covered by the employee; it is not a per-child rate. Contribution payments will be collected by Contributing Employers via payroll deductions.

o The dependent child(ren) contribution rate for employees working in a classification under the Collective Bargaining Agreement (CBA) which requires Health and Welfare Fund contributions at a rate that is less than the Journeyman Health and Welfare contribution has been set at $250 per month, per child. This contribution requirement was effective April 1, 2017 and notice was provided in a memo dated January 31, 2017. As of April 1, 2017, these classifications include Helper, Pipe Tradesman and Residential. Contribution payments must be self-paid by employees.

• Employees who are out of work may elect to pay their dependent coverage contributions by withdrawing hours from their bank. One hour will be worth the value of the then-current hourly Journeyman Health & Welfare contribution rate. For example, based on the current rate of $5.51, 4.54 hours may be withdrawn in order to pay a $25.00 contribution. ($25.00 / $5.51 = 4.54 hours). Employees will be required to complete a request form in order to do this. Employees may elect to self- pay the contribution instead.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

• Each year, during an “Open Enrollment” period, employees must decide whether or not to cover their dependent spouses and/or children for the upcoming year. Enrollment elections may be made using a paper form or online through the Member Portal website; details will be provided in a separate Open Enrollment notice.

• Employees may not change their dependent coverage election during the year, outside of the Open Enrollment period, unless a Qualifying Event has occurred. Qualifying Events include life changes such as marriage, divorce and birth of a child.

• The first Open Enrollment will be conducted from May 1st – May 20th for coverage effective September 1, 2017. During this Open Enrollment period, employees will be given the opportunity to elect dependent spouse and/or dependent child(ren) coverage effective September 1, 2017.

• An in-person Open Enrollment meeting will be held at the Local 72 Union Hall from 8:00 a.m. – 5:00 p.m. on May 2, 2017. Further announcements will be made regarding in-person meetings to be scheduled at large employer sites.

• Subsequent Open Enrollments will be conducted each September for coverage changes effective the following January. During each annual Open Enrollment, employees may enroll new dependents, drop existing dependents or elect not to carry dependent coverage.

• Employees who do not elect coverage during Open Enrollment will lose coverage for their dependent spouse and/or child(ren) effective August 31, 2017. Dependents may be re-enrolled during the next Open Enrollment period for coverage effective January 1, 2018.

• Spouses and dependent children who lose coverage will be provided with a certificate of coverage showing the date coverage was lost. Spouses and dependent children may need this certificate in order to enroll in another plan.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Early Retirees Who Retire on or After March 1, 2018

• Early retirees are those retirees who elect retiree coverage prior to age 65.

• Each early retiree who retires on or after March 1, 2018, who elects to cover his/her spouse as a dependent, must make a monthly contribution of $108.34, in addition to the regular retiree contribution. Contribution rates are set by the Board of Trustees and may be modified periodically.

• Each early retiree who retires on or after March 1, 2018, who elects to cover his/her dependent child(ren), must make a monthly contribution of $21.67, in addition to the regular retiree contribution. Contribution rates are set by the Board of Trustees and may be modified periodically.

Enclosed with this memorandum is a Summary of Material Modifications (SMM) which describes these changes in detail. The SMM should be kept with your Summary Plan Description (SPD). Also enclosed is an Open Enrollment notice which provides details regarding how you may elect spousal and dependent child(ren) coverage. As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – June 1, 2017

Active Employees and Non-Bargaining Unit Employees

Eligibility Changes – Dependent Coverage

• Effective for coverage September 1, 2017 and after, non-bargaining unit employees and bargaining unit employees working under Collective Bargaining Agreement (CBA) classifications that permit spousal coverage must make an election to cover their spouse as a dependent. As of the date of this memo, the classifications include: • 1st - 5th year Apprentice • Foreman, Crew Foreman, & General Foreman • Mechanical Equipment Serviceman • Provisional Journeyman • Journeyman • Tradesman (Not Including Pipe Tradesman)

• Each employee who elects to provide coverage to a dependent spouse under the Fund must make a weekly contribution of $25. First year Apprentices are exempt from this contribution requirement. Weekly spousal coverage contributions will be collected via payroll deductions.

• Effective for coverage September 1, 2017 and after, non-bargaining unit employees and bargaining unit employees working in a classification under the Collective Bargaining Agreement (CBA) which requires Health and Welfare Fund contributions at a rate that is at least equal to the Journeyman Health and Welfare contribution rate must make an election to cover their dependent child(ren) under the Fund and make a weekly contribution of $5, regardless of the number of dependent children

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

covered. First year Apprentices are exempt from this contribution requirement. Weekly dependent child(ren) coverage contributions will be collected via payroll deductions.

• Employees who are out of work may elect to pay their dependent spouse and/or dependent child(ren) coverage contributions by withdrawing hours from their bank. One hour will be worth the value of the then-current hourly Journeyman Health and Welfare contribution rate.

Early Retirees Who Retire on or After March 1, 2018

Eligibility Changes – Dependent Coverage

• Early retirees are those retirees who elect retiree coverage prior to age 65.

As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: Pipe Tradesmen, Helper and Residential Plan Participants of the Board of Trustees Atlanta Plumbers and Steamfitters Health and Welfare Fund Union Trustees From: Board of Trustees Date: January 31, 2017 Mr. Jeff Housworth RE: Important Announcement regarding Plan Changes Co-Chairman UA Local Union 72

As a member of Plumbers, Pipefitters, & HVACR Technicians Local 72 (“Local Mr. Terry Newsome, Jr. 72”), you receive health care benefits through the Atlanta Plumbers and UA Local Union 72 Steamfitters Health and Welfare Fund (the “Fund”). The Fund is run by a group Mr. Steve Newsome of people called the Board of Trustees; the Trustees include Local 72 UA Local Union 72 representatives and representatives from employers that employ Local 72 members. Mr. Terry Sinyard UA Local Union 72 On an ongoing basis, the Board of Trustees monitors the financial status of the Mr. Greg Stephens Fund; their focus is to provide you with the best benefits available using the UA Local Union 72 monies paid into the Fund by your employers. Sometimes it is necessary for them to modify, reduce or eliminate benefits in order to protect the long term Employer Trustees financial health of the Fund, which is also in the best interest of participants. Mr. Jon Sterling Co-Chairman When the Trustees are faced with these difficult decisions, they carefully Maxair Mechanical, Inc. consider their options and aim to protect the benefits which they believe are Mr. Gary Fowler most important to participants. The Trustees have determined, with the Mechanical Contractors assistance of their professional advisors, that changes are necessary. Association of Georgia  First, the current Pipe Tradesmen, Helper and Residential Plan benefits Mr. Ken Harbour program is costing far more in claims expenses than it is receiving in Cleveland Mechanical employer contributions; therefore, effective April 1, 2017, the existing Services benefits have been modified so that expected expenses more closely Mr. John McKenney match expected contributions. Enclosed with this notice is an updated McKenney’s Inc. Summary of Benefits and Coverage (SBC) which describes your new benefits. Mr. Grant Willis Willis Mechanical, Inc.

ADMINISTRATIVE MANAGER:

National Employee Benefits Administrators, Inc. 1.888.365.0072 (Toll Free) • 954.266.6322 • 954.266.2079 (Fax) www.nebainc.com 2010 N.W. 150th Ave, Suite 100 374 Maynard Terrace, S.E., Suite 72 3715 Northside Parkway, Suite 2-495 Pembroke Pines, FL 33028 Atlanta, GA 30316 Atlanta, GA 30327

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

 Second, the current contributions for the Pipe Tradesmen, Helper and Residential Plan do not support providing coverage for dependents at no additional cost to employees; therefore, effective April 1, 2017, coverage will be provided at no cost for employees only.

Effective April 1, 2017, coverage for dependent children may be elected at a cost, which must be self-paid by the Participant.

Effective April 1, 2017, dependent spouses will no longer be covered under the Pipe Tradesmen, Helper and Residential Plan.

Please know that these important steps were taken with the sole focus of preserving the financial integrity of the Fund so that good benefits can continue to be provided to you now and in the future.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – April 1, 2017

Benefit Changes effective April 1, 2017  The Pipe Tradesmen, Helper and Residential Plan benefits have been modified in accordance with the enclosed Summary of Benefits and Coverage (SBC).

Eligibility Changes effective April 1, 2017  The Pipe Tradesmen, Helper and Residential Plan no longer includes coverage for dependent spouses.  The Pipe Tradesmen, Helper and Residential Plan no longer affords coverage to dependent children at no cost. Participants may elect to cover Dependent children at a cost of $250 per month, per child. Please contact NEBA at 1-888-365-0072 if you wish to elect coverage for dependent children.

Your dependent coverage contribution check must be payable to the Atlanta Plumbers and Steamfitters Health and Welfare Fund and must be received by NEBA no later than the 15th day of the month prior to the coverage month, as shown in the examples below.

Coverage Month Dependent Child Contribution Due Date April March 15th May April 15th June May 15th July June 15th August July 15th September August 15th etc.…

As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Board of Trustees Summary of Material Modifications – January 1, 2017 Union Trustees

UA Local Union 72  Effective January 1, 2017, charges for the purchase and fitting of hearing aids at Costco Wholesale stores and retail locations will be Mr. Greg Stephens covered according to the hearing aid limitations outlined in the UA Local Union 72

Schedule of Benefits. Although Costco Wholesale stores do not Employer Trustees participate in the Anthem/Blue Cross Blue Shield provider networks, hearing aid services incurred in a Costco Hearing Center will be Mr. Jon Sterling considered a covered expense subject to the in-network Hearing Aid Co-Chairman benefit. Maxair Mechanical, Inc.

Mr. Gary Fowler Mechanical Contractors If you have any questions, please contact National Employee Benefits Association of Georgia Administrators, Inc. at (888) 365-0072. Mr. Ken Harbour Cleveland Mechanical Services

Mr. John McKenney McKenney’s Inc.

Mr. Grant Willis Willis Mechanical, Inc.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: Participants in the Atlanta Plumbers and Steamfitters Board of Trustees Health and Welfare Fund Union Trustees From: Board of Trustees Date: May 20, 2016 Mr. Jeff Housworth RE: Important Announcement regarding Plan Changes Co-Chairman UA Local Union 72

As a member of Plumbers, Pipefitters, & HVACR Technicians Local 72 (“Local Mr. Terry Newsome, Jr. 72”) you receive health care benefits through the Atlanta Plumbers and UA Local Union 72 Steamfitters Health and Welfare Fund (“the Fund”). The Fund is run by a group Mr. Steve Newsome of people called the Board of Trustees; the Trustees include Local 72 UA Local Union 72 representatives and representatives from employers that employ Local 72 members. Mr. Terry Sinyard UA Local Union 72 On an ongoing basis, the Board of Trustees monitors the financial status of the Mr. Greg Stephens Fund; their focus is to provide you with the best benefits available using the UA Local Union 72 monies paid into the Fund by your employers. Sometimes it is necessary for them to modify, reduce or eliminate benefits in order to protect the long term Employer Trustees financial health of the Fund, which is also in the best interest of participants. Mr. Jon Sterling When the Trustees are faced with these difficult decisions, they carefully Co-Chairman consider their options and aim to protect the benefits which they believe are Maxair Mechanical, Inc. most important to participants. The Trustees have determined, with the Mr. Gary Fowler assistance of their professional advisors, that changes are necessary. Mechanical Contractors  First, the current dental and vision programs are no longer affordable Association of Georgia

for the Fund to continue to provide at this time; therefore, effective Mr. John Helms June 1, 2016, the existing dental and vision benefit plans are being W.B. Wallis & Company suspended. It is the intent of the Trustees to reinstate the benefits after stabilizing the financial status of the Fund. Mr. John McKenney McKenney’s Inc. The decision to suspend these benefits was not made lightly; it is important to Mr. Grant Willis the Trustees that the Fund be in a position to offer dental and vision coverage Willis Mechanical, Inc. in the future and they will continue to monitor the finances and look for an

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072 affordable way to offer these benefits when the suspension is lifted. Dental and vision claims incurred on or before May 31, 2016 will continue be processed in accordance with the plan of benefits in effect at the time the claims were incurred.

 Second, an increase in the Emergency Room deductible is necessary to more accurately reflect the cost of receiving benefits in an Emergency Room setting. Effective June 1, 2016, the Emergency Room deductible has increased to $250 per visit.

These benefit changes are reflected in the new Summary of Benefits and Coverage (SBC) that was recently sent to your home, in April 2016.

 Third, the Trustees have determined that they can obtain better discounts on healthcare services by changing Preferred Provider Networks.

Effective September 1, 2016, Anthem Blue Cross Blue Shield of Georgia will replace Cigna as the Preferred Provider Organization. Blue Cross Blue Shield of Georgia is the largest insurer in Georgia. They have over 16,000 physicians, over 130 hospitals and an excellent reputation. They were able to provide a significant improvement in discount levels over the current Cigna provider network. Please expect some additional communications in the coming months which more fully explain the transition from Cigna to Blue Cross Blue Shield of Georgia.

 Fourth, the Trustees have determined that the current method of delivering healthcare benefits to retired participants does not take full advantage of subsidies and discounts that Medicare affords plans that cover Medicare-eligible retirees. As a result, the Trustees have decided to change the way benefits are delivered to Medicare-eligible retirees.

Effective September 1, 2016, the Board of Trustees is pleased to announce that they have established a stand alone retiree plan for retired participants of the Atlanta Plumbers and Steamfitters Health and Welfare Fund.

Effective September 1, 2016, coverage will be provided to Medicare-eligible retirees and their Medicare- eligible dependents under the new plan, the Atlanta Plumbers and Steamfitters Retiree Health and Welfare Fund (“the Retiree Fund”).

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Non-Medicare-eligible retirees and dependents will continue to be provided coverage under the active plan at this time.

Medicare-eligible retirees and their Medicare-eligible spouses covered under the Retiree Fund will receive a Health Reimbursement Arrangement (HRA) account to help them pay for new coverage through a private Medicare exchange. The exchange provides individuals with a choice of benefit plans at a defined cost. The Trustees have carefully evaluated the numerous plan options available via the exchange to determine the HRA funding level that will enable all Medicare-eligible retirees and their Medicare-eligible spouses to obtain coverage similar to their current coverage, with the potential for some participants to reduce their costs. The Trustees have set the funding level of the HRA account at $200 per month per covered Medicare-eligible retiree and $200 per month per Medicare-eligible spouse of a covered retiree.

The Trustees understand that this method of delivering benefits is very different than what has been done in the past, so they have selected RightOpt, a private health insurance exchange, to help Medicare-eligible retirees and spouses navigate their available plan options and enroll in the plans that best meet their needs. RightOpt has representatives, called Enrollment Advocates, who will work one on one with each individual to be sure that they understand all of the options available to them and walk them through the process of enrolling. There is no cost to use RightOpt’s services. RightOpt will send you more information and their Enrollment Advocates will reach out to you to explain next steps.

Since your current group coverage will end on September 1, 2016, you will enroll in new coverage through RightOpt from July 1 through August 19. This will ensure your new coverage is in place and you do not have a gap in coverage.

Please know that these important steps were taken with the sole focus of preserving the financial integrity of the Fund so that good benefits can continue to be provided to you and your families now and in the future.

Enclosed with this memorandum is a Summary of Material Modifications (SMM) which describes these changes. The SMM should be kept with your Summary Plan Description (SPD). As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – June 1, 2016

 Effective June 1, 2016, the self-insured dental and vision plans have been temporarily suspended.

 Effective June 1, 2016, the Emergency Room Deductible has increased to $250.

 Effective September 1, 2016, Anthem Blue Cross Blue Shield of Georgia will replace Cigna as the Preferred Provider Organization.

 Effective September 1, 2016, retired Medicare-eligible participants of the Atlanta Plumbers and Steamfitters Health and Welfare Fund and their Medicare-eligible dependents will no longer be provided coverage through the Fund; retired Medicare-eligible Participants and their Medicare- eligible dependents will be provided coverage under a new stand alone retiree plan through the Atlanta Plumbers and Steamfitters Retiree Health and Welfare Fund (“Retiree Fund”).

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

To: Participants in the Atlanta Plumbers and Steamfitters Health and Welfare Fund From: Board of Trustees Date: March 31, 2016 RE: Eligibility Changes

The purpose of this Notice is to inform you that the Trustees of the Health and Welfare Fund have changed some of the rules governing how eligibility is determined based on work performed on and after May 1, 2016.

Eligibility which is based on work performed before May 1, 2016 will be determined in accordance with the rules in effect at that time.

The enclosed document sets forth the new rules in detail. Here are the highlights:

Changes applicable to new Participants and Participants that have been ineligible for 6 or more consecutive months:

 Employees who lose coverage for a period of six (6) consecutive months or more must meet the initial eligibility requirements in order to be reinstated. Previously, Employees who lost coverage had to meet the continuing eligibility requirements to be reinstated.

 There are two levels of coverage for initial eligibility with different minimum hour requirements. The first level includes eligibility for the Employee and his or her dependent children; the second level includes eligibility for the Employee, dependent children and spouse. Previously, there was one level of coverage which included the Employee, dependent children and spouse.

 The number of hours required for initial eligibility for the Employee and his or her dependent children has increased to 800 hours within a twelve (12) consecutive month period. The number of hours required for initial eligibility for the Employee, dependent children and spouse has increased to 1,200 hours within a twelve (12) consecutive month period. Previously, the number of hours required for initial eligibility was 390 hours in a three (3) consecutive month period.

ADMINISTRATIVE MANAGER:

Page 2

Changes applicable to Apprentices attending school:

 Apprentices attending school must meet the same continuing eligibility requirements as all other classifications. Previously, Apprentices attending school had a reduced minimum hour requirement for continuing eligibility.

Changes applicable to the Residential Job Classification:

 The Contribution (Work) Months and Benefit Months will be the same for all classifications. Previously, the Residential classification had a shorter administrative lag between the Contribution (Work) Month and the Benefit Month.

Please review the enclosed notice for further details regarding the changes. As always, please feel free to call the Plan’s Third Party Administrator, National Employee Benefits Administrators, Inc. (“NEBA”) at (888) 365-0072 with any questions.

ADMINISTRATIVE MANAGER:

Atlanta Plumbers and Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 1 (888) 365-0072

Summary of Material Modifications – May 1, 2016

This document is a “Summary of Material Modifications” (SMM) which describes changes to the Atlanta Plumbers and Steamfitters Health and Welfare Fund (the “Plan”). This SMM modifies the language found in your Summary Plan Description (SPD). All statements made in this document are subject to the terms and conditions of the Plan Document. If there is a discrepancy between the SPD or this SMM and the Plan Document, the Plan Document will govern. Copies of the SPD and Plan Document are available for review at any time during normal working hours at the Plan’s office.

The Board of Trustees has approved the following changes to the Rules of Eligibility effective for work performed on or after May 1, 2016, unless otherwise noted herein.

Changes to the Rules of Eligibility

Transition Rule

Employees who have earned coverage for future periods based on work performed prior to May 1, 2016 will remain eligible for coverage in accordance with the eligibility rules in effect prior to May 1, 2016. Please refer to your Summary Plan Description (SPD) for a full description of these rules.

Eligibility Rules Effective for Work Performed on and after May 1, 2016

Initial Eligibility | All Classifications

Initial eligibility for coverage for the Employee and his or her eligible dependent children begins on the first day of the Benefit Month that corresponds to the first Contribution (Work) Month in which contributions for at least 800 hours have been made on behalf of a bargaining unit Employee within a period of twelve (12) consecutive months or less.

Initial eligibility for coverage for the Employee’s eligible spouse begins on the first day of the Benefit Month that corresponds to the first Contribution (Work) Month in which contributions for at least 1,200 hours have been made on behalf of a bargaining unit Employee within a period of twelve (12) consecutive months or less.

Bargaining unit Employees who have been ineligible for benefits for a period of six (6) or more consecutive calendar months are treated in the same manner as bargaining unit Employees who have not been previously eligible for benefits.

ADMINISTRATIVE MANAGER:

National Employee Benefits Administrators, Inc. 1.888.365-0072 (Toll Free) • 954.266.6322 • 954.266.2079 (Fax) www.nebainc.com 2010 N.W. 150th Ave, Suite 100 374 Maynard Terrace, S.E. 3715 Northside Parkway Pembroke Pines, FL 33028 Suite 72 Suite 2-495 Atlanta, GA 30316 Atlanta, GA 30327

Page 2

Continuing Eligibility |All Classifications

Once a bargaining unit Employee satisfies the Initial Eligibility requirements, eligibility for coverage shall continue thereafter for each subsequent Benefit Month for which at least 130 hours of contributions are made on behalf of the bargaining unit Employee, withdrawn from the bargaining unit Employee’s Hour Bank or self-paid by the bargaining unit Employee for the corresponding Contribution (Work) Month.

This Continuing Eligibility Rule shall apply to Apprentices attending school, effective for work performed on and after May 1, 2016.

Contribution (Work) Months and the corresponding Benefit Months shall be as follows.

Contribution (Work) Months and Benefit Months | All Classifications

All bargaining unit Employees who satisfy the minimum hour requirement during a Contribution (Work) Month will be eligible for benefits during the Benefit Month that corresponds to the Contribution (Work) Month during which the hour requirement was satisfied. The Contribution (Work) Months and Benefit Months are as follows:

Contribution (Work) Month Benefit Month

October January November February December March January April February May March June April July May August June September July October August November September December

Reinstatement of Eligibility

A bargaining unit Employee whose eligibility for benefits has been terminated will have his or her eligibility reinstated on the first day of the Benefit Month that corresponds to the Contribution (Work) Month during which at least 130 hours of contributions are made on the Employee’s behalf.

Bargaining unit Employees who have been ineligible for benefits for a period of six (6) or more consecutive months are treated in the same manner as bargaining unit Employees who have not been previously eligible for benefits, and may earn eligibility in accordance with the Initial Eligibility Rules described herein.

If you have any questions, please contact National Employee Benefits Administrators, Inc. at 1 (888) 365-0072.

Atlanta Plumbers & Steamfitters Health and Welfare Fund c/o National Employee Benefits Administrators, Inc. 2010 N.W. 150th Avenue, Suite 100 | Pembroke Pines, FL 33028 1 (888) 365-0072 | Fax (954) 266-2079

Date: January 1, 2016 To: All Eligible Participants From: Board of Trustees Re: 2016 Forms

Happy New Year! In preparation for the year ahead, NEBA has designed a number of forms for your use in 2016. Enclosed are the following documents:

 Annual Claim Form - This form provides NEBA with updated information about you and your enrolled dependents. You must file this form on an annual basis. If NEBA has not received your annual claim form and a claim is submitted for you or your enrolled dependents, the claim will be denied and a request for the form will be sent to you. You will have a limited period of time to return the form in order to have your claims reprocessed. Please refer to your Summary Plan Description for details regarding claims filing deadlines. File the claim form at the beginning of each year to promote more efficient processing of your claims.

 PHI Authorization Form – This form enables you and/or your enrolled dependents to authorize NEBA staff to speak with other individuals about your Protected Health Information (PHI), including eligibility and claims. This form is only required if you wish to authorize this.

 Accident/Injury Details Form – This form may be requested from you if NEBA receives a claim with a diagnosis that could be related to an accident or an injury. This form helps NEBA staff determine if your claim should be covered by the Atlanta Plumbers & Steamfitters Health and Welfare Fund and if additional information is needed. If you have an accident, or suffer an injury, you should submit this form to NEBA.

There are several ways to return the forms to NEBA.

 Visit https://www.nebainc.com/SendFile.aspx and use the Secure File Upload. If you visit the site on your mobile device you can use your device camera to upload photos of the documents. Photos must be clear enough to read and you must include a photo of all pages of the form(s).  Visit https://luxsci.com/perl/public/securesend.pl and register to use the Secure Send Encrypted Email Portal. The portal allows you to create a free email account only for use in sending emails to NEBA in an encrypted fashion.  Mail them to NEBA at 2010 N.W. 150th Avenue, Suite 100 | Pembroke Pines, FL 33028.  Fax them to NEBA at (954) 266-2079.

If you have any questions, please call NEBA at 1-888-365-0072.

ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72 FRINGE BENEFIT FUNDS

IMPORTANT ANNOUNCEMENT – NEW ADMINISTRATIVE MANAGER EFFECTIVE 1/1/2016

NEW ADMINISTRATIVE MANAGER IN 2016 DO YOU HAVE UNFILED NEBA, Inc. to replace Southern Benefit Administrators, Inc. REMINDER: The Board of Trustees of If you have unfiled prescription PRESCRIPTION DRUG the Atlanta Plumbers & Steamfitters drug claims, please file them with CLAIMS? Local 72 Fringe Benefit Funds has SBAI before December 23, 2015. selected National Employee Benefits SBAI will continue to process FILE THEM BY 12/23/15 TO Administrators (NEBA) to serve as prescription claims they receive AVOID ANY DELAY IN Administrative Manager to the through December 31, 2015. REIMBURSEMENT Fringe Benefit Funds effective January 1, 2016. NEBA will replace After January 1, 2016, there will Send claims to Southern Southern Benefit Administrators, be a short period of time where Benefit Administrators, Inc. Inc. (SBAI). processing times will be longer (SBAI) through 12/23/15.

NEBA can be reached at: than usual while NEBA loads 1-888-365-0072 weekdays from 8:00 historical data from SBAI into their After 12/23/15, send claims a.m. – 5:00 p.m. EST. systems. to NEBA at 2010 N.W. 150th

NEBA will also have a representative Avenue, Ste. 100 Once this is complete, normal Pembroke Pines, FL 33028 at Local Union 72 to serve you processing times will resume. beginning in early February.

ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72

FRINGE BENEFIT FUNDS IMPORTANT ANNOUNCEMENT – NEW ADMINISTRATIVE MANAGER EFFECTIVE 1/1/2016

NEW ADMINISTRATIVE MANAGER IN 2016 DO YOU HAVE UNFILED NEBA, Inc. to replace Southern Benefit Administrators, Inc. PRESCRIPTION DRUG REMINDER: The Board of Trustees of If you have unfiled prescription the Atlanta Plumbers & Steamfitters drug claims, please file them with CLAIMS? Local 72 Fringe Benefit Funds has SBAI before December 23, 2015. FILE THEM BY 12/23/15 TO selected National Employee Benefits SBAI will continue to process AVOID ANY DELAY IN Administrators (NEBA) to serve as prescription claims they receive REIMBURSEMENT Administrative Manager to the through December 31, 2015. Fringe Benefit Funds effective Send claims to Southern January 1, 2016. NEBA will replace After January 1, 2016, there will Southern Benefit Administrators, Benefit Administrators, Inc. be a short period of time where (SBAI) through 12/23/15. Inc. (SBAI). processing times will be longer

than usual while NEBA loads NEBA can be reached at: historical data from SBAI into their After 12/23/15, send claims 1-888-365-0072 weekdays from 8:00 th a.m. – 5:00 p.m. EST. systems. to NEBA at 2010 N.W. 150 Avenue, Ste. 100 NEBA will also have a representative Once this is complete, normal Pembroke Pines, FL 33028 at Local Union 72 to serve you processing times will resume. beginning in early February.

ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72 FRINGE BENEFIT FUNDS

IMPORTANT ANNOUNCEMENT – NEW ADMINISTRATIVE MANAGER EFFECTIVE JANUARY 1, 2016 ATTENTION RETIREES: NEW ADMINISTRATIVE MANAGER IN 2016 WHO IS NEBA? NEBA, Inc. to replace Southern Benefit Administrators, Inc. (SBAI) NEBA stands for “National The Board of Trustees of the Atlanta Plumbers & Employee Benefits Steamfitters Local 72 Fringe Benefit Funds is pleased to Administrators, Inc.” announce that they have selected a new Administrative NEBA is a Third Party Manager to serve the Fringe Benefit Funds effective Administrator (TPA) that January 1, 2016. specializes in administering benefit ROLE OF THE ADMINISTRATIVE MANAGER plans that cover employees working for Effective January 1, 2016, EFFECTIVE Contributing Employers NEBA will take over all of JANUARY 1, 2016, under Collective the day-to-day administra- NATIONAL Bargaining Agreements tive tasks. This includes EMPLOYEE (CBAs) with various many important tasks such Unions across the United BENEFITS as issuing retirement States. benefit payments. ADMINISTRATORS, NEBA has been in

business for over twenty NEBA’s friendly, know- INC. (NEBA) WILL (20) years and employs ledgeable staff will be REPLACE approximately eighty (80) available toll free at: SOUTHERN Union members covered 1-888-365-0072 under a Collective Weekdays from 8:00 a.m. BENEFIT Bargaining Agreement to 5:00 p.m. EST. ADMINISTRATORS with the United Food and You may also visit their AS THE Commercial Workers Local Atlanta or Florida offices in ADMINISTRATIVE Union 1625. person. NEBA’s staff looks forward MANAGER FOR THE to being of service to you FRINGE BENEFIT and your family beginning FUNDS January 1, 2016!

December 15, 2015

WHO WILL ISSUE MY PENSION CHECKS? NEBA OFFICE LOCATIONS

 Southern Benefit Administrators Atlanta, GA will issue your January 2016 pension payment. 3715 Northside Parkway Suite 2-495 Atlanta, GA 30327  NEBA will issue your pension payment for February 2016 and and after based on the information Beginning in early Southern Benefit Administrators has February… on file for you. Local Union 72 374 Maynard Terrace, S.E. WHO WILL ISSUE MY 2015 TAX Atlanta, GA 30316 FORM? Jacksonville, FL  NEBA will issue your 1099R for 2015. 8657 Baypine Road Building 5 – Suite 200 DO I NEED TO DO ANYTHING? Jacksonville, FL 32256

 Tell NEBA if you have moved or had West Palm Beach, FL a change in your bank account 1920 N. Florida Mango Rd. where your check is direct West Palm Beach, FL 33409 deposited. Pembroke Pines, FL WHO CAN I CALL IF I HAVE 2010 N.W. 150th Avenue QUESTIONS? Suite 100 Pembroke Pines, FL 33028  Call NEBA at 1-888-365-0072.

IMPORTANT ANNOUNCEMENT FROM THE BOARD OF TRUSTEES OF THE ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72 FRINGE BENEFIT FUNDS NEW ADMINISTRATIVE MANAGER EFFECTIVE JANUARY 1, 2016

Atlanta Plumbers & Steamfitters Local 72 Fringe Benefit Funds c/o NEBA, Inc. 2010 N.W. 150th Avenue, Suite 100 Pembroke Pines, FL 33028

ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72 FRINGE BENEFIT FUNDS

IMPORTANT ANNOUNCEMENT – NEW ADMINISTRATIVE MANAGER EFFECTIVE JANUARY 1, 2016

ATTENTION PARTICIPANTS: WHO IS NEBA? NEW ADMINISTRATIVE MANAGER IN 2016 NEBA, Inc. to replace Southern Benefit Administrators, Inc. (SBAI) NEBA stands for “National The Board of Trustees of the Atlanta the Fringe Benefit Funds effective Employee Benefits Plumbers & Steamfitters Local 72 January 1, 2016. Look for further Administrators, Inc.” Fringe Benefit Funds is pleased to communications regarding this announce that they have selected a transition, which will be sent during NEBA is a Third Party new Administrative Manager to serve the month of December. Administrator (TPA) that ROLE OF THE ADMINISTRATIVE MANAGER specializes in NEBA to take over all of the functions currently handled by SBAI administering benefit Effective January 1, 2016, NEBA will NEBA has offices to serve you in plans that cover take over all of the day to day Atlanta, as well as three Florida offices employees working for administrative located in Contributing Employers functions. This Pembroke Pines, EFFECTIVE under Collective includes many Jacksonville, and important tasks JANUARY 1, 2016, West Palm Beach. Bargaining Agreements such as: NATIONAL EMPLOYEE Their friendly, (CBAs) with various collecting fringe knowledgeable BENEFITS Unions across the United benefit staff will be contributions ADMINISTRATORS, INC. available Monday States. from (NEBA) WILL REPLACE through Friday NEBA has been in Contributing SOUTHERN BENEFIT from 8:00 a.m. to business for over twenty Employers, 5:00 p.m. Eastern determining ADMINISTRATORS, INC. Standard Time via (20) years and employs eligibility for AS THE ADMINISTRATIVE telephone. You approximately eighty (80) health care MANAGER FOR THE may also visit Union members covered benefits, their offices in under a Collective processing FRINGE BENEFIT FUNDS person. health care In order to Bargaining Agreement claims, determining eligibility for provide you with convenient access to with the United Food and retirement benefits, calculating information regarding your benefits, Commercial Workers Local retirement benefits, issuing retirement NEBA will also be making available a Union 1625. benefit payments, etc. mobile-ready website which you can NEBA will work closely with the Board access via the internet on your tablet, NEBA’s staff looks forward of Trustees and their professional computer, or smart phone. This will be to being of service to you advisors to deliver excellent available once NEBA completes the and your family beginning administration services to you. conversion of data from SBAI in the January 1, 2016! summer of 2016.

November 15, 2015

IMPORTANT ANNOUNCEMENT FROM THE BOARD OF TRUSTEES OF THE ATLANTA PLUMBERS & STEAMFITTERS LOCAL 72 FRINGE BENEFIT FUNDS NEW ADMINISTRATIVE MANAGER EFFECTIVE JANUARY 1, 2016

Atlanta Plumbers & Steamfitters Local 72 Fringe Benefit Funds c/o NEBA, Inc. 2010 N.W. 150th Avenue, Suite 100 Pembroke Pines, FL 33028

[Type the recipient name] [Type the recipient address]

ATLANTA PLUMBERS & STEAMFITTERS LOCAL NO. 72 HEALTH & WELFARE FUND

NOVEMBER 5, 2014

BENEFIT IMPROVEMENTS ANNOUNCED EFFECTIVE JANUARY I, 20 IS

Dear Participant: New Annual Out-Of-Pocket Maximum Added for the Purchase of Specialty Drugs Our primary duty as Trustees of the Atlanta Plumbers As is provided for under the Schedule of Benefits availa and Steamfitters Local No. 72 Health and Welfare Fund ble to you and your family, each covered person is sub is to provide the best schedule of health care benefits ject to an annual out-of-pocket maximum of $3,000, in possible to you and your eligible dependents while doing cluding any covered charges not paid due to application our part to help contain the cost of those benefits. This of the Plan's $300 calendar year deductible. Further, no means that we must contiimally examine the adequacy of more than two covered persons in each family are re the Plan's reserves and ensure that the Plan's income and quired to satisfy the out-of-pocket maximum during a reserves are sufficient to pay for those benefits over time. calendar year. What this means, very simply, is that no Of course, federal law which regulates these benefits is covered person is responsible for any covered medical evolving on almm~t a daily basis, requiring that the bene expenses incurred during the course of the calendar year fits we attempt to provide to your family are in compli which exceeds $3,000, and no family is responsible for ance with federal mandates. more than $6,000 during the calendar year.

We are very pleased to announce that in recognition of There is currently one exception to the manner in which all of these responsibllities, we recently approved two the annual out-of-pocket maximum is applied. Costs in -enhancements which will not only broaden the coverage curred for the purchase of specialty drugs are covered by available to you and your family, but which will enable the Plan at 80%. Unlike the expenses incurred for other the Fund to maintain compliance with federal law, in covered medical charges, however, the 20% maximum cluding the· Affordable Care. Act. Those. changes are as for which the covered person is responsible has no limit. follows: In other words, the covered person's 20% share of spe cialty drug costs cannot be applied toward the individu al's out-of-pocket maximum nor is it limited to any par ticular dollar amount. ATLANTA PLUMBERS & STEAMFIITERS LOCAL NO. 72 HEALTH & WELFARE FUND We are very pleased to announce, however, that effective with specialty drug charges incurred on and after January 1, 2015, an annual out-of-pocket maximum is being im plemented for specialty drug costs. The new maximum is $3,600 per calendar year, which is the Fund's Plan Year. Administered by: Thus, for a covered person who does not use specialty Southern Benefit Administrators, Incorporated drugs, the only cost sharmg which will be applied will be 3835 Presidential Parkway, Suite·123 the annual $300 major medical deductible and the Plan's Atlanta, Georgia 30340 20% copayment percentage, but only up to the existing Phone: (770) 455-3802, Fax: (770) 455-6845 $3,000 annual out-of-pocket maximum. For individuals Toll-Free: (800) 382~926. who require the use of specialty drugs, your $3,000 annu al out-of-pocket maximum for all covered medical ex- PAGE 2 ATlANTA PLUMBERS & STEAHfllTERS LOCAL NO. 12 HEALTH & WELFARE FUND

penses, which includes the $300 annual deductible, plus Best regards, an additional $3,600 only for specialty drug charges must be satisfied each calendar year. BOARD OF TRUSTEES

This Plan improvement can have the effect of dramati Union Trustees: cally reducing a covered person's share of costs for the Mr. JeffHousworth, Co-Chairman purchase of specialty drugs because effective with those Mr. John Home purchased on and after January 1, 2015 you will never be Mr. Charlie Key required to pay out of your pocket more than $6,600 in Mr. Steve Newsome tota~ medical expenses. For those who must use specialty Mr. Greg Stephens drugs, this can mean a savings of several thousands of dollars per year. As we explained in a prior announce Management Trustees: ment, specialty drugs are generally those that are identi Mr. Jon Sterling, Co-Chairman fied as costing more than $500 per month, typically re Mr. Gary P. Fowler quire special handling, and in many cases are available Mr. John Helms only as injectable or infusion drugs. Mr. John McKenney Mr. Grant Willis Annual Vision Care Benefit Maximum Eliminated for Eligible Dependent Children Under 19 Years of JTB/mhb 72hl014 Age Currently, each covered person eligible for benefits un der the Plan is entitled to reimbursement for up to $200 in vision care costs per calendar year. In a previous change, we also agreed that any unused portion of the maximum: could be carried over for one additional calen dar year so that up to $400 in covered charges for vision care could be paid during that year.

· Because eligible dependent children sometimes have special needs and in an effort to ensure compliance with. the Affordable Care Act, we have eliminated the annual benefit maximum as.it applies to eligible dependent chil dren under 19 years of age. However, any covered vision charges incurred by an eligible dependent child under 19 years of age above the existing $200 calendar year maxi mum, or up to $400 in a two consecutive year period, will be covered by the Plan's major medical benefit and· be subject to the annual deductible and the applicable copayment percentage.. Please note that all other exclu sions and limitations applicable to vision care will re inain in effect. While we believe this action will be in the best interest of all eligible dependent children under the age of 19 years, we want to encourage you to continue to incur charges for vision care only as required. The Plan establishes certain usual, customary and reasonable standards which will be applied to ensure that charges paid by the Fund for this coverage will be reasonable.

We hope you are pleased with our continuing efforts to maximize•the benefits. available to you and your family. Should you have any questions concerning these changes or regarding your Plan of Benefits in general, please do not h~sitate to contact the Fund Office. ATLANTA PLUMBERS & STEAMFITTERS LOCAL NO. 72 HEALTH & WELFARE F.UND

NOVEMBER 5, 2014

BENEFIT IMPROVEMENT ANNOUNCED EFFECTIVE JANUARY I, 20 IS . " ...... ,___ .-.:·. ;.->

Dear Participant: New Annual Out-Of-Pocket Maximum Added for the Purchase of Specialty Drugs · · . Our primary duty as Trustees .of the Atlanta Plumbers As is provided for under the Schedule of Benefits availa and Steamfitters Local No. 72 Health and Welfare Fund ble to you and your~amily, each covered person is sub;. . is to provide the best schedule of. health care benefits ject to an annual out-of-pocket m~imum ()f $3,0?0, .in possible to you and. your eligible dependents while doing cluding any covered charges not patd due to apphcatton our part to help contain the cost ofthose benefits. This of the Plan's $3'00 calendar year deductible. Further, no means that we must continually examine the adequacy of more than two covered p~rsons in each· family are re the Plan's reserVesand.ensure.thatthe income and Pl~n's quired to satisfy the out-of~pocket maximum during a · reserves are sufficient to pay for tho~e benefits overtime. calem:lar year. What this means, very' simply; is that no . Of col1rse, (ederallaw which regul~tes these benefits is covered person is :responsible for any cov~ted mediCal evolving. on almost a daily basis~ requiring that the bene .expenses incurred during the course of 'the cal~ndar year fits we attemptto provide to your family are in conipli~ which exceeds $3 000 and no family. is responsible for · ancewith federalmand~tes, · · . ' , :· ·,...... more thal1 $6,000 during the calendary~ar.

We are very pleased to announce thatin recognition of There is currently one exception to the t;n'afiner in which all of these responsibilities, we. recently approved abene the annual out-of-pocket maximum is applied. Costs. in fit ellhancement.·which will·not only broaden the cover .curred for the purchase of specialty

penses, which includes the $300 annual deductible, plus an additional $3,600 only for specialty .drug charges. must be satisfied each calendar year. . '

This Plan improvement can. have the effect of dramati cally reducing a·covered person's share of costs for the purchase. of specialty drugs because effective with those. purchased on and after Januaryl, 2015 you.will never be required to pay out of your pocket more than $6,600 in total medical expenses. Forthose who must use specialty drugs, this can mean a savings of several thousands of dollars per year. As we explained in a prior announce ment, specialty drugs are generally those that are identi-:-. tied as costing more than $500 per month, typically re quire special handling, ·and ill many cases are .available only as injectable or infuSion drugs.

·. We hope you are pleased with our continuing efforts to inaximize the· benefits available to you· and. your· family. ·Should you have any questi()ns concerning this change or regarding your Plan of Benefits in general, please do not hesitate to· contaCt the. Fund Office. .

Bes.t regards,

BOARD OF TRUSTEES

. Union Trustees: ... Mr~JeffHousworth, Co-Chairman Mr. JoOO: Home . . .. . Mr. Charlie Key · Mr. Steve Newsome Mr.. Greg Stephens

Management Trustees: Mr. Jon.Sterling, cO-chairman · Mr. GaryP~ Fowler ·Mr. John HeliD.s · · ·Mr~ John McKenney Mr. Grant Willis

ITB/rrihb 72hll0514Helpers ATLANTA PLUMBERS & STEAMFITTERS HEALTH & WELFARE FUND

OCTOBER 28, 2013 IMPORTANT PLAN DESIGN CHANGES ANNOUNCED - EFFECTIVE JANUARY I, 2014

Dear Participant:

The purpose of this notice is to announce to you a num Again, all of the calendar year benefit payment maxi ber of improvements to the benefits provided to you and mums mentioned above are being removed from the plan . your eligible family members under the Atlanta Plumb effective with covered charges incurred on and after Jan ers and Steamfitters Health and Welfare Fund. The uary 1, 2014. changes announced herein become effective with cov ered charges incurred on and after January 1, 2014. We encourage you to carefully read this notice in its entirety PRE-EXISTING CONDITIONS LIMITATION ELIMINATED and then place it with your permanent records for future ' reference. Currently, the fund has a pre-existing conditions limita- . tion which applies to all Covered Family Members, with CALENDAR YEAR BENEFIT MAXIMUMS ELIMINATED the exception of dependent children under the age of 19. Effective with covered charges incurred on and after Jan The following calendar year benefit payment maximums uary 1, 2014, the pre-existing conditions limitation is per individual are being removed from the plan effective being removed from the plan in its entirety. with covered charges incurred on and after January 1, 2014: Please feeLfree to contact the fund office with any ques tions you may have regarding the changes anriounced in $250,000 - all covered charges combined this notice. ($150,000 for Residential Employees) ($50,000 for Helpers) Best regards, $10,000- outpatient prescription drugs $500 - oxygen/oxygen refills BOARD OF TRUSTEES $400 - new onset diabetes education Union Trustees: Mr. JeffHousworth, Co-Chairman Mr. John Home Mr. Charlie Key ATLANTA PLUMBERS & STEAMFIITERS Mr. Steve Newsome HEALTH & WELFARE FUND Mr. Greg Stephens

Management Trustees: Mr. Jon Sterling, Co-Chairman Mr. Gary P. Fowler Administered by: Mr. John Helms Southern Benefit Administrators, Incorporated Mr. David M. McKenney 3835 Presidential Parkway, Suite 123 Mr. Grant Willis Atlanta, Georgia 30340 Phone: (770) 455-3802, Fax: (770) 455-6845 Toll-Free: (800) 382-6926 JDB/bkr 72hl013 ATLANTA PLUMBERS & STEAMFITTERS

HEALTH & WELFARE FUND i ! MARCH 22, 2013 IL ______IM_Po_~_AN_r~cH_AN_G_Es_AN_N_ou_Nc_Eo ______~ll Dear Participant: after January 1, 2013. At our most recent meeting we /'

decided to fine-tune that change to allow unused portions 1 In a notice dated November 27, 2012 we announced a of the $200 maximum to be carried forward to the next number of important plan design changes which were calendar year, subject to a maximum accumulation of enacted with an effective date of January l, 2013. The $400 per person. This change is effective retroactively to purpose of this notice is to. inform you that we have de January 1, 2013, and we have instructed the fund office cided to fine-tune two of those changes in an effort to to first look back to 2012 for any possible carry overs, make them work better· for you. but only up to $200. For example, if you incurred $180 in covered vision charges during 2012, you will be allowed 1 First, as you may recall, we announced an overall revi to carry forward a total of $20 to 2013, resulting in a ! sion to the manner in which coverage is provided under maximum of$220. However, ifyou incurred$210 duri?g \ the plan for prescription drug charges. Among the chang 2012 no charges will be carried forward to 2013. Agam, · es announced was a requirement that covered drugs must each year going forward, unused portions of the $200 be pw:chased using the InformedRx discount card in or maximum will be carried forward to the next calendar der for the charges to be eligible for reimbursement un year, but you will not be allowed to accumulate a vision der the plan. We. have learned, however, that in a number care maximum in excess of $400. In other Words, any of instances, you are able to purchase some drugs at cer unused portion of any carryover amount will not be car tain locations on a less expensive basis without using the ried forward to the next year. drug card. Therefore, effective immediately, rather than reimbursing for drugs only if they are purchased using Please do not hesitate to contact the fund office with any the discount card, coverage will also be provided under questions you may have regarding the changes an the plan for covered drugs purchased without the drug nounced in this notice. card, if those drugs can be purchased on a less costly basis without the card. Best regards,

We aiso informed you in the November 27 notice that ·BOARD OF TRUSTEES the plan's calendar year vision care payment maximum was being reduced from $400 to $200 per covered family Union Trustees: member. effective with covered charges incurred on and Mr. Richard L. Oliver, Co-Chairman Mr. Jeff Housworth ATLANTA PLUMBERS & STEAMFIITERS Mr. Ben Jacobs HEALTH & WELFARE FUND Mr. Steve Newsome

Management Trustees: Mr. Jon Sterling, Co-Chairman Mr. Gary P. Fowler ·Administered by: Mr. John Helms Southern Benefit Administrators, Incorporated Mr. David M. McKenney 3835 Presidential Parkway, Suite 123 Mr. Grant Willis Atlanta, Georgia 30340 Phone: (770) 455-3802, Fax: (770) 4554i845 72h313 Toll-Free: (800) 382-6926 ".\·}

ATLANTA PLUMBERS & STEAMFITTERS HEALTH & WELFARE FUND

NOVEMBER 27. 2012 IMPORTANT PLAN DESIGN CHANGES ANNOUNCED - EFFECTIVE JANUARY I, 2013

Dear Participant: calendar year. These changes also give us the opportunity to focus more ori preventive benefits by significantly im One of our primary duties as trustees of the Atlanta proving and expanding the wellness benefits the plan has Plumbers and Steamfitters Health and Welfare Fund is to been providing for many years. All of the changes, as provide the best and broadest,plan of benefits possible described below, will become effective with covered from· the resources· which are available to us. To make charges incurred on and after January 1, 2013. We en sure we accomplish this goal, we employ the services of courage you to carefully read this notice in its entirety professional advisors to help us determine whether the and then place it with your permanent records for future benefits are being properly funded. We also meet on a reference. regular basis to monitor the ongoing fmancial experience oftheplan. COVERAGE FOR IN-NETWORK PREVENTIVE CARE As you are no doubt aware, the lengthy economic reces CHARGES EXPANDED - TO BE COVERED AT I 00% sion and downturn in employment has caused hardships WITH NO COST SHARING throughout this country. Nowhere is this more evident . than in the construction trades industry. For your infor . Effective with covered charges ·incurred on aild after Jan mation, employment among plan participants has uary 1, 2013, an array of in-network preventive care ser dropped precipitously ·over the course of the past two vices will be covered under the plan at 100% with no years and, during just the most recent two year period, cost sharing ·requirements. You may visit the fund's assets have fallen by approximately www.healthcare.gov/news/factsheets/20 10/07/preventive ($5,800,000), with ($4,672,000) of the. loss occurring -services-list.html for an up to date list of these in during just the latest year. Moreover, we expect the fund network preventive services which will be covered by. the to continue to suffer losses on a regular basis going for plan. Included are services such as·s~reening for Type 2 ward absent corrective action.on our part. · diabetes for adults with high blood pressure, PSA tests for men, mammography screenings every one to two Therefore we have ·decided to .implement_ a number of plan design changes which· will hopefully stem the tide years for women over 40 years ofage, and cervical can cer screening for women. Those·areonly few examples ofthe ongoing losses and allow the fund to at least break a of the many new preventive serv-ices·.whlch will be cov"" even from a financial standpoint during the upcoming ered by the plan beginning on January 1, 201:>. Many of the new covered services apply to all covered adults, ATLANTA PLUMBERs & STEAMFITTERS while some are gender specific, with an array of services HEALTH 8t WELFARE FUND for women only, and some for children only. Again, you should visit the website mentioned above for a compre- . hensive list of these new covered services~ FUTURE COVERAGE RESTRICTED TO IN-NETWORK Administered by: PROVIDERS ONLY AT NEW BENEFIT PERCENTAGE Southern Benefit Administrators, Incorporated 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 3034-0 • "Since September 1, 2006 Cigna.HealthCare has served as Phone: (770) 4-55-3802, Fax: (770) 4-55-684-5 the Fund's Preferred Provider .. Organization (PPO). Un Toll-Free: (800) 382-6926 der our arrangement with Cigna, Cigna is responsible for maintaining a broad network .of health care providers •· ~

PAGE 2 ATlANTA PWMBERS &STEAMFIJTERS HEALTH &WElfARE. FUND .. . .. ·who offer diseounts in return for referrals o{patients. ·. At tlte present time, the plan's payment perce11tage in:" Cigna has negotiated these discounts which they ~cu~ creases to 100% for covered charges incuired With a. PPO . late before Southern Benefit processes your da.inis. Over· ; ptoyider once the total of covered PPO charges not paid · the last six years we have worked diligently with Cigna by the fund, including covered charges not paid due ·to to expand their network 'in our area so that. it will beSt · .aPPli~on ofthe.calendar year deur$ed at 100% ·. er and the ainoup.t tllat will: be· payable :will be. $0~ of and will not be subject to the major medical deductible;. qigna' s llegotiated,price with the provid,er, . · · · · · •. Brand drugs will be reimbursed at the following per~ ··•· · . · · · · · · · ·· ·. .· · . ·. centages after, the major. medicid. deductible has been . R~@izmg that circum$tances sometimes· arise that can satisfied• and the· Plan's out-:Qf.;;pocket :iliaxinium ·will ···i>i~;Verit the: use of an· in"-netwoik .pmvider, ·we< have ap- ,·· . 11ever:·beapplied'to them:· •ci~~,~~.:st~n:v.;~~7erii'f~ic:r·. : =~~!t~::;:;~nOt - • Charges for tr~~dment incun:ed :with ~ . out-Of~ , . • AIL·sp~ialty medications, iadudfug allhlfusion anq1> . · net.Wqrk, providet.Whell it is M~fPliJ;J.ed tblit ·lli:~~ is .. , ··Injectable dtugs, will be paid a8 brand drUgs with the . · .no..· w-net'W()rk proy~der. q1u~ljfiep. tQ a~Miis~C?f: tpaJi: ;, . exception of insulin. purchased on a generic baSis. . treatineritwithin40 111ile~.oftb.~·patienf s;zip'~e; ·· .· ·•; .· • .... Initial.d:iarges for Life·Thr~i.eriing Elll~rgencies ~ ;,;, Jt:is important to remember that these new niles will be that'teJllllS defmed in tbe PJa,fi; 3}.td:: ...... ·.· ... :". , strictly applied in all situations -whether the· dnig is ad-· • AwolJ!lts charge.d for.anesthesiology,.radjology:; pa:"··· ·•· ministered by a phyl)ician or self·a~.rvices, is $t,ooo per · ··· · : caleh9ar year. Effective with·¢dy~f:~'charges incurred on

, .. ,:. INCREASED-·. ·.;,:,. ;,,,,,: • · 1 1 andafterJan~t.2o13,th~ii~~j::taaryearmaximumis ~-_.;.;;..;..;.;,.;...;..;,;;.;;;..,..;;.;:...... ,;---:.....,;....;;...;..;;,;....,.;...... ---;.;;;.;,;...... _.....;...;;;iioi;... F being reauced tO $500. ' .?. ·... :. <.. The pl~'s c~iehoar y6ar otrt-of~poeket fririxiin\lttfi~ b&-:; iiig increased from .• $2~000 per covered ·family member/· CALENDAR YEAR PAyMENT MAXIMU~·.FORVISI08 .. ·. $4~000: per·. family of. covered individuals< to $3,000/: . BENEFITS REDUCED: . $6~00~ effective. ~ith covered charges irtcurred on Jllld . . . . ~. . .·, ~er January 1, 2013, · · · · · , . · .·. · ''<.The;plan's calendar year vision care payment maximu:m :Y:····· . ::;~ PAGE 3 ATlANTA PWHBERS &STEAHF11TERS HEAI,TH &WELFARE FUND is also being reduced from $400 per covered family member to $200 per covered family member effective with covered charges incurred on and after. January 1, 2013.

CHANGES THAT APPLY TO SCHEDULE OF BENEFITS FOR RESIDENTIAL EMPLOYEES

A number of the changes announced above do not apply to the schedule of benefits in effect for residential em ployees because of differences which already exist be tween the plan's regular schedule of benefits and the schedule of benefits for residential employees. Those changes which do apply are: the increase in the calendar year out-of-pocket maximum from $2,000/$4,000 to $3,000/$6,000; the elimination of non-PPO coverage from the plan with the three exceptions, and a proportion al decrease in the major medical payment percentage for charges incurred with a Cigna PPO provider. Fot the resi dential schedule, .the major medical payment percentage is being reduced from 80% to 75%. Additionally, no cov erage will be provided for prescription drugs unless they are purchased using the discount drug card from a partici pating lnformedRx pharmacy. Also, prescription drug charges will not be credited toward the out-of-pocket maximum and the payment percentage ·for prescription drugs will never increase to 100% .

.We hope you understand the need for the very difficult decisions addressed in this notice which. are required to preserve the plan and, more importantly, the benefits available to you and your family. Please do not hesitate to contact the fund office with ·any questions you may have regarding any of the changes announced herein.

Best regards,

BOARD OF TRUSTEES

Union Trustees: Mr. Richard L. Oliver, Co-Chairman Mr. Bruce A. Earnest Mr~ JeffHousworth Mr. Ben Jacobs

Management Trustees: Mr. Jon Sterling, Co-Chairman Mr. Gary P. Fowler Mr. John Helms Mr. David M. McKenney Mr. Grant Willis

72h1112 FUND OFFICE ADDRESS AND PHONE NUMBERS

Atlanta Plumbers and Steamfitters Health and Welfare Fund 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 30340 Phone: (770) 455-3802 Toll-Free: (800) 382-6926

PREFERRED PROVIDER ORGANIZATION The Fund participates in the CIGNA HealthCare preferred provider organization (PPO). As explained in this booklet, services obtained from a participating provider are subject to substantial discounts. A participating provider is any doctor or hospital or other provider that is a member of the PPO.

The plan provides greater coverage for covered expenses when a PPO provider is utilized. A listing of PPO providers is automatically furnished to all participants in a separate booklet. If you have not received one, contact the Fund office and a directory will be furnished free of charge. To determine whether your doctor or hospital is a member of the PPO, you may call CIGNA at: Toll-Free: (800) 768-4695 Or you may search for participating providers on the internet at: www.cigna.com/SA-PPO2

MAIL ORDER DRUG COVERAGE/PHARMACY DISCOUNT PROGRAM Coverage for prescription drugs is provided under the Comprehensive Major Medical Expense Benefit as outlined in the Schedule of Benefits. The Fund has entered into an arrangement with InformedRx to secure discounts on prescription drugs. When you have a prescription filled at a participating pharmacy, the cost of the prescription is discounted to both you and the Fund. Additionally, InformedRx offers a mail order drug program for maintenance drugs.

You should have received a drug discount card which is to be presented to your pharmacy when you have a prescription filled. If you have not received one, please contact the Fund office. For information, or to locate a pharmacy, you may call InformedRx at: Toll-Free: (800) 880-1188 Or you may contact them on the internet at: www.informedrx.com ATLANTA PLUMBERS AND STEAMFITTERS HEALTH AND WELFARE FUND

Dear Plan Participant:

We are pleased to provide you with this updated summary of the health and welfare benefits available to you and your covered family members. This booklet has been revised and updated to bring it into compliance with recent important federal legislation, including the Affordable Care Act, commonly referred to as “health care reform,” and the Mental Health Parity and Addiction Equity Act.

In accordance with provisions of the Affordable Care Act, the schedules of benefits have been totally restated. AmongBLANK the more important benefit changes are the elimination of the $1 million overall lifetime cap on benefits, the extension of coverage for dependent children up to age 26, and exempting children under age 19 from the pre-existing condition exclusion. In addition to removing the overall lifetime maximum, individual lifetime maximums on the following types of services have been eliminated as well:

• Organ transplants, • Convalescent hospital room and board benefits, • Hearing and audiometry testing, • Durable medical equipment, • Treatment of sleep apnea, and • Treatment of temporomandibular joint dysfunctions (TMJ).

In order to comply with the Mental Health Parity and Addiction Equity Act, benefits have been revised to assure that claims related to mental and nervous disorders and substance abuse are paid the same as for any other illness.

In addition to describing the benefits available to you and your dependents, this booklet contains a detailed explanation of the rules of eligibility. It also includes many other important sections, including information regarding claims filing deadlines, your right to appeal denied claims and a statement of your additional rights under the provisions of the Employee Retirement Income Security Act.

Please read this booklet carefully. Along with your Fund ID card and your PPO directory it will help you access important health coverage for you and your family members. If you do not have a current Fund ID card or PPO directory, please contact the Fund office and these items will be provided to you free of charge. If you should have absolutely any questions regarding the contents of this booklet or concerning the operation of your Plan, please feel free to contact the Fund office at the address and telephone numbers listed in this booklet.

Best regards,

Your Board of Trustees INDEX Board of Trustees – Plan Administrator ...... 1 Schedules of Benefits: Schedule of Benefits for Non-Residential Employees and Retirees . . . . . 3 Schedule of Benefits for Residential Employees ...... 8 Claim Procedures ...... 11 Definitions: Accidental Injury ...... 14 Average Semi-Private Room Rate...... 14 Convalescent Hospital ...... 15 Covered Employment ...... 15 Covered Family Member ...... 15 Custodial Care ...... 15 Disabled/Disability ...... 16 Eligible Dependent ...... 16 Eligible Employee ...... 17 Emergency Room ...... 17 Hospice Care ...... 18 Hospital ...... 18 Intensive Care and Coronary Care Accommodations ...... 19 Life-Threatening Emergency ...... 19 Medically Necessary ...... 19 Non-Occupational Disease or Injury ...... 20 Other Hospital Services and Supplies ...... 20 Out-of-Area Treatment ...... 21 Physician ...... 21 Reasonable and Customary Charges ...... 21 Retiree ...... 21 Room and Board ...... 21 Surgical Procedure ...... 21 Rules of Eligibility ...... 23 Eligibility for Non-Bargaining Employees ...... 31 Notice Regarding Continuation (COBRA) Coverage ...... 33 Employee and Retiree Death Benefit ...... 38 Dependent Death Benefit ...... 39 Employee Accidental Death and Dismemberment Benefit ...... 40 Employee Loss of Time Benefit ...... 43 Physical Examination Benefit ...... 45 Comprehensive Major Medical Expense Benefit ...... 46 Pre-Existing Conditions Limitation ...... 56 Vision Benefits ...... 60 Dental Benefits ...... 61 Appeal Procedures ...... 64 Coordination of Benefits ...... 70 Subrogation and Reimbursement ...... 76 Information You Should Know...... 78 Rights of Plan Participants ...... 87 Information Required by ERISA: Name of Plan ...... 90 Type of Plan...... 90 Name and Address of Plan Administrator ...... 90 Type of Administration ...... 91 Collective Bargaining Agreements ...... 91 Plan Sponsors ...... 91 Source of Contributions ...... 92 Funding Medium ...... 92 Circumstances that May Result in Loss of Eligibility or Benefits ...... 92 Agent for Service of Legal Process ...... 93 Plan Identification Numbers ...... 93 Fiscal Year ...... 93 ATLANTA PLUMBERS AND STEAMFITTERS HEALTH AND WELFARE FUND

This Plan is Administered by: THE BOARD OF TRUSTEES

Contract Administration Services Are Provided By:

SOUTHERN BENEFIT ADMINISTRATORS, INCORPORATED 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 30340

Phone: (770) 455-3802 Toll-Free: (800) 382-6926 Fax: (770) 455-6845

The Trustees of the Fund are:

UNION TRUSTEES: EMPLOYER TRUSTEES:

MR. GEORGE S. HEAD MR. GARY P. FOWLER Plumbers & Steamfitters Mechanical Contractors Local Union No. 72 Association of Georgia P.O. Box 17806 4500 Hugh Howell Road, Suite 250 Atlanta, Georgia 30316 Tucker, Georgia 30084-4709

MR. BRUCE A. EARNEST MR. JOHN HELMS Plumbers & Steamfitters W.B. Wallis & Company Local Union No. 72 P.O. Box 847 1900 Clark Avenue Scottdale, Georgia 30079 Albany, Georgia 31705 MR. DAVID M. McKENNEY MR. BEN JACOBS 5026 Green Pine Drive 20 Spring Court Sandy Springs, Georgia 30342 Newborn, Georgia 30056

(1) UNION TRUSTEES: EMPLOYER TRUSTEES:

MR. CHARLIE KEY MR. JON STERLING 299 Tony Trail Maxair, Incorporated Mableton, Georgia 30126 1621 Sands Place Marietta, Georgia 30067 MR. TERRY SINYARD Plumbers & Steamfitters MR. GRANT WILLIS Local Union No. 72 Willis Mechanical, Incorporated P.O. Box 17806 3230-R Peachtree Corners Circle Atlanta, Georgia 30316 Norcross, Georgia 30010

The Fund Consultant is:

SOUTHERN BENEFIT ADMINISTRATORS, INCORPORATED P.O. Box 1449 Goodlettsville, Tennessee 37070-1449

The Fund Attorney is:

CHARLES ELROD PARKER, HUDSON, RAINER & DOBBS, LLP 1500 Marquis Two Tower 285 Peachtree Center Avenue, N.E. Atlanta, Georgia 30303

The Fund Auditor is:

DENNIS G. JENKINS, C.P.A. 1690 Stone Village Lane Suite 501 Kennesaw, Georgia 30152

(2) SCHEDULES OF BENEFITS

Following are the Schedules of Benefits. In addition to the various maximums, restrictions and limitations listed as a part of the Schedules of Benefits, there are other restrictive Plan provisions outlined in this booklet. Please review this booklet very carefully before incurring expenses which you anticipate will be paid by the Fund.

SCHEDULE OF BENEFITS FOR NON-RESIDENTIAL EMPLOYEES AND RETIREES

PARTICIPANT CLASSIFICATIONS CLASS I – Active Employees and Non-Bargaining Employees CLASS II – Helpers CLASS III – Retirees with Medicare CLASS IV – Retirees without Medicare CLASS V – Employees of Local 72

BENEFITS

CLASSES I, IV AND V

DEATH BENEFIT

Employee ...... $10,000 Dependent Spouse or Child ...... $ 2,000

CLASS III

RETIREE DEATH BENEFIT

Retiree Under Age 65 (Disabled Retiree) ...... $10,000 Retiree Age 65 or Older ...... $ 5,000

(3) CLASSES I, IV AND V

EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

Full Benefit ...... $10,000

CLASS I

EMPLOYEE LOSS OF TIME BENEFIT

To receive this benefit, you must be disabled and under the regular care of a medical doctor (M.D.)

Weekly Benefit ...... $285

Benefit Duration ...... 36 Weeks

Payment Begins: If Due to Accidental Injury ...... First Day If Due to Illness ...... Eighth Day*

*Unless Hospital confined within such eight day period, in which case benefits begin on the first day of Hospital confinement. Benefits will also be paid for the first seven days of a disability due to an illness if the disability continues longer than 21 days.

CLASSES I, IV AND V

PHYSICAL EXAMINATION

Maximum Benefit per Individual per Calendar Year: For Eligible Employees and Spouses ...... $800 For Dependent Children ...... $200

(4) FOR ALL CLASSES (Except As Noted)

COMPREHENSIVE MAJOR MEDICAL EXPENSE BENEFIT (Non-Occupational)

Calendar Year Deductible: For a routine colonoscopy performed on an Eligible Employee or spouse age 50 or older when rendered by a participating PPO provider ...... None For the Purchase of Generic Equivalent Prescription Drugs ...... None For all other Covered Charges: Per Person ...... $300 Per Family ...... $900

Hospital Emergency Room Deductible: Per Visit ...... $100

Payment Percentage: Prescription Drugs– Generic equivalent prescription drugs ...... 100% Brand name prescription drugs when a generic equivalent is not available or when a generic equivalent is not medically appropriate as documented by the Covered Family Member’s attending Physician ...... 90%* All other name brand prescription drugs ...... 75%* For treatment by or under the supervision of a chiropractor (subject to the maximum payments and minimum age limit outlined in this Schedule) ...... 100% For the purchase and fitting of replacement prosthetic devices or parts, when furnished to an Eligible Employee, Retiree or spouse ...... 75% For a routine colonoscopy performed on an Eligible Employee or spouse age 50 or older when rendered by a participating PPO provider ...... 100% For all other Covered Charges— For treatment rendered by a PPO provider, for Out-of-Area Treatment, and for treatment of a Life-Threatening Emergency 85%* For All Other Treatment Rendered By a Non-PPO Provider ...... 75%

(5) *The payment percentage will be increased to 100% for these types of Covered Charges once the total of such types of Covered Charges incurred but not paid by the Fund, including any Covered Charges not paid due to application of the calendar year deductible, equal or exceed $2,000 per Covered Family Member or $4,000 per family of covered individuals in any calendar year. The payment percentage will not be increased when other group health care coverage is available and the Plan coordinates benefits with the other coverage.

NOTE: Charges incurred for non-PPO anesthesiology, radiology, pathology or related laboratory services during the course of a confinement in a participating PPO Hospital, or in connection with services provided by a participating PPO Physi- cian, will be paid as though incurred with a PPO provider.

Maximum Calendar Year Payment Per Individual: For education in connection with the diagnosis of new onset diabetes ...... $400 For the purchase of oxygen or oxygen refills ...... $500 For all Covered Charges incurred for the purchase of outpatient prescription drugs, other than drugs administered as chemotherapy treatment, or in connection with chemotherapy treatment ...... $10,000 For All Covered Charges combined— For Helpers ...... $50,000 For All Others ...... $250,000

Other Limits: Hospital Room and Board limit ...... Semi-private room rate Treatment by or under the supervision of a chiropractor (chiropractic coverage is not provided to Eligible Dependent children under seven years of age )– Maximum payment per visit (payable at 100%): Initial office visit ...... $50 Each subsequent visit ...... $25 Maximum number of visits ...... 1 per day 3 per week 45 per calendar year For the Purchase and Fitting of Hearing Aids– Maximum payment per hearing aid ...... $1,000 Maximum Frequency ...... One per Ear Every Five Years

(6) For a routine colonoscopy performed on an Eligible Employee or spouse age 50 or older when rendered by a participating PPO provider– Maximum Frequency ...... Once Every Five Years

CLASSES I, III, IV AND V

VISION BENEFITS

Maximum Payment per Covered Family Member per Calendar Year ...... $400

CLASSES I, IV AND V*

DENTAL BENEFITS

Maximum per Individual per Calendar Year (Excludes Preventive Services) ...... $1,000

Deductible per Individual per Calendar Year for Basic, Complex, or Restorative Services ...... $50

Payment Percentage: Preventive Services – Type A (Not subject to deductible or calendar year maximum) ...... 100% Basic Restorative Services – Type B ...... 75% Complex or Major Restorative Services – Type C ...... 50% Orthodontic Care – Type D (For Eligible Dependent children under age 19 only) ...... 100%

Orthodontic Lifetime Benefit for Eligible Dependent children under age 19 ...... $250

NOTE: Pre-certification with the Fund office is recommended for expenses over $150.

*Dental Benefits are also provided to the spouses of Class III Retirees until the date on which those spouses become eligible for Medicare benefits.

(7) SCHEDULE OF BENEFITS FOR RESIDENTIAL EMPLOYEES

EMPLOYEE DEATH BENEFIT ...... $5,000

EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

Full Benefit ...... $5,000

EMPLOYEE LOSS OF TIME BENEFIT

To receive this benefit, you must be disabled and under the regular care of a medical doctor (M.D.).

Weekly Benefit ...... $100 Benefit Duration ...... 13 Weeks Payments Begin: If Due to Accidental Injury ...... First Day If Due to Illness ...... Eighth Day*

*Unless Hospital confined within such eight day period, in which case benefits begin on the first day of Hospital confinement.

COMPREHENSIVE MAJOR MEDICAL EXPENSE BENEFIT (Non-Occupational)

Calendar Year Deductible: For all Covered Charges: Per Person ...... $200 Per Family ...... $600

Hospital Emergency Room Deductible: Per Visit ...... $100

Payment Percentage: For the purchase of generic equivalent prescription drugs ...... 80% For the purchase of name brand prescription drugs ...... 70%

(8) For the purchase and fitting of replacement prosthetic devices or parts, when furnished to an Eligible Employee, Retiree or spouse ...... 75% For All Other Covered Charges— For treatment rendered by a PPO provider, for Out-of-Area Treatment, and for Treatment of a Life-Threatening Emergency ...... 80%* For all other treatment rendered by a non-PPO provider ...... 70%

*The payment percentage will be increased to 100% for Covered Charges incurred with a PPO provider once total Covered Charges incurred with PPO providers but not paid by the Fund, including any Covered Charges not paid due to application of the calendar year deductible, equal or exceed $2,000 per Covered Family Mem- ber or $4,000 per family of covered individuals in any calendar year. Covered PPO charges will continue to be paid at 80% when other group health care coverage is available and the Plan coordinates benefits with the other coverage.

Other Limits: Hospital Room and Board Limit ...... Semi-private room rate Treatment by or under the supervision of a chiropractor (chiropractic coverage is not provided to Eligible Dependent children under seven years of age)– Maximum payment per visit (payable at 100%): Initial office visit ...... $50 Each subsequent visit ...... $25

(9) Maximum number of visits ...... 1 per day 3 per week 45 per calendar year For the Purchase and Fitting of Hearing Aids— Maximum payment per hearing aid ...... $1,000 Maximum Frequency ...... One per Ear per Five Year Period

(10) CLAIM PROCEDURES

HOW TO FILE YOUR CLAIMS

When you have a claim, please follow the instructions outlined below.

1. Time Limit for Filing a Claim — All claims must be submitted within 180 days after the end of the calendar year in which they are incurred.

2. When you receive services from a doctor, hospital or other health care provider, you must furnish to that provider the information needed to file a claim. This information is found on your Fund ID card. The provider should then file the necessary bills and related information with the Fund’s PPO.

3. Claims for non-medical benefits must be filed by you (or your beneficiary in case of your death) directly with the Fund office. Forms for these types of claims are available at the Fund office.

4. If a claim is filed without sufficient information or documentation regarding the claim, you will be notified within 30 days after the Fund receives the claim. To the extent possible, missing information will be requested from your health care provider. However, on some occasions, it may be necessary to request some information directly from you.

Remember, it is your responsibility to provide your doctor, hospital and any other medical service providers with information about your coverage under the plan and about their responsibility to file claims with the Fund.

PAYMENT OF CLAIMS BY FUND OFFICE

Once the information required to make a determination as to whether a claim is payable has been received, a decision will be made promptly by the Fund office staff and you will be notified regarding any benefit payments. However, in no event will the decision regarding payment be made more than 30 days after the claim has been fully and properly filed.

If the Fund office determines that additional information is required from you or in your behalf, you will be given 45 days in which to provide any missing information necessary to process the claim.

(11) PRE-APPROVAL OF A CLAIM

This Fund has no pre-certification or pre-approval requirements for treatment. However, certain treatments and procedures are not covered under the Fund, and you may wish to contact the Fund office prior to receiving treatment in order to assure that the treatment will be covered. The following rules apply to pre- approval of treatment:

1. Approval of Medically Necessary Treatment — As explained in this booklet, a charge must be Medically Necessary to be covered by the plan. If there is any doubt about whether your expected treatment will be considered Medically Necessary under the plan, you may contact the Fund office for an advance decision. As explained in this booklet, you may appeal any adverse decision made by the Fund office regarding Medical Necessity.

2. Compliance With Plan Provisions, Exclusions and Limitations — In an effort to help control the cost of providing benefits under the plan, and in order to limit coverage to benefits for treatment of a medical nature, various plan provisions, exclusions and limitations have been included in the plan. These are very specific and they are described in this booklet. However, questions sometimes arise as to whether a particular provision, exclusion or limitation applies to a specific condition or treatment.

If there is any question as to whether your anticipated treatment will be covered under the plan, you should contact the Fund office in advance. Once appropriate information is received, the Fund office staff will let you know whether your expected treatment will be covered under the plan. If you receive an adverse decision, you may of course appeal that decision as explained in this booklet.

THE PLAN’S RESPONSIBILITIES TO RESPOND TO YOUR REQUESTS FOR PRE-APPROVAL

As explained in the preceding section, even though the plan does not have any pre- certification or pre-approval requirements, you may want to request pre-approval of treatment to ensure that it will be covered under the plan. The Fund office staff will respond to all such requests in a timely manner, as follows:

1. Urgent Care Claims — If proposed treatment is determined to be urgent in

(12) nature, as defined below, a decision on your request for pre-approval will be made and communicated to you within 72 hours of receipt of your request. If it is determined that additional information is necessary to make a decision on your claim, you will be notified of such as soon as possible but in no instance more than 24 hours after receipt of the request. You will then be given not less than 48 hours to provide the required information.

An Urgent Care Claim is a claim which, if treated as a claim for non-urgent care:

(a) Could seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function, or

(b) In the opinion of a Physician with knowledge of the claimant’s medical condition, would subject the claimant to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim.

2. Non-Urgent Care Claims — If proposed treatment is determined to be of a non-urgent nature, a decision on your request for pre-approval will be made and communicated to you within 15 days of receipt of your request. If it is determined that additional information is necessary to make a decision on your claim, the plan may require up to an additional 15 days to make a decision on your request. If such an extension is required, you will be notified within 15 days of receipt of your request regarding the extension and a decision will be made as soon as possible. If the extension is required because it is necessary for you to provide additional information, you will be given at least 45 days to provide the requested information.

These procedures for processing requests for pre-approval of both urgent and non- urgent care claims have been adopted solely as guidelines and to assure compliance with applicable federal law. It will continue to be the practice of the Trustees, as the plan administrator, along with the Fund office staff, to timely process all requests for pre-approval and to respond to all such requests immediately where possible, but always within the time periods prescribed above.

(13) DEFINITIONS

In order to properly explain each of the benefits to which you and your family may be entitled, it has been necessary to use certain specific terms in this booklet to describe these benefits. The definitions of many of those terms are as follows:

ACCIDENTAL INJURY

“Accidental Injury” means an injury sustained by a Covered Family Member that:

1. Results from and is caused by a sudden and violent event;

2. Is caused by an external force or object; and

3. Occurs unexpectedly and by chance, and is not due to any fault or misconduct on the part of the injured person.

The term “Accidental Injury” does not include any injury that is the result of a self-destructive act or intentionally self-inflicted injury, illness or condition, unless the self-destructive act or intentionally self-inflicted injury, illness or condition is the result of the Covered Family Member’s medical condition, including both physical and mental health conditions.

The term “Accidental Injury” also does not include any injury sustained by a Cov- ered Family Member involving any act for which the individual is convicted, or pleads guilty or nolo contendere to, driving while intoxicated or driving under the influence of alcohol or illegal drugs by a court of competent jurisdiction.

AVERAGE SEMI-PRIVATE ROOM RATE

“Average Semi-Private Room Rate” means:

1. The standard charge made by a Hospital for semi-private room and board accommodations, or the average of such charges where a Hospital has more than one established level of such charges; or

2. 80% of the lowest charge made by a Hospital for single bed room and board accommodations when the Hospital does not provide semi-private room and board accommodations.

(14) CONVALESCENT HOSPITAL

“Convalescent Hospital” means an institution which:

1. Primarily provides skilled nursing under the supervision of a Physician or registered nurse;

2. Has available, on duty or call, at all times a Physician who is a staff member of a Hospital;

3. Has a registered nurse on duty 24 hours a day;

4. Maintains daily medical records for each patient;

5. Complies with all licensing and other legal requirements; and

6. Is not, except incidentally, a place for Custodial Care, for the aged, for drug addicts, for alcoholics, for the care of the mentally ill or persons with nervous disorders, for the care of senile or mentally deficient persons, a hotel, or a similar institution.

COVERED EMPLOYMENT

“Covered Employment” means hours worked for an employer for which the employer is obligated to make contributions to the Fund under a collective bargaining agreement or other written agreement. Covered Employment also means hours worked for the Union, the JATC or the North Georgia Building Trades for which contributions are made to the Fund.

COVERED FAMILY MEMBER

“Covered Family Member” means any Eligible Employee or Retiree who is covered under this Fund and the Eligible Dependents of an Eligible Employee or Retiree.

CUSTODIAL CARE

“Custodial Care” means care which:

1. Is provided mainly to maintain an individual;

(15) 2. Is designed in order to help the individual meet his activities of daily living; or

3. Is not provided mainly as a type of therapy in the treatment of a sickness or injury.

“Custodial Care” includes but is not limited to the following:

1. Help in walking, bathing, dressing or feeding;

2. Preparing special diets; and

3. Supervising the administration of medications that do not require constant attention of trained medical personnel.

DISABLED/DISABILITY

See pages 43 and 58.

ELIGIBLE DEPENDENT

“Eligible Dependent” means the following:

1. The spouse of an Eligible Employee or Retiree. A spouse will cease to be an Eligible Dependent on the date the Eligible Employee or Retiree and his or her spouse are divorced or legally separated.

2. The following child or children of an Eligible Employee or Retiree:

(a) Any child who has not yet attained age 26; and

(b) Any unmarried child who is incapable of self-sustaining employment because of mental or physical handicap and who is chiefly dependent on the Eligible Employee or Retiree for support and maintenance, regardless of age, provided (i) the incapacity commenced prior to age 26, (ii) the Eligible Employee or Retiree was eligible for benefits at the time the incapacity commenced, or the child is the natural child of the Eligible Employee or Retiree, is over age 26 and was incapacitated at the time the Eligible Employee or Retiree became eligible for benefits under the

(16) Plan, and (iii) the incapacity was not caused by or in connection with alcohol or drug abuse or addiction. A child will only be considered incapacitated if proof of the incapacity is submitted to the Fund office within 31 days of the date his coverage would otherwise terminate, and subse- quently, as may be required by the Trustees. Proof of the Eligible Dependent’s incapacity will not be required more frequently than annually after the two-year period following the child’s attaining age 26.

As used in this section, “child” means only an Eligible Employee’s or Retiree’s natural children, step-children and adopted children as well as any children placed with the Eligible Employee or Retiree for adoption, but where the adoption has not become final. Being placed for adoption means that the Eligible Employee or Retiree has assumed, and retains, a legal obligation for total or partial support of the child in anticipation of adoption of the child. The child’s placement with the Eligible Employee or Retiree terminates upon termination of the legal obligation. Upon an adoption becoming final, the child may continue to meet the definition of Eligible Dependent in accordance with (a) or (b) above.

No child who has other employer-sponsored coverage available in his or his spouse’s name will be considered an “Eligible Dependent.”

For the purposes of benefits payable as a result of pregnancy, “Eligible Depen- dent” means the Eligible Employee’s or Retiree’s spouse only.

ELIGIBLE EMPLOYEE

“Eligible Employee” means any employee who meets the Rules of Eligibility as outlined in this booklet.

EMERGENCY ROOM

“Emergency Room” means a facility which is established for the emergency treatment of accidents and life-threatening illnesses and which is attached to or on the premises of a licensed Hospital. Additionally, the facility must be open and must provide Physician services 24 hours a day, and must have available such services so as not to require referral to other similar facilities. “Emergency Room” also includes a free-standing or walk-in clinic that is not attached to a Hospital, but only to the extent of emergency treatment for accidents and life-threatening illnesses.

(17) HOSPICE CARE

“Hospice Care” means a coordinated program of home and in-patient care for the special physical, psychological and social needs of terminally ill persons and their families. A terminally ill person is one who has been diagnosed by a Physician as having a life expectancy of six months or less. A hospice is a facility, or part of one, which:

1. Provides in-patient care;

2. Is licensed as such and operating within the scope of the license;

3. Maintains medical records on each patient and provides an ongoing quality assurance program;

4. Has full-time supervision by at least one Physician; and

5. Provides 24-hour nursing services by registered nurses.

HOSPITAL

“Hospital” means an institution that is licensed as a hospital (if licensing is required by law where the institution is located) and which meets all of the following requirements:

1. It is engaged primarily in providing medical care and treatment of sick and injured persons on an in-patient basis at the patient’s expense and maintains diagnostic and therapeutic facilities for medical diagnosis and treatment of such persons by or under the supervision of a staff of duly qualified Physi- cians;

2. It continuously provides twenty-four (24) hour a day nursing services by or under the supervision of registered graduate nurses;

3. It has an operating room where surgical procedures are performed (unless the institution is a duly licensed psychiatric hospital);

4. It maintains daily medical records for each patient; and

(18) 5. It is not, other than incidentally, a clinic, convalescent home, institution for drug addicts or alcoholics, a place of rest, a place for the aged, or a nursing home.

In addition, for the purposes of benefits paid under this Plan for Mental or Nervous Disorders, the term Hospital will include an institution which is accredited by a state licensing agency for the treatment of Mental or Nervous Disorders and which has accommodations for resident bed patients, facilities for the treatment of Men- tal or Nervous Disorders, a resident psychiatrist always on duty or call, and as a regular practice charges the patient for the expense of confinement.

INTENSIVE CARE AND CORONARY CARE ACCOMMODATIONS

“Intensive Care and Coronary Care Accommodations” means an accommodation which is exclusively reserved for critically and seriously ill patients requiring constant audio-visual observation as prescribed by the Physician attending the Cov- ered Family Member and which provides room and board, specialized registered nursing care and other nursing care, and special equipment or supplies immediately available on a stand-by basis and segregated from the rest of the Hospital facilities.

LIFE-THREATENING EMERGENCY

“Life-Threatening Emergency” means a medical condition that manifests itself suddenly by symptoms of sufficient severity, including severe pain, that without immediate medical attention could reasonably be expected, by a prudent lay person who possesses an average knowledge of health and medicine, to result in:

1. Serious jeopardy to the mental or physical health of the individual;

2. Danger of serious impairment of the individual’s body functions;

3. Serious dysfunction of any of the individual’s bodily organs; or

4. In the case of a pregnant woman, serious jeopardy to the health of the fetus.

MEDICALLY NECESSARY

“Medically Necessary” means that a service or supply which the patient receives is required to identify or treat an illness or Accidental Injury or other covered

(19) condition which a Physician has diagnosed or reasonably suspects. To be Medi- cally Necessary the service or supply must:

1. Be consistent with the diagnosis and treatment of the patient’s condition;

2. Be in accordance with standards of good medical practice;

3. Not be for the convenience of the patient or his Physician; and

4. Be performed in the least costly setting required by the patient’s medical condition.

NON-OCCUPATIONAL DISEASE OR INJURY

“Non-Occupational Disease or Injury” means a disease or Accidental Injury that does not arise out of (or in the course of) any work for pay or profit, nor in any way results from such work for pay or profit. However, if proof is furnished to the Trustees that an individual covered under a workers’ compensation law (or other law of similar purpose) is not covered for a particular disease under such law, that disease will be considered “non-occupational” regardless of its cause.

In the event an employee claims that a disease or injury is work connected and the employer disputes this contention, the Trustees agree to be bound by the final decision of any court or commission which determines the issue. In the event a legal determination is not sought in such case, the Trustees may decide whether the illness or accident is occupational or non-occupational. In the event payments are made under this plan for a condition later determined to be occupational and compensable under any workers’ compensation or similar law, the employee receiving the payments is obligated to make restitution (pay back) to the Trustees of the amount of benefits received from any settlement or judgement obtained.

OTHER HOSPITAL SERVICES AND SUPPLIES

“Other Hospital Services and Supplies” means the actual charges made by a Hospital, in its own behalf, for services and supplies rendered to the individual, and required for treatment of that person, other than charges for Room and Board, the professional services of any Physician, and any private duty or special nursing services (including intensive nursing care by whatever name called), regardless of whether such services are rendered under the direction of the Hospital or otherwise.

(20) OUT-OF-AREA TREATMENT

“Out-of-Area Treatment” means treatment rendered by a non-PPO provider to a Covered Family Member whose residence is at least 35 miles from the nearest PPO provider capable of providing the required treatment.

PHYSICIAN

“Physician” means a doctor of medicine (M.D.), a doctor of osteopathy (D.O.), a chiropractor (D.C.M.), a dentist (D.D.S.), a psychologist (Ph.D), or an optometrist (O.D.) practicing within the scope of his license and who is licensed to practice as such in the state in which treatment is rendered.

REASONABLE AND CUSTOMARY CHARGES

“Reasonable and Customary Charges” means the prevailing fee or fees most frequently charged by the providers of a like service or supply with similar training and experience for the performance of a comparable service, or a service of comparable gravity, severity and magnitude, in the locality where the service was performed.

RETIREE

“Retiree” means a former Eligible Employee who meets the requirements for Re- tiree eligibility as outlined in this booklet.

ROOM AND BOARD

“Room and Board” means all charges for room and board, general duty nursing, and any other charges by whatever name such charges are called, which are made by a Hospital as a condition of occupancy of the class of accommodations occupied, but not including charges for professional services of Physicians.

SURGICAL PROCEDURE

“Surgical Procedure” means any procedure included in one of the following categories that is performed by a Physician, other than a resident Physician or intern of a Hospital, and also customary post-operative care for a period not to exceed two weeks following the surgery:

(21) 1. The incision, excision, or electrocauterization of any organ or part of the body;

2. The manipulative reduction of a fracture or dislocation;

3. The suturing of a wound; or

4. The removal by endoscopic means of a stone or other foreign object from the larynx, bronchus, trachea, esophagus, stomach, urinary bladder, urethra, colon or ureter or the diagnostic examination by endoscopic means of these organs.

“Surgical Procedure” does not include any alternative medical treatment, whether or not such alternative treatment is in place of or accomplishes the same result as the performance of the corresponding surgical operation or procedure.

(22) RULES OF ELIGIBILITY

An employee working for a contributing employer or employers within the jurisdiction of the Fund will be eligible to receive benefits and will become an Eligible Employee after meeting the requirements outlined below.

INITIAL ELIGIBILITY

1. FOR EMPLOYEES OF EMPLOYERS CURRENTLY PARTICIPATING:

An employee and his Eligible Dependents will become initially eligible for benefits on the first day of the third month following a period of three consecutive months or less during which the employee has worked at least 390 hours for which Employer contributions are paid to the Fund or for which a reciprocal contribution is received by the Fund. This requirement is reduced to 300 hours for apprentices who are attending school as a part of the apprenticeship program. Eligibility will be continued for the remainder of the month in which eligibility is gained. Continuing eligibility will then be based on other applicable sections of these Rules of Eligibility.

2. FOR EMPLOYEES OF A NEW SIGNATORY EMPLOYER:

For those employees employed by an employer located within the jurisdiction of the Union at the time that employer first becomes signatory to a written agreement requiring contributions to the Fund, the following initial eligibility requirement will apply in place of that outlined in 1. above, but only for the period of employment immediately following and continuous with the employer’s initial participation. This requirement will apply only to full- time employees who have been continuously employed by the employer for a minimum period of six consecutive months as of the date of the agreement, and to whom group health benefits have been continuously provided by the employer during that period. The requirement outlined in 1. above will apply to all other employees of the employer.

The employer will be required to begin making contributions as required under the written agreement for the month in which the agreement is effective (the first month of participation). The initial contribution must be made for the prior month, based on hours worked by the employees during the prior month. For example, if the written agreement requiring contributions

(23) to the Fund is effective on January 1, the first contribution will be due in January for hours worked in December. All later contributions will be made as required in the written agreement.

If an employee described above continues in such employment, he will become initially eligible for benefits on the first day of the second month of participation. For example, if contributions are first made in the month of January for work performed in December, the employee will become initially eligible on February 1. Eligibility will then be continued for the remainder of the month in which eligibility has been gained, provided the employee continues in employment for which employer contributions are required. Continuing eligibility will be based on other applicable sections of these Rules of Eligibility. However, if such an employer later ceases participation in the Fund, the eligibility of all employees described under this provision will terminate as of the date the employer’s obligation to make contributions to the Fund ceases. No further eligibility will be granted under any section of these Rules of Eligibility.

CONTINUING ELIGIBILITY

Once an employee and his Eligible Dependents become eligible for the benefits provided under this Fund, they will remain eligible during each successive Benefit Month provided the employee has worked a minimum of 130 hours during the corresponding Contribution Month for which employer contributions are paid to the Fund or for which a reciprocal contribution is received by the Fund. The monthly eligibility requirement for apprentices who are attending school as a part of the apprenticeship program is 100 hours.

Contributions months and the corresponding benefit months are as follows:

Contribution Months Benefit Months

Hours Worked In: Earn Eligibility For:

October ...... January November ...... February December ...... March January ...... April February ...... May

(24) March ...... June April ...... July May ...... August June ...... September July...... October August ...... November September ...... December

HOUR BANK

Once an employee has satisfied the requirements for Initial Eligibility, any hours for which employer contributions are received during a Contribution Month in excess of 130 (100 for apprentices attending school) will be credited to the employee’s hour bank. However, no more than 780 hours may be accumulated in the employee’s hour bank at any time (600 hours for apprentices attending school).

If for any reason an employee works an insufficient number of hours during a Contribution Month, the number of hours necessary to continue eligibility will be withdrawn from the employee’s hour bank, if such hours are available.

SELF-CONTRIBUTIONS FOR ACTIVE ELIGIBLE EMPLOYEES

If, after becoming initially eligible for benefits under the Fund, an Eligible Em- ployee is in danger of losing his eligibility because he has failed to work the required 130 hours (100 for apprentices attending school), and if the hours accumulated in the Eligible Employee’s hour bank are not sufficient to continue his eligibility, the Eligible Employee will be entitled to make self-contributions to continue his eligibility in effect. Self-payments will be in an amount equal to the difference between the hours actually worked for the Contribution Month specified and 130 hours (100 hours for apprentices while in school), multiplied by the then current employer contribution rate.

Self-contributions will be limited to six consecutive Benefit Months, except that those employees working under a reciprocal agreement requiring contributions to this Fund in their behalf will be entitled to make unlimited additional consecutive self-contributions for each Contribution Month in which contributions are trans- ferred to this Fund for at least one hour worked. All self-contributions must be received by the Fund office no later than the date established by the Trustees from time to time.

(25) TERMINATION OF EMPLOYEE ELIGIBILITY

In the event an Eligible Employee’s hours worked plus his accumulated hour bank hours are insufficient to continue his coverage under the Fund, and if he does not make the appropriate self-contribution, or is not entitled to do so, his eligibility will terminate as of the last day of the last Benefit Month for which he is eligible, and any hours remaining in his accumulated hour bank will be immediately forfeited.

Additionally, should an employee enter employment within the geographical jurisdiction of the United Association of Plumbers and Pipefitters of the United States and Canada, AFL-CIO, in the same industry, trade or craft as that covered by the collective bargaining agreement in effect between the employers and the union for an employer who is not required to make contributions to the Fund for such employment, or should he continue in such employment after his employer ceases to be obligated to make such contributions, his eligibility will terminate as of the last day of the month in which he commences such employment. Upon termination of eligibility under this paragraph, any hours accumulated in the employee’s hour bank will be immediately forfeited and the employee will not be entitled to continue his eligibility under the SELF-CONTRIBUTIONS FOR ACTIVE ELIGIBLE EMPLOYEES provisions.

REINSTATEMENT OF ELIGIBILITY

Once an employee has gained eligibility under the Fund and later lost his eligibility, he will once again become eligible for benefits upon satisfying the requirements for CONTINUING ELIGIBILITY.

DISABILITY CREDIT

For each seven day period during which an Eligible Employee is entitled to a Loss of Time Benefit under this Plan, or is entitled to workers’ compensation benefits, the Eligible Employee’s hour bank will be credited with an amount determined by the Trustees from time to time as if the employee had worked in employment for which contributions were due the Fund during such period.

DUAL COVERAGE UNDER THE PLAN

If both a husband and wife are covered under the plan as Eligible Employees and/ or Retirees, Eligible Dependent children of such husband and wife will be eligible

(26) for coverage under both parents, subject to the COORDINATION OF BENEFITS provisions outlined in this booklet. Likewise, if a husband and wife are both covered under the Plan as Eligible Employees, such individuals will be covered as Eligible Dependent spouses of one another, subject to the COORDINATION OF BENEFITS provisions. In no event will benefits provided under the Plan exceed 100% of covered charges.

SERVICE IN THE ARMED FORCES

An Eligible Employee who is inducted or enlists or is otherwise called to active duty in the Uniformed Services of the United States of America will be entitled to credit or the right to make self-contributions for continued coverage as set forth below.

1. For active uniformed service of 31 days or less – The Eligible Employee will be credited with 8 hours per day for each day (Monday-Friday) of active uniformed service provided the Eligible Employee reports to work no later than the first regularly scheduled working period one week after termination of active duty.

2. For active uniformed service of more than 31 days – All benefits for an Eli- gible Employee and his Eligible Dependents will be terminated on the date he enters uniformed service for a period of service in excess of 31 days, except as follows:

(a) The Eligible Employee may choose to continue coverage through the use of any current hours worked, as calculated for CONTINUING ELI- GIBILITY, or through the use of hour bank hours.

The Eligible Employee may elect to use this accumulated eligibility to continue coverage under the Fund, or may elect to defer the use of his eligibility until his reemployment as described on the following page, or may elect to use a portion of his hours and defer usage of the remainder. Failure to affirmatively elect continued coverage will result in an auto- matic deferral of the use of accumulated eligibility.

(b) Upon termination of coverage as otherwise outlined in this section, and following any extension of coverage under paragraph (a) above, an Eli- gible Employee may elect to continue coverage for the period of active

(27) uniformed service, not to exceed 24 months, by making self-contributions in the amount and under the terms set forth in this booklet for making self-contributions for continued coverage (COBRA coverage). In order to be entitled to make self-contributions, the Eligible Employee must notify the Fund office in writing within 60 days of his entry into active uniformed service.

Former Eligible Employees who are discharged from active uniformed service of 60 months or less will be reinstated for benefits provided the individual submits an application for reemployment or seeks reemployment through a participating local union within 14 days (if the active uniformed service is for 31 to 181 days) or 90 days (if the active uniformed service is more than 181 days) after discharge. The time for reemployment application will be extended in the event of injury or hospitalization as further provided in the Uniformed Services Employment and Reemployment Rights Act of 1994.

If an Eligible Employee has chosen to use his accumulated eligibility credits as outlined above and, as a result, has insufficient eligibility accumulated to his credit to continue his coverage under the Fund upon his reemployment, the Eligible Employee will be required to make monthly payments to the Fund in order to regain and continue his coverage. Monthly payments will be required until such time as the employee has worked sufficient hours to satisfy the requirements for CONTINUING ELIGIBILITY.

The term active uniformed services includes active duty with the Armed Forces, the Army National Guard and the Air National Guard (when engaged in active duty training, inactive duty training or full time National Guard duty), the commissioned corps of the Public Health Service and any other category of persons designated by the President of the United States in the time of war or emergency.

TERMINATION OF DEPENDENT ELIGIBILITY

An Eligible Dependent’s eligibility for benefits under the Plan will terminate on the earliest of the following:

1. On the date the Eligible Dependent ceases to be an Eligible Dependent;

2. Except as provided under ELIGIBILITY FOR RETIREES AND THEIR SPOUSES on the following page, the date on which the Eligible Employee’s or Retiree’s coverage under the Plan terminates;

(28) 3. The date on which the Eligible Dependent enters the United States Armed Forces on full time active duty, except as outlined above;

4. The date on which the Plan is terminated;

5. In the event of the death of the Eligible Employee or Retiree, the later of the last day of the Benefit Month in which the Eligible Employee or Retiree dies or the last day of any Benefit Month for which the Eligible Employee or Retiree would have been eligible based on hours worked prior to the death of the Eligible Employee or Retiree, including hour bank hours; or

6. The date on which the Plan is amended so as to terminate the benefits of the Eligible Dependent.

SUSPENSION OF HOUR BANK HOURS FOR EMPLOYEES ENTERING NON-COVERED EMPLOYMENT

If an Eligible Employee enters employment with a contributing employer in work that is not Covered Employment, the use of his accumulated hour bank hours toward continuing eligibility will be suspended. The accumulated hours will once again become available on the date on which the employee returns to Covered Employment, but only if he does so within the twelve consecutive month period immediately following the date he entered non-Covered Employment. If the former Eligible Employee fails to return to Covered Employment within the allotted time, his suspended hour bank hours will be permanently forfeited.

ELIGIBILITY FOR PREGNANCY BENEFITS

Subject to the other provisions outlined in this booklet, an Eligible Employee, Retiree or Eligible Dependent spouse will be eligible for benefits arising out of pregnancy if, at the time expenses are incurred, such person is either eligible for benefits or has ceased to be eligible because of disability due to pregnancy which prevents the individual from engaging in her regular or customary occupation. Eligible Dependents who are not spouses of Eligible Employees or Retirees will not be eligible for benefits arising out of pregnancy.

ELIGIBILITY FOR RETIREES AND THEIR SPOUSES

1. Retiree Eligibility. An Eligible Employee who retires from employment may continue coverage under the Fund, subject to the following:

(29) (a) The Eligible Employee must have been a member in good standing of Local 72 for a period of at least 36 consecutive months leading up to and continuous with his or her retirement date;

(b) The retirement date for the Eligible Employee will be the effective date of benefits under either the Atlanta Plumbers and Steamfitters Pension Fund or the Plumbers and Pipefitters National Pension Fund;

(d) The Eligible Employee must elect at the actual time of his or her retirement to continue eligibility under the Fund either under these provisions or under the provisions for COBRA Continuation Coverage. Election of one of these options will automatically constitute a waiver of the other option;

(e) The Eligible Employee must have satisfied any one of the following requirements:

(1) The Eligible Employee must have been continuously eligible under this Fund for a minimum period of 36 consecutive months leading up to and continuous with his or her retirement date; or

(2) The Eligible Employee must have been available for work as certified by Local 72 for a minimum period of 36 consecutive months leading up to and continuous with his or her retirement date; or

(3) The Eligible Employee must have worked for a contributing employer in a capacity that did not require contributions to this Fund for a minimum period of 36 consecutive months leading up to and continuous with his or her retirement date; or

(4) The Eligible Employee must have satisfied a combination of any of the provisions outlined in (1), (2) and (3) above to make up the 36 month requirement;

(f) The Retiree must remit all payments for coverage on a timely basis in the amount and manner established by the Trustees; and

(30) (g) The Retiree must maintain membership in good standing with Local 72.

2. Benefits for Medicare-Eligible Retirees/Dependents. This Plan will not duplicate the payment of any benefits by Medicare to a Retiree or his Eligible Dependents. The medical benefits payable by the Fund for Retirees and their Eligible Dependents are limited to only those Covered Charges which are not payable under Medicare.

3. Dependent Spouses of Retirees. The Eligible Dependent spouse of a Retiree will mean only the spouse, if any, to whom the Retiree is legally married on the date on which he first qualifies under the Fund as a “Retiree.” Spouses acquired at a later date, including those acquired during a period of reemployment, are excluded from coverage under this provision.

ELIGIBILITY FOR NON-BARGAINING (OPTIONAL) EMPLOYEES

An employer who is obligated through a collective bargaining agreement or other written agreement to make contributions to this Fund on behalf of employees covered by that agreement may elect to also make contributions on employees whose employment is not covered by that agreement. These other, non-bargaining employees are referred to as Optional Employees. The employer may make application to the Fund office to make contributions for the purpose of maintaining eligibility for those Optional Employees under the Fund. Participation of Optional Employees is subject to the approval of the Trustees.

The employer will be required to make a monthly contribution to the Fund on behalf of each and every Optional Employee regularly employed by the employer on a full-time basis. Eligibility for each Optional Employee will begin on the first day of the month for which a contribution is first made in his behalf. Eligibility will terminate on the last day of the last month for which a contribution is made for the employee. No hour bank will be established for Optional Employees, nor will they be allowed to make self-contributions to continue their coverage, whether as an active or retired employee, except as explained under the Continuation Cover- age “COBRA” provisions as outlined in this booklet. Additionally, no disability credit will be granted for time off due to disability.

Except as outlined in this subsection, all other provisions of these Rules of Eligi- bility will apply to Optional Employees.

(31) CHANGE IN BENEFITS FOR RESIDENTIAL EMPLOYEES

An Eligible Employee who changes from residential work to non-residential work will become eligible for the Schedule of Benefits for Non-Residential Employees and Retirees effective with the Benefit Month for which he has satisfied the eligibility requirement as a non-residential employee.

CHANGE IN ELIGIBILITY RULES

The Trustees may, in their discretion, change or amend these Eligibility Rules at any time.

(32) AN IMPORTANT NOTICE ABOUT YOUR CONTINUATION COVERAGE RIGHTS UNDER COBRA

This notice is furnished to you as a covered participant under the Atlanta Plumbers and Steamfitters Health and Welfare Fund (the Plan). This notice contains important information about your rights to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. 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 and to other members of your family who are covered under the Plan when you would otherwise lose your group health coverage. 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 Plan administrator is the Board of Trustees of the Fund. The responsibility for administering COBRA continuation coverage has been delegated to the Fund office staff at:

Atlanta Plumbers and Steamfitters Health and Welfare Fund 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 30340 Phone: (770) 455-3802 Toll-Free: (800) 382-6926

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.” Spe- cific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” A qualified beneficiary is someone who will lose coverage under the Plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries. 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:

(33) 1. Your hours of employment are reduced; or

2. 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:

1. Your spouse dies;

2. Your spouse’s hours of employment are reduced;

3. Your spouse’s employment ends for any reason other than his or her gross misconduct; or

4. 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 qualifying events happens:

1. The parent-employee dies;

2. The parent-employee’s hours of employment are reduced;

3. The parent-employee’s employment ends for any reason other than his or her gross misconduct; or

4. The child stops being eligible for coverage under the plan as an “Eligible Dependent.”

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Fund office has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, your employer will notify the Fund office automatically. In the event of the death of an employee, your employer is required to notify the Fund office. How- ever, it may be in the best interest of qualified beneficiaries to contact the Fund office as well so that notification of death can be made as timely as possible. Your employer must notify the Fund office within 30 days of any of these events.

(34) 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 Fund office in writing within 60 days after the qualifying event occurs. You must send this notice to the Fund office at the address listed in this section. In the event of divorce or separation, you must also furnish a copy of the divorce decree or separation papers. In the event of a child ceasing to qualify as an Eligible Dependent, you must furnish a copy of the dependent’s birth certificate or other proof of date of birth.

Once the Fund office receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that Plan coverage would otherwise have been lost.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is your death, your divorce or legal separation, or a dependent child losing eligibility as an Eligible Dependent, COBRA continuation coverage lasts for up to 36 months.

When the qualifying event is the end of employment or reduction of your hours of employment, COBRA continuation coverage lasts for up to 18 months. There are three 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 at any time during the first 60 days of COBRA continuation coverage and you notify the Fund office in a timely fashion, you and your entire family can receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. You must make sure that the Fund office is notified of the Social Security Administration’s determination within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage. You must send this notice and proof of determination of disability to the Fund office at the address listed on page 33.

(35) Maximum Period of 24 Months for Service in the Armed Forces

As described on pages 27 and 28, if you enter active duty in the Uniformed Services of the United States of America for a period of more than 31 days, the maximum period of COBRA coverage which you may elect is 24 months, provided you notify the Fund office in writing within 60 days of your entry into active uniformed service.

Second Qualifying Event Extension of 18-Month Period of Continua- tion Coverage

If your family experiences another qualifying event while receiving COBRA continuation coverage, your spouse and dependent children can get additional months of COBRA continuation coverage, up to a combined maximum of 36 months. This extension is available to your spouse and dependent children if you die or get divorced or separated. The extension is also available to your dependent child when that child stops being eligible under the Plan as an Eligible Dependent child. In all of these cases, you must make sure that the Fund office is notified of the second qualifying event within 60 days of the second qualifying event. This notice must be sent to the Fund office along with proof of divorce or separation or date of birth of your dependent child.

PROCEDURE FOR OBTAINING CONTINUATION COVERAGE

Once the Fund office knows that an event which qualifies you or a dependent for continuation coverage has occurred, the Fund office will send an election notice to your last known address or to the address of your dependent, as applicable. You will have sixty days after the date on the election notice in which you or your dependent must notify the Fund office of an election to continue coverage. If you or your dependent do not elect coverage within the sixty day time period, the right to continue group health coverage will end. A period of forty-five days will be allowed from the date of an election of continued coverage in which to make any retroactive payment due under this provision. Each employee, or each covered dependent if electing separately, will be required to make monthly payments in an amount and manner which will be determined by the Trustees in accordance with applicable law. The monthly amount of each payment will be established no more often than once a year.

(36) TYPE OF COVERAGE EXTENDED

The benefits provided under COBRA will be the same as those provided to all other employees in your Class.

CANCELLATION OF COBRA COVERAGE

Continued coverage will be cancelled by the Fund upon the occurrence of any of the following events:

1. You do not make the required monthly payment by the due date, including the allowable 30 day grace period;

2. The Plan terminates;

3. You become covered under any other group health care plan, unless the other plan contains an exclusion or limitation with respect to any pre-existing conditions (coverage under this provision will then continue until such time as the waiting period under the other plan is satisfied, subject to the maximum period of coverage under this Plan); or

4. You become covered by Medicare.

IF YOU HAVE QUESTIONS

If you have questions about your COBRA continuation coverage, you should contact the Fund office or you may contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District Offices are available through EBSA’s website at www.dol.gov/ebsa.

KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES

In order to protect your family’s rights, you should keep the Fund office 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 Fund office.

(37) EMPLOYEE AND RETIREE DEATH BENEFIT

(Class I, Class III, Class IV, Class V and Residential Employees Only)

On receipt of proof of the death of an Eligible Employee or Retiree covered under this benefit, the Fund will pay the amount of Death Benefit specified in the Sched- ules of Benefits, subject to the provisions outlined below.

BENEFICIARY

Each covered Eligible Employee and Retiree may designate a beneficiary in writing to the Fund office. If, on the death of the Eligible Employee or Retiree, there is no surviving designated beneficiary for all or any part of the benefit payable, the benefit will be paid to the Eligible Employee’s or Retiree’s surviving spouse. If no spouse survives the Eligible Employee or Retiree, then the benefit will be paid to the Eligible Employee’s or Retiree’s estate. Any payment so made will, to the extent of such payment, release the Trustees from all liability.

The Eligible Employee or Retiree may change the designated beneficiary from time to time by filing a written notice of change with the Fund office. The change of beneficiary will be effective as of the date the Eligible Employee or Retiree signs the notice of change, whether or not the Eligible Employee or Retiree is living on the date the notice is received, but without prejudice to the Trustees on account of any payment made before the notice of change has been received.

If more than one beneficiary is designated and the Eligible Employee or Retiree has failed to specify each beneficiary’s respective interest, the beneficiaries will share equally. If any designated beneficiary predeceases the Eligible Employee or Retiree, the interest of that beneficiary will terminate, and his share will be payable equally to the remaining beneficiaries.

ASSIGNMENT

The benefits provided hereunder are not assignable.

(38) DEPENDENT DEATH BENEFIT

(Non-Residential Class I, Class IV and Class V Only)

If an Eligible Employee’s or Retiree’s Dependent (see definition below) dies while covered under this benefit, the Fund will pay the amount of the Dependent Death Benefit specified in the Schedule of Benefits to the Eligible Employee or Retiree only.

DEFINITION OF DEPENDENT

For purposes of this benefit, Dependent will include only the following:

1. The Eligible Employee’s or Retiree’s spouse, as long as the employee and spouse are not divorced or legally separated; and

2. The Eligible Employee’s or Retiree’s Eligible Dependent children over 10 days of age but under 26 years of age and not otherwise covered under the Fund as an Eligible Employee.

ASSIGNMENT

The benefits provided hereunder are not assignable.

TERMINATION OF BENEFIT

The Dependent Death Benefit terminates on the earlier of:

1. The date a Dependent ceases to satisfy the definition of “Dependent” as outlined above; or

2. The exact time of the Eligible Employee’s or Retiree’s death.

(39) EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

(Class I, Class IV, Class V and Residential Employees Only)

An Accidental Death and Dismemberment Benefit will become payable if:

1. A Covered Eligible Employee or Retiree has sustained any of the losses listed in the following Table of Losses as a direct result of Accidental Injury; and

2. The loss occurred independently of all other causes, as evidenced by a visible contusion or wound on the exterior of the body (except in the case of drowning or internal injuries revealed by an autopsy); and

3. The date of occurrence of the injury was not more than 90 days prior to the date the loss was sustained.

In such an event, the Fund will pay to the Eligible Employee or Retiree or his designated beneficiary or other person, if there is no designated beneficiary, the amount specified below, and in the Schedules of Benefits. The term “Full Benefit” means the maximum amount payable as a benefit on account of accidental death or dismemberment of an Eligible Employee or Retiree.

LOSS BENEFIT Life ...... Full Benefit Both hands, Both Feet or Both Eyes ...... Full Benefit One Hand and One Foot, One Hand and One Eye, or One Foot and One Eye ...... Full Benefit One Hand, One Foot, or One Eye...... One Half of the Full Benefit

With respect to hands or feet, “loss” means dismemberment by severance at or above the wrist or ankle joint. With respect to eyes, “loss” means the entire and irrecoverable loss of sight. No more than the Full Benefit will be paid for all losses sustained by the Eligible Employee or Retiree as the result of any one accident.

(40) EXCLUSIONS

No benefit will be payable for any loss which results directly or indirectly, wholly or partly, from:

1. Self-destruction or attempted self-destruction or intentionally self-inflicted injury, while sane or insane;

2. Insurrection or war, or any act attributable thereto;

3. Participation in a riot;

4. Committing an assault or felony;

5. Operating or riding in or descending from any kind of aircraft if the Eligible Employee or Retiree is a pilot, officer or member of the crew of such aircraft or is giving or receiving any kind of training or instruction or has any duties aboard such aircraft or requiring descent therefrom;

6. Disease of the body or mental infirmity, or as a result of medical or surgical treatment or diagnosis therefor;

7. Ptomaines or bacterial infection (except pyogenic infection occurring simul- taneously with and in consequence of a visible accidental cut or wound);

8. Taking of poison, whether voluntary or involuntary; or

9. Asphyxiation from inhaling gas, whether voluntary or involuntary, which does not arise out of or in the course of employment.

EXAMINATION

The Fund has the right and opportunity to examine any individual whose injury is the basis of a claim when and as often as it may reasonably require while a claim is pending, and also the right and opportunity to make an autopsy in case of death, where it is not forbidden by law.

BENEFICIARY

Benefits for loss of life, if any, and all other benefits which remain unpaid at the

(41) death of the Eligible Employee or Retiree, are payable to the beneficiary on the same basis as under the Employee Death Benefit. All other benefits are payable to the Eligible Employee or Retiree or his personal representative or guardian or executor.

ASSIGNMENT

The benefits provided hereunder are not assignable.

(42) EMPLOYEE LOSS OF TIME BENEFIT

(Class I and Residential Employees Only)

On receipt of proof from a licensed Doctor of Medicine (M.D.) that an Eligible Employee has become Disabled, as defined below, due to a Non-Occupational Disease or Injury, the Fund will pay to the Eligible Employee the Loss of Time Benefit shown in the Schedules of Benefits. Loss of Time Benefits will be payable for the portion of the period of disability beginning on the day shown in the Sched- ules of Benefits, up to the maximum period of benefits shown in the Schedules of Benefits for each separate disability.

Successive periods of disability due to the same or related causes are considered one period of disability unless they are separated by the Eligible Employee’s return to full-time active employment with a participating employer for all of the regular working days in a two consecutive week period. Successive periods of disability due to entirely unrelated causes are considered one period of disability unless separated by the Eligible Employee’s return to full-time active employment with a participating employer for at least one full day.

Benefits are compared and paid on a weekly basis. Payments for partial weeks of disability are paid at the daily rate of one-seventh of the weekly benefit.

DEFINITION OF DISABILITY

An Eligible Employee will be considered Disabled under this provision only if he is prevented, solely because of a Non-Occupational Disease or Injury, from engaging in his regular or customary occupation, provided that he will not be deemed to be Disabled during any period in which he is engaged in any other occupation for compensation or profit. Disability will also include pregnancy if a female Eligible Employee is prevented by such condition from engaging in her regular or customary occupation.

EXCLUSIONS

No benefit will be paid under this provision for:

1. Any period of disability during which the Eligible Employee is not under the care of a Doctor of Medicine (M.D.);

(43) 2. Any disability resulting from injuries sustained while doing any act of or pertaining to any occupation or employment for remuneration or profit, or from sickness for which benefits are payable in accordance with the provisions of any workers’ compensation or similar law;

3. Any disability not certified by the Eligible Employee’s Physician and employer;

4. Any disability certified by a chiropractor;

5. Any disability for a period when the Eligible Employee was actively at work in Covered Employment;

6. Any disability for a period when the Eligible Employee was on the out-of- work list with the union; or

7. Any disability commencing prior to the employee becoming eligible for benefits under the Plan.

TAX ON BENEFITS

Loss of Time Benefits may be required to be included as part of your gross income for federal income tax purposes unless you are totally and permanently disabled and are retired on disability. You should contact a competent tax advisor to determine whether you are subject to this tax.

Additionally, federal law requires that the Fund withhold FICA taxes from Loss of Time Benefits. This tax is automatically deducted from such payments and deposited in accordance with applicable federal laws and regulations. The Fund itself will pay that portion of the FICA tax normally paid by an employer.

(44) PHYSICAL EXAMINATION BENEFIT

(Non-Residential Class I, Class IV, and Class V Only)

On receipt of proof that a Covered Family Member has received a physical examination from a Physician, the Fund will pay the amount actually charged for the examination, not to exceed the maximum amount shown in the Schedule of Benefits. This Physical Examination Benefit covers routine check-ups and examinations, and, for Eligible Dependent children, routine immunizations and other well child charges. This benefit will not apply when such charges are otherwise covered under the Plan due to an illness or injury.

(45) COMPREHENSIVE MAJOR MEDICAL EXPENSE BENEFIT

(All Classes Except as Noted)

Comprehensive Major Medical Expense Benefits become payable if a Covered Family Member incurs Covered Charges which are in excess of the deductible amount.

The deductible amounts, Covered Charges, payment percentages and maximum amounts are described on the following pages and shown in the Schedules of Benefits.

The deductibles, payment percentages and maximums are applied separately for each Covered Family Member unless otherwise specified. The deductible and charges in excess of the amount paid by the Plan are the responsibility of the Eligible Employee or Retiree.

USE OF PREFERRED PROVIDER ORGANIZATION (PPO)

The Fund uses the services of the CIGNA HealthCare preferred provider organization to help provide quality health care at affordable prices to plan participants. A preferred provider organization (PPO) is a network of health care providers including doctors, hospitals and other facilities which provide services at discounted or fixed rates.

By securing your health care services from a participating CIGNA provider, you reduce not only the cost of providing coverage under the Fund, but also the amount of your portion of any bill payable for such medical services. You may of course choose to receive services from a non-participating provider, but in that case, PPO discounts do not apply, and your benefits will be paid at a lower level.

A directory of participating providers has been furnished to plan participants. If you would like to verify that a particular doctor or hospital is still participating in the PPO, please contact your PPO at the telephone number listed on the inside front cover. If you need a PPO directory, contact the Fund office and one will be provided free of charge.

CALENDAR YEAR DEDUCTIBLE AMOUNT

The Calendar Year Deductible amount is the amount to be paid in cash for services

(46) or supplies for treatment of an illness or injury or other covered condition. The amount of the deductible which must be met during a calendar year by each Covered Family Member, and by each family, is specified in the Schedules of Benefits. Only Covered Charges as outlined in this section may be used to meet the deductible.

If an individual is suffering from a condition for which Covered Charges are incurred in two or more calendar years, the deductible must be met for each calendar year. Any expenses applied during October, November or December of a calendar year to that year’s deductible will also be applied in the same amount to the deductible of the next calendar year.

PAYMENT PERCENTAGE

Once the applicable deductible has been satisfied by a Covered Family Member, the Plan will pay the percentages specified in the Schedules of Benefits of the Covered Charges incurred by that person during the remainder of the calendar year. The amounts remaining after the appropriate deductible has been satisfied will have the payment percentages applied to them.

MAXIMUM OUT-OF-POCKET EXPENSE

As indicated in the Schedules of Benefits, many Covered Charges are subject to a maximum out-of-pocket expense. For such Covered Charges, the payment percentage will be increased to 100% once the total Covered Charges not paid by the Fund, including any charges not paid due to the application of the calendar year deductible, equal or exceed the amount indicated in the Schedules of Benefits.

COVERED CHARGES

Covered Charges will include only the Reasonable and Customary Charges which a Covered Family Member actually incurs for medical care, services and supplies received or furnished by or upon the recommendation and approval of a Physician who is attending the Covered Family Member for the Medically Necessary treatment of a disease or Accidental Injury or other covered condition, and provided such charges are not otherwise excluded or limited as outlined in this booklet and are not for Custodial Care.

For Retirees eligible for Medicare, Covered Charges are limited to those charges approved by Medicare, except for prescription drugs which are covered at the actual reasonable cost.

(47) A Covered Charge will be considered incurred on the date on which the particular service, treatment or supply giving rise to the expense is rendered or obtained. In the absence of proof to the contrary, when a single charge is made for a series of services, treatments or supplies, each service, treatment or supply will be deemed to bear a pro-rata share of the charge. Charges incurred for and during a Hospital confinement will be considered incurred on the date of admission to the Hospital.

Covered Charges are limited to the following:

1. Charges for Hospital Room and Board incurred as an inpatient subject to the following:

(a) The maximum Covered Charge for confinement in a semi-private room or in an Intensive Care or Coronary Care Accommodation will be the actual charge, and

(b) The maximum covered charge for confinement in a private room will be the Average Semi-Private Room Rate.

2. Charges incurred as an inpatient for Other Hospital Services and Supplies.

3. Charges actually made by a professional anesthetist or by a Physician for anesthetics, oxygen, and their administration.

4. Charges actually made by a Physician as fees for diagnosis, treatment or the performance of a Surgical Procedure.

5. Charges actually made for x-ray, radiotherapy (including the use of x-ray, radium, cobalt, or other radioactive substances), or diagnostic laboratory examinations.

6. Charges incurred on an outpatient basis for Other Hospital Services and Supplies for emergency sickness treatment, emergency accident treatment within 48 hours of an Accidental Injury, and medical care and treatment received on the day of and in connection with a Surgical Procedure.

7. Convalescent Hospital room benefits up to the daily Room and Board limit. Benefits are payable only if confined to a Hospital as a registered inpatient for at least three consecutive days and then confined to a Convalescent

(48) Hospital within fourteen days after discharge from the Hospital for the same or related injury or disease that caused the Hospital confinement.

8. Charges made for speech therapy, physical therapy, occupational therapy, cardiac rehabilitation therapy and any other type of therapy provided by an individual licensed or certified to deliver such services which is recommended by an attending Physician, provided that such therapy is certified as being Medically Necessary by the case management/medical management consultant retained by the Trustees for such purpose.

9. Charges for Hospice Care, subject to review.

10. Pre-admission tests or exams.

11. Charges for repair of Accidental Injuries to natural teeth arising from an outside force, including replacement and treatment of a fractured jaw and related x-rays.

12. Local ambulance charges for emergency transportation to the nearest Hospital.

13. Private duty nursing care by a licensed nurse (R.N. or L.P.N.). Payment will be made for only that portion of the nurse’s services that require the special knowledge and skill of a trained professional nurse, and then only upon receipt of a Physician’s written documentation of such need and a listing of the special care services to be provided. Nursing care is not covered for routine patient care that is provided by a registered nurse or which is provided by a non- professional individual on a maintenance of care basis.

14. Radiation therapy treatment.

15. Casts, splints, surgical dressings and trusses.

16. The rental cost – up to the purchase price – of durable medical equipment. This will include coverage for the cost of a wheelchair, along with any special features and accessories, required in the permanent care or maintenance of a Covered Family Member, when certified as Medically Necessary by the attending Physician.

17. Blood transfusions – including the cost of whole blood or plasma not donated or replaced.

(49) 18. Prosthetic devices required due to a loss or injury, subject to the following:

(a) Coverage is limited to one such device in any twelve consecutive month period when required by an Eligible Dependent child;

(b) With regard to Eligible Employees, Retirees and Eligible Dependent spouses, coverage will be provided for the purchase and fitting of the initial device the same as any other Covered Charge. Thereafter, limited coverage will be provided for the purchase and fitting of replacement devices or parts contingent on the Eligible Employee or Retiree providing proof of payment of the Covered Family Member’s portion of the total charge made for the device or part.

19. Charges made by an ambulatory surgical center when a Surgical Procedure is performed.

20. Drugs or medicines which by law need to be prescribed by a Physician, subject to the annual maximum listed in the Schedules of Benefits. Birth control pills, other contraceptives or any kind of contraceptive devices, regardless of the purpose for which they are prescribed, are not covered. Drugs not approved by the Federal Food and Drug Administration, dietary supplements, vitamins, and food extracts are also not covered.

21. Charges for home health care by a home health care agency, subject to review.

22. Charges for chiropractic services and treatment rendered by a licensed chiropractor, subject to the limitations outlined in the Schedules of Benefits. This benefit is provided only for those services where a chiropractor is acting within the scope of his license, and only when services are rendered to a Covered Family Member seven years of age or older. Maintenance care is not considered a Covered Charge.

23. Charges for hearing and audiometry testing as well as for the purchase and fitting of hearing aids, subject to the limitations listed in the Schedules of Benefits.

24. Benefits for pregnancy and pregnancy-related conditions of Eligible Employees/Retirees and Eligible Dependent spouses, payable in the same manner and subject to the same limitations and conditions as any other

(50) disability (injury or sickness) under the Plan. Charges for any abortion other than a non-elective abortion are not Covered Charges.

25. Charges incurred due to complications of pregnancy (for female Eligible Dependent children). If, while covered under the Plan, a female Eligible Dependent child incurs expenses due to a complication of pregnancy, Comprehensive Major Medical Expense Benefits only will be payable in the same manner and subject to the same limitations and conditions as any other sickness.

Complications of pregnancy means: (a) conditions requiring Hospital confinement (when the pregnancy is not terminated), the diagnoses of which are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion, preeclampsia, intra-uterine fetal growth retardation, and similar medical and surgical conditions of comparable severity, and (b) ectopic pregnancy which is terminated.

26. Charges incurred for the purchase of oxygen or oxygen refills subject to the annual maximum listed in the Schedules of Benefits (exclusive of the equipment required to administer the oxygen, as covered under item 16).

27. Charges made by a Hospital or a Physician for routine care of an Eligible Dependent newborn during the Hospital confinement immediately following birth, including circumcision of a newborn male infant.

28. Charges made for a cardiac rehabilitation and exercise program accompanied by cardiac monitoring for the purpose of modifying coronary risk factors and promoting recovery, when ordered by an attending Physician and performed by an individual duly licensed or certified to render the service, up to a maximum treatment period of twelve weeks.

29. Charges made for the following services and supplies when rendered in connection with reconstructive breast surgery following a mastectomy:

(a) Reconstruction of the breast on which the mastectomy was performed,

(b) Surgery and reconstruction of the other breast to produce symmetrical appearance, and

(51) (c) Coverage for prostheses and physical complications of all stages of mastectomy including lymphedemas,

in a manner determined in consultation with the attending physician and patient.

30. Charges incurred in connection with a reduction mammoplasty when there is medical documentation of intractable pain, not amenable to other forms of treatment, and which is the result of excessively large, pendulous breasts. This procedure will be covered only if all of the following criteria are met, and are documented in writing by a Physician:

(a) The pain must have been present at least one year,

(b) The suprasternal notch to nipple measurement must be at least 21 centi- meters, and

35. Charges incurred for the education of a Covered Family Member in connection with a diagnosis of new onset diabetes, subject to the annual maximum listed in the Schedules of Benefits.

36. Charges incurred for services rendered by a podiatrist (D.P.M.), but only when the Covered Family Member has been referred to the podiatrist by a Doctor of Medicine (M.D.).

37. Charges incurred for gastroenterostomy, gastric stapling, jejunoileal bypass and other surgical procedures of a like nature, provided the surgery is certified as Medically Necessary by the medical case manager retained by the Trustees for that purpose.

38. Charges made for, or in connection with, pain management, provided such services are certified as being Medically Necessary by the medical case manager retained by the Trustees for that purpose.

39. For Non-Residential Eligible Employees and spouses only, charges made for a routine colonoscopy performed on an Eligible Employee or his or her

(52) Eligible Dependent spouse, provided the individual is age 50 or older and the services are rendered by a participating PPO provider, and subject to the limitation outlined in the Schedule of Benefits.

LIMITATIONS AND EXCLUSIONS

No benefits will be payable for or in connection with any charges:

1. For dental work or treatment, except (i) charges in connection with the removal of impacted teeth, and (ii) charges in connection with and as a result of injuries to natural teeth, including the initial replacement of natural teeth, sustained in an accident, to the extent the dental work or treatment is received promptly after such accident. No charge for the initial replacement of natural teeth in excess of $50 multiplied by the number of natural teeth replaced as a direct cause of such accident will be included as a Covered Charge.

2. For blood and plasma for which the Hospital or other supplier makes a re- fund or allowance to or on behalf of the Covered Family Member, either as a result of the operation of a group blood bank, private donor or otherwise.

3. For medical care, services or supplies received or furnished in connection with, or as a result of, any cosmetic surgery, except (i) charges in connection with and as a result of the necessary repair of disfigurement caused by bodily injuries sustained in an accident, provided such cosmetic surgery is received promptly after such accident, (ii) charges in connection with and as a result of an abnormal congenital condition, and (iii) charges specifically listed under the Covered Charges.

4. For hearing aids or the fitting of hearing aids except as specifically outlined under Covered Charge 23.

5. For medical care, services or supplies received or furnished in connection with, or as a result of, any injury or sickness resulting from, or caused, directly or indirectly, wholly or partly, by (a) war or any act of war, whether declared or undeclared, (b) service in any military, naval or air force of any country while such country is engaged in war, whether declared or undeclared, (c) police duty as a member of any military, naval or air force organization, (d) insurrection, (e) participation in a riot, or (f) any atomic explosion or other release of nuclear energy (except when being used solely for medi-

(53) cal treatment of a Non-Occupational Injury or Sickness) whether in peace or in war and whether intended or accidental.

6. For medical care, services or supplies received in, or furnished by, a Hospi- tal, institution or other facility owned or operated by the United States (other than a Veterans Administration hospital), or any agency or instrumentality thereof unless otherwise required by law.

7. Charges which would not have been made in the absence of this coverage or which the Eligible Employee, Retiree or Eligible Dependent is not legally obligated to pay.

8. For any medical care, services or supplies received or furnished in connection with, or as a result of, (a) any bodily injury which arises out of, or in the course of, any employment or occupation for compensation or profit, or (b) any sickness for which benefits are payable under any workers’ compensation law, occupational disease law, or any other legislation of similar purpose.

9. For medical care, services or supplies received or furnished in connection with, or as a result of, any injury or sickness resulting from participation in, or in consequence of having participated in, the commission of an assault or a felony except in cases of domestic violence.

10. For any medical care, services or supplies not recommended and approved by the Physician who is attending the Covered Family Member.

11. For any medical care, services or supplies received or furnished while the individual is not eligible for benefits.

12. For a disability not directly caused by Non-Occupational Disease or Injury.

13. For treatment of infertility, artificial insemination or in vitro fertilization, microsurgical resectioning and reanastomosis of tubes, reversal of vasecto- mies and vasoplasty.

14. For any surgical or laser procedure intended to correct or improve impaired vision resulting solely from presbyopia/myopia, hyperopia, astigmatism or other refractive error except when the individual’s vision cannot be corrected to at least 20/70 in the better eye by normal corrective glasses and the individual cannot, for medical reasons, wear contact lenses.

(54) 15. In the case of an Eligible Dependent who is employed:

(a) For expenses due to an accident on the job whether or not such accident is covered by workers’ compensation or similar legislation, or

(b) For expenses due to an illness which is covered by workers’ compensation or similar legislation.

16. To the extent that benefits are payable with respect to:

(a) An Eligible Employee, Retiree or Eligible Dependent under workers’ compensation or similar legislation,

(b) An Eligible Employee, Retiree, or Eligible Dependent under any insurance contract, plan or fund for which an employer, directly or indirectly, has paid part or all of the cost, or

(c) Visits or treatment of an Eligible Dependent if such individual is entitled to benefits as an Eligible Employee or Retiree.

17. Resulting from an act of war occurring while the individual is covered.

18. For treatment in a charitable hospital which does not bill patients for services rendered.

19. Resulting from occupational injury, disease or sickness.

20. Which are duplicate charges incurred by a person covered under the Plan and by any other group insurance or government sponsored medical program.

21. Incurred in connection with confinement to any institution or part thereof used principally as a rest facility, a facility for the aged, chronically ill, drug addicts or alcoholics, or as a facility providing primarily custodial, educa- tional or rehabilitative care.

22. Except as specifically provided, for routine physical examinations or any other routine care.

23. For maternity benefits for Eligible Dependent children, except for complications arising as specifically outlined under Covered Charge 25.

(55) 24. For eye care charges: any charge for or in connection with (a) exams to determine the need for (or changes of) eyeglasses or lenses of any type, (b) eyeglasses or lenses of any type except initial replacements for loss of the natural lens, (c) eye surgery such as radial keratotomy, where the primary purpose is to correct myopia (nearsightedness), hyperopia (farsightedness) or astigmatism (blurring), except as provided in item 14 of this section.

25. For unnecessary services or supplies: charges for services or supplies, including tests and check up exams, that are not Medically Necessary for medical care of a diagnosed sickness or Accidental Injury (except as specifically provided).

26. Related to any abortion other than an abortion performed because the mother’s life would be endangered if the fetus were carried to term.

27. For weight control programs.

28. In connection with sex transformation or sexual dysfunctions.

29. In connection with smoking cessation.

30. For reversal of sterilizations.

31. For or in connection with infertility treatments or procedures.

32. To the extent that they are in excess of the Reasonable and Customary Charges for the applicable services or supplies.

33. Which the patient is not required to pay.

34. Incurred for treatment by, or under the supervision of, a chiropractor (D.C.M.) when rendered to an individual under the age of seven years.

35. Which are incurred due to an injury that does not meet the definition of Ac- cidental Injury as it appears in this booklet.

PRE-EXISTING CONDITIONS LIMITATION

1. No benefits will be paid for any charge incurred by a Covered Family Mem- ber for or in connection with a medical condition, regardless of the cause of

(56) the condition, for which medical advice, diagnosis, care or treatment was recommended or received during the look-back period. As used in this section, “look-back period” means the ninety-day period ending on the later of the following dates:

(a) For an Eligible Employee or Eligible Dependent, the first day of the calendar month in which the employee commenced a period of employment upon which initial eligibility or regained eligibility was granted under the Plan; or

(b) For an Eligible Dependent who was not a dependent of the employee on the date outlined under (a) above, the date on which the Eligible Depen- dent became a dependent of the employee.

A “medical condition,” as used in this section, means any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury (whether or not accidental), or congenital malformation, exclusive of genetic information.

2. This exclusion for such medical condition will end at the end of a twelve month period beginning on the later of (i) the first day of the calendar month mentioned in 1(a) above, or (ii) the date outlined in 1(b) above.

3. EXCEPTIONS

(a) Credit for days of “creditable coverage,” as defined in Section 2590.701-2 of the Employee Retirement Income Security Act, as amended, will be applied to reduce the waiting period described above.

(b) No pre-existing condition exclusion will apply to any Eligible Depen- dent child under the age of 19.

4. YOUR RIGHT TO CREDITABLE COVERAGE

Federal law requires that you be given credit for “creditable coverage” toward the waiting period described under (2) above. “Creditable Coverage” is previous coverage for health benefits or health insurance. In order to qualify

(57) as “creditable coverage,” your previous coverage must not have terminated more than sixty-three days prior to the day on which you commenced employment for a contributing employer or, for a dependent you acquire after your date of employment, sixty-three days prior to the date on which that person becomes your dependent.

In order to receive credit for “creditable coverage” you can request a certificate from your prior plan or insurance carrier certifying your previous coverage. If you would like, the Fund office will be glad to assist you in requesting a certificate of your previous coverage from your former plan or insurance carrier. You may contact the Fund office for a more complete description of the effect any “creditable coverage” may have on reducing your waiting period under this pre-existing condition exclusion.

EXTENSION OF COMPREHENSIVE MAJOR MEDICAL EXPENSE BENEFIT

In the event coverage under the Plan is terminated for an Eligible Employee or Eligible Dependent, and on that date such individual is Disabled, as defined in the following paragraph, and under a Physician’s care, such person’s Comprehensive Major Medical Expense Benefit will be extended. During the period of extended benefits, coverage will apply only to the Disabled Eligible Employee or Eligible Dependent, and only for covered charges incurred as a result of the disability for which benefits are extended.

As used in this section, Disabled means, with respect to an Eligible Employee, that he is prevented, solely because of a Non-Occupational Disease or Injury, from engaging in his regular or customary occupation. An Eligible Employee will not be deemed to be Disabled during any period in which he is engaged in any other occupation for compensation or profit. With respect to an Eligible Dependent, Disabled means that the individual is prevented solely because of disease or Accidental Injury from engaging in substantially all of the normal activities of a person of like age and sex in good health.

Benefits extended under this provision will terminate on the earliest of:

1. The date on which the Eligible Employee’s or Eligible Dependent’s disability terminates,

(58) 2. The last day of the third month following the month in which the benefits would have otherwise terminated, or

3. The date the Eligible Employee or Eligible Dependent becomes eligible under any other group health plan providing benefits similar to those continued under this provision.

(59) VISION BENEFITS

(Non-Residential Class I, Class III, Class IV and Class V Only)

If a Covered Family Member incurs expenses as a result of a vision examination made by a licensed optometrist or ophthalmologist, or for the purchase of lenses or frames, including contact lenses, or for laser-assisted in situ keratomileusis (lasik) surgery or a similar procedure designed to improve vision when performed by a medical doctor (M.D.), he will be entitled to coverage for such expenses subject to the limitations outlined below and the maximum amount per calendar year outlined in the Schedule of Benefits.

EXCLUSIONS

Covered charges do not include any charges for:

1. Any lenses which do not require a prescription; or

2. Any service performed or supplies provided in connection with special procedures such as orthoptics or visual training.

(60) DENTAL BENEFITS

(Non-Residential Class I, Class IV and Class V Only)

This benefit provides for the coverage of the dental services described below when rendered to a Covered Family Member by a dentist as a result of a Non-Occupational Disease or Injury, for care and treatment of any disease or defect, or for preventive dental care. Charges covered under this provision are subject to the maximum dental benefit listed in the Schedule of Benefits.

The deductible listed in the Schedule of Benefits is applied separately to each Covered Family Member. If two or more Covered Family Members in the same family are injured in one accident, only one deductible will be applied in each calendar year to all of the covered dental charges incurred as a result of that accident.

The following classes of dental services are covered:

• Type A – Preventive Services ...... Paid at 100% These charges are not subject to the deductible or calendar year maximum. Diagnostic and preventive care, including sterilization fees, are covered up to two visits in each calendar year and one full set of mouth x-rays in any consecutive thirty-six month period.

• Type B – Basic Restorative Services ...... Paid at 75% These charges are subject to the deductible and maximum payment. Restorative (fillings), oral surgery, endodontics and periodontic procedures are covered.

• Type C – Complex or Major Restorative Services...... Paid at 50% These charges are subject to the deductible and maximum payment amount. Charges are covered for porcelain crowns, gold crowns, gold inlays, dentures and implants.

• Type D – Orthodontic Care ...... Paid at 100% Subject to the maximum lifetime benefit listed in the Schedule of Benefits, payment will be made for orthodontic services rendered to Eligible Dependent children only, and only prior to attainment of age nineteen.

(61) EXCLUSIONS:

No benefit will be paid under this provision for:

1. Treatment or supplies furnished on account of a dental defect which arises out of, or in the course of, any occupation for wage or profit.

2. Any loss sustained as a result of a declared or undeclared war, or any act thereof, or of military or naval service for any country.

3. Dental procedures performed in a hospital or facility owned by the United States Government or any agency thereof, unless required by law.

4. Any expense for dental procedures or supplies to the extent that payment is received from any other group policy or prepayment plan (individual policies are not affected by this limitation).

5. Orthodontia, except as specifically outlined in this section.

6. Any treatment which is performed for cosmetic purposes.

7. Treatment by other than a legally qualified dentist, except charges for cleanings performed by a licensed dental hygienist under the supervision and direction of a dentist.

8. In connection with dentures, bridgework, crowns or prosthetic devices for:

(a) expenses for prosthetic devices started prior to the effective date of coverage,

(b) expenses for replacement made less than five years after an immediately preceding placement or replacement,

(c) expenses for extension bridges or prosthetic devices previously paid for by the Fund except for expenses incurred for new extended areas, or

(d) loss or theft.

9. Expenses incurred which are for procedures not completed within a 90-day period after the initial commencement of work for which the claim is made.

(62) NOTE: These benefits are also provided to the spouses of Class III Retirees until the date on which such a spouse becomes eligible for Medicare benefits.

(63) APPEAL PROCEDURES

A Person whose claim for benefits has been denied under the terms of the plan is entitled to certain rights, including the right to receive a full explanation of the denial and an opportunity to appeal the denial. The following procedures have been adopted by the Board of Trustees explaining those rights:

NOTICE OF ADVERSE BENEFIT DETERMINATION (Notice of Denial)

Upon determination that a claim submitted by or on behalf of a Covered Family Member is not covered under the plan, the Eligible Employee or Retiree will be notified in writing within the time frame set forth in this booklet regarding the adverse benefit determination. This notice will set forth, in a manner calculated to be understood by the claimant, all of the following information:

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan provisions on which the determination is based;

3. A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary;

4. A description of the Plan’s review procedures and the time limits applicable to such procedures, including a statement of the claimant’s right to bring a civil action under section 502(a) of the Employee Retirement Income Secu- rity Act of 1974, as amended, following an adverse benefit determination on review;

5. If an internal rule, guideline, practice or procedure was relied upon in making the adverse determination, a statement that a copy of such rule, guideline, practice or procedure will be provided free of charge to the claimant upon request;

6. If the adverse benefit determination is based on medical necessity or experimental treatment or similar exclusion or limit, an explanation that the claimant will be provided free of charge upon request an explanation of the scientific or clinical judgment applied to the terms of the plan with respect to the claimant’s medical circumstances used in making the determination; and

(64) 7. If the claim involves urgent care, a description of the expedited review process applicable to such claims. If an adverse benefit determination involves an urgent claim, the contents of this notice may be provided orally to the claimant. However, in such instances, this written notification will be furnished to the claimant not later than three days after the oral notification.

CLAIMANT’S RIGHT TO APPEAL AN ADVERSE BENEFIT DETERMINATION

A claimant whose claim for benefits has been denied under the terms of the plan and to whom a notice of adverse benefit determination has been issued in accordance with the preceding section will have the right to appeal the adverse benefit determination and will be entitled to a full and fair review of the decision by the Board of Trustees, or by a committee appointed by them. The procedures by which the claimant may appeal the adverse benefit determination and receive a full and fair review of the claim are as described below. The procedures will:

1. Provide claimants at least 180 days following receipt of a notification of an adverse benefit determination in which to appeal the determination;

2. Provide for an independent review by the Board of Trustees, or their committee. The review will not be conducted by the individual who made the adverse benefit determination that is the subject of the appeal, nor by the subordinate of such individual;

3. Provide that, in deciding an appeal of any adverse benefit determination that is based in whole or in part on a medical judgment, including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate, the Trust- ees or their committee shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment;

4. Provide for the identification of medical or vocational experts whose advice was obtained on behalf of the plan in connection with a claimant’s adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination;

5. Provide that the health care professional engaged for purposes of this appeal

(65) is neither an individual who was consulted in connection with the adverse benefit determination that is the subject of the appeal, nor the subordinate of any such individual; and

6. Provide, in the case of a claim involving urgent care, for an expedited review process under which —

(a) a request for an expedited appeal of an adverse benefit determination may be submitted orally or in writing by the claimant, and

(b) all necessary information, including the Plan’s benefit determination on review, will be transmitted between the plan and the claimant by telephone, facsimile or other available similarly expeditious method.

NOTICE OF TRUSTEES’ DECISION

The Board of Trustees, or their committee, will review all appeals in accordance with the following and will notify the claimant as indicated:

1. Urgent Care Claims — When the appeal of a claim involving urgent care, as that term is defined on page 13 of this booklet, is received as provided by the Plan, a decision on the appeal will be made and will be communicated in writing (and otherwise as appropriate) within 72 hours of receipt of the claimant’s request for review of an adverse benefit determination. Appeals of adverse benefit determinations involving urgent care will be addressed promptly by the Trustees, or by their committee, taking into account the urgent nature of the claim, but in no instance will the decision be made later than 72 hours after receipt of the claimant’s request.

2. Non-Urgent Care Claims — Appeals of adverse benefit determinations received from claimants which are of a non-urgent care nature shall be reviewed by the Trustees, or their committee, in accordance with the following guidelines, and notification of the decision shall be communicated in writing to the claimant within the time period prescribed.

(a) Pre-Service Claims — If the appeal involves a request for review of an adverse benefit determination for medical services which have not yet been provided, the Trustees or their committee will make a decision on the appeal and the decision will be communicated in writing to the

(66) claimant not later than 30 days after receipt of the claimant’s request for review.

(b) Post-Service Claims — If the claimant’s request for review of an adverse benefit determination involves a claim for medical services which have already been provided, a decision on the claimant’s appeal will be made by the Trustees or their committee and communicated in writing to the participant within five days of the decision. The appeal will be reviewed at the meeting of the Trustees or the committee which immediately follows the Plan’s receipt of a request for review, unless the request for review is filed within 30 days preceding the date of such meeting. In such case, a benefit determination will be made no later than the date of the second meeting following the plan’s receipt of the request for review, but in no instance more than 120 days following receipt of the appeal.

3. Notwithstanding the statements set forth above, notice of every appeals determination will be given to the claimant within 5 days of the determination.

ACCESS TO PLAN DOCUMENTS

At any time during the course of these appeal proceedings a claimant will be granted access to, and copies of, documents, records and other information relied upon by the Trustees or the committee in making their decision, as requested by the claimant.

NOTIFICATION OF DECISION ON APPEAL

Each claimant whose adverse benefit determination has been appealed to the Trustees will receive notification in writing, within the time period outlined above, of the Trustees’ or the committee’s decision. Such notification will set forth, in a manner calculated to be understood by the claimant:

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan provisions on which the benefit determination is based;

3. A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claimant’s claim for benefits;

(67) 4. A statement describing any additional voluntary appeal procedures offered by the plan and the claimant’s right to obtain information about such procedures, should the Board of Trustees adopt such procedures, and a statement of the claimant’s right to bring an action under section 502(a) of the Employee Retirement Income Security Act of 1974, as amended; and

5. The following information where applicable —

(a) If an internal rule, guideline, practice or procedure was relied upon in making the adverse determination, a statement that such rule, guideline, practice or procedure was relied upon in making the adverse determination and that a copy of the rule, guideline, practice or procedure will be provided free of charge to the claimant upon request;

(b) If the adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, a statement that an explanation of the scientificBLANK or clinical judgment for the determination, applying the terms of the plan to the claimant’s medical circumstances, will be provided free of charge to the claimant upon request; and

(c) A statement that you and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State Insurance Regulatory Agency. While the Plan does not currently offer voluntary alternative dispute resolution options to the procedures set forth above, you may contact the Local U.S. Department of Labor Office and your State Insurance Regulatory Agency to determine what options might be available to the Plan.

COMPLIANCE WITH APPEAL PROCEDURES

1. You may, at your own expense, have legal representation at any stage of these Appeal Procedures.

2. Every effort will be made by the Trustees to interpret plan provisions in a consistent and equitable manner, and you will be given maximum opportunity to present your viewpoints regarding any claim for benefits.

(68) 3. Every participant and beneficiary will be required to exhaust each and every step of these Appeal Procedures before he proceeds to litigation, and any attempt to circumvent these Appeal Procedures in any manner will be resisted by the Trustees.

BLANK

(69) COORDINATION OF BENEFITS

The objective of this Coordination of Benefits provision is to limit the reimbursement from this Plan and any other plan providing benefits to 100% of Allowable Expenses. Payments made by the Fund cannot be more than what would normally be paid if this provision did not exist.

Benefits are coordinated with other group plans including the following coverages:

1. Group, blanket, or franchise insurance coverage;

2. Hospital or medical service organizations, group practice and other prepayment coverage;

3. Any coverage under any labor-management plans, union welfare plans, employer organization plans or employee benefit organization plans; and BLANK 4. Any coverage provided under government programs or any coverage required or provided by any statute.

ALLOWABLE EXPENSES

Benefits are paid under this Coordination of Benefits provision for Allowable Expenses. In addition to expenses covered under this Plan, Allowable Expenses include any necessary, reasonable and customary expense that is covered under another plan. This does not imply that this Fund would normally pay benefits for such expenses. It means that when expenses are calculated to determine the Coordination of Benefits payments, any charge that is covered under another plan but is not covered under this Plan, will, for this purpose only, be considered an Allowable Expense.

CLAIM DETERMINATION PERIOD

The Coordination of Benefits provision is administered on a calendar year basis. This calendar year basis for administration of the Coordination of Benefits provision is sometimes referred to as the Claim Determination Period. Any benefit savings resulting from this Coordination of Benefits provision in any calendar year will be held in a benefit account for that individual for that calendar year. Monies will be released from the benefit credit during that calendar year, if necessary, to give reimbursement of 100% of Allowable Expenses.

(70) BENEFIT DETERMINATION

1. General. When there is a claim under this Plan and another plan, this Plan is a secondary plan which has its benefits determined after those of the other plan, unless:

(a) the other plan has rules coordinating its benefits with those of this Plan; and

(b) both those rules and this Plan’s rules, in paragraph 2. below, require that this Plan’s benefits be determined before those of the other plan.

2. Rules. The Plan determines its order of benefits using the first of the following rules which applies:

(a) Non-Dependent/Dependent. The benefits of the plan which covers the person as an employee, member or subscriber (that is, other than as a dependent) are determined before those of the plan which covers the person as a dependent, except under the circumstances outlined in the following sentence. If the person is also a Medicare beneficiary and, under applicable Federal regulations, Medicare is secondary to the plan covering the person as a dependent and primary to the plan covering the person as other than a dependent (for example as a retired employee), then the benefits of the plan covering the person as a dependent are determined before those of the plan covering that person as other than a dependent.

(b) Dependent Child/Parent Not Separated or Divorced. Except as stated in subparagraph (3) below, when this Plan and another plan cover the same child as a dependent of different persons:

(1) the benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year; but

(2) if both parents have the same birthday, the benefits of the plan which covered the parent longer are determined before those of the plan which covered the other parent for a shorter period of time.

(71) (3) However, if the other plan does not have the rule described in (1) immediately above, but instead has a rule based upon the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.

(c) Dependent Child/Separated or Divorced Parents. If two or more plans cover a person as a dependent child of divorced or separated parents, benefits for the child are determined in this order:

(1) first, the plan of the parent with custody of the child; and

(2) then, the plan of the spouse of the parent with custody of the child; and

(3) finally, the plan of the parent not having custody of the child.

However, if the specific terms of a court decree state that one of the parents is responsible for the health care expenses of the child, and the individual obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. This paragraph does not apply with respect to any benefits which are actually paid or provided before the individual has that actual knowledge.

When the group health plan with which this plan is being coordinated does not contain the rules described in this sub-paragraph (c), the plan covering the dependent as a dependent of a male shall be the primary plan and the plan covering the dependent as a dependent of a female shall be the secondary plan.

(d) Joint Custody. If the terms of a court decree state that the parents shall share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child shall follow the Order of Benefit Determination Rules outlined under (b) above.

(e) Active/Inactive Employee. The benefits of a plan which covers a person as an employee who is neither laid off nor retired (or as that employee’s

(72) dependent) are determined before those of a plan which covers that person as a laid off or retired employee (or as that employee’s dependent). If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this section (e) is ignored.

(f) Continuation Coverage. If a person whose coverage is provided under a right of continuation under Federal or State Law also is covered under another group health plan, the following will be the order of benefit determination;

(1) First, the benefits of the plan covering the person as an employee, member or subscriber (or as that person’s dependent);

(2) Second, the benefits under the continuation coverage.

If the other plan does not have the rule described above, and if as a result the plans do not agree on the order of benefits, this rule is ignored.

(g) Longer/Shorter Length of Coverage. If none of the above rules determines the order of benefits, the benefits of the plan which covered an employee, member or subscriber longer are determined before those of the plan which covered that person for the shorter time.

RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION

For the purpose of determining the applicability of and implementing the terms of this provision of this Plan or any provision of similar purpose of any other plan, this Plan may, without the consent of or notice to any other person, release to or obtain from any insurance company or other organization or person, any information, with respect to any person, which the Fund deems to be necessary for such purposes. Any person claiming benefits under this Plan will be required to furnish to the Fund such information as may be necessary to implement this provision.

RIGHT OF RECOVERY

Whenever payments have been made in error by the Fund in excess of Covered Charges, the Fund shall have the right to recover such payments, to the extent of any excess payment, from among one or more of the following, as the Fund shall determine:

(73) 1. The Eligible Employee or Retiree,

2. The payee, if other than the Eligible Employee or Retiree,

3. Any insurance company or other organization furnishing coverage to the Covered Family Member, or

4. Any further claims made to this Fund by the Covered Family Member.

GENERAL

Under the Coordination of Benefits Provision, it is necessary that claim be made for any benefits the individual may be entitled to from any source. Whether or not claim is made to these other sources, the Coordination of Benefits Provision will be fully operable as if claim were made.

COORDINATION WITH MEDICARE

Regardless of any other provisions to the contrary, this Fund’s benefits will be paid primary to those of Medicare in behalf of any Eligible Employee, or the Eligible Dependent of any Eligible Employee, unless:

1. The Eligible Employee or Eligible Dependent, has elected, in accordance with procedures established by the Trustees under appropriate federal law, to have Medicare as his or her primary coverage, or

2. The Eligible Employee or Eligible Dependent is entitled to Medicare benefits as a result of end stage renal disease, in which case benefits are coordinated as outlined below. During the period outlined below, this Plan’s benefits will be determined before any benefits payable by Medicare in behalf of any Covered Family Member who is entitled to Medicare benefits due to end stage renal disease. This period of primary coverage for the Plan will begin on the earliest of the following and will end 30 months afterward:

(a) The month in which the Covered Family Member began a regular course of renal dialysis,

(b) The month in which the Covered Family Member received a kidney transplant,

(74) (c) The month in which the Covered Family Member was admitted to a Hospital in anticipation of a kidney transplant that was performed within the next two months, or

(d) The second month before the month in which the kidney transplant was performed, if performed more than two months after admission.

COORDINATION OF DUAL COVERAGE BY HUSBAND AND WIFE

If a husband and wife are both eligible for benefits under the Plan as Eligible Employees, benefits for such husband and wife and their Eligible Dependent children shall be coordinated and shall be paid on the basis of paying the maximum amount available based upon the eligibility of both husband and wife, provided, however, that in no event shall the total benefits paid for any Covered Family Member exceed the total amount of expenses incurred on behalf of such individual.

(75) SUBROGATION AND REIMBURSEMENT

In the event that an Eligible Employee or Eligible Dependent (collectively referred to as a “Covered Family Member”) receives any benefits (the “Benefits”) under this Plan arising out of any loss, injury, or illness (the “Injury”) for which the Covered Family Member has asserted or may assert any claim or right to recovery against a third party or parties or his or her or their insurer(s), except against any insurer on any policy of insurance issued to and in the name of such Covered Family Member, then any payment or payments by the Fund for such benefits shall be made on the condition and with the agreement and understanding that the Fund shall be reimbursed by the Covered Family Member to the extent of, but not exceeding, the amount or amounts received by the Covered Family Member (the “Recovery”) from such third party or parties or his or her or their insurer(s) (the “Responsible Party”), whether by way of settlement or in satisfaction of any judgment(s) or otherwise.

The Covered Family Member shall reimburse the Fund, starting with the first dollar that the Covered Family Member receives from the Responsible Party, no matter whether the Recovery is designated as actual or punitive damages, costs or expenses, medical expenses, pain and suffering, lost wages, workers’ compensation, disability payments, loss of consortium, loss of work payments, emotional distress, or otherwise, and the Covered Family Member shall continue to reimburse the Fund until all Benefits related to the Injury are reimbursed or the full amount of the Recovery is paid to the Fund, whichever occurs first.

The Fund has the right to first recovery and the “make whole” doctrine is not applicable to the Fund’s subrogation and reimbursement rights. The Fund has the right of first reimbursement for all Benefits paid related to the Injury, such first reimbursement to be paid out of any Recovery the Covered Family Member is able to obtain, even if the Covered Family Member has not been fully compensated for the Injury.

The Fund does not recognize the “common-fund doctrine,” the “Fund Doctrine,” the “Attorneys’ Fund Doctrine,” or any other legal theory compelling the Fund to reduce the amount it is owed hereunder in order to pay any portion of a Covered Family Member’s attorney’s fees and costs. Rather, if it becomes necessary for the Covered Family Member to retain an attorney in order to obtain a Recovery or to recover Benefits paid by the Fund relating to the Injury, the amount to be reimbursed to the Fund may, at the sole discretion of the Fund, be reduced by the Fund’s pro rata share of those attorneys’ fees and expenses.

(76) If the Trustees retain an attorney to recover any amounts that are owed under this provision, then the Covered Family Member shall be liable for, in addition to all amounts outlined in the previous paragraphs, all costs of collection of the Fund, including the Fund’s reasonable attorneys’ fees and expenses. As a means of collecting the amount owed under this provision, the Fund may, in addition to any other means allowed by law, set off future Benefits to the Covered Family Member or lessen the reduction allowed by the Fund for the Covered Family Member’s attorneys’ fees and expenses incurred in obtaining the Recovery. However, this provision shall not limit the Fund’s right to collect its attorneys’ fees and expenses and shall be cumulative with all other rights the Fund may have to collect its attorneys’ fees and expenses.

As security for all amounts due to the Fund under this provision, the Fund shall be subrogated to all of the claims, demands, actions, and rights of recovery of the Covered Family Member against the Responsible Party or his, her, or their insurer(s) to the extent of any and all Benefits paid under this Plan. The Covered Family Member shall execute and deliver any instruments and documents requested by the Trustees and shall do whatever else the Trustees shall deem necessary to protect the Fund’s rights. The Covered Family Member shall take no action to prejudice the Fund’s rights to such reimbursements and subrogation. The Trustees may withhold any Benefits to which the Covered Family Member is entitled under this Plan until the Covered Family Member executes and delivers any such instruments and documents as may be requested by the Trustees.

Prior to the payment of Benefits under this Plan to a Covered Family Member or assignee of a Covered Family Member for injuries, expenses, or losses for which a third party is or may be liable in whole or part, the Covered Family Member or assignee or both may be required to execute a written subrogation and reimbursement agreement in form and substance satisfactory to the Plan.

(77) INFORMATION YOU SHOULD KNOW

THIS BOOKLET IS ONLY A SUMMARY

Although this booklet contains a great deal of information about your Plan, it is not the purpose of this booklet to cover every detail or every situation that might arise under your Plan.

However, there is a complete set of rules and regulations which governs the operation and administration of this Plan. These rules and regulations are set forth in a legal document referred to as the Plan document.

So that you have all the details readily available, a copy of the Plan document will be made available for your examination at the Fund office or a copy of it will be reproduced for you at your request for a reasonable charge.

The rules and regulations set forth in the Plan document are final and binding. Nothing in this booklet is meant to interpret or extend or change in any way the provisions expressed in the Plan document itself. If there is any difference between the Plan document and the summary in this booklet, the Plan document will control.

THE TRUSTEES INTERPRET THE PLAN

Any interpretation of the Plan’s provisions rests with the Board of Trustees. However, the Board of Trustees has authorized the administrative manager and the Fund office staff to handle routine requests from participants regarding eligibility rules, benefits and claims procedures. But, if there are questions involving interpretation of any Plan provisions, the administrative manager will secure from the Board of Trustees a final determination for you. No person other than a Trustee or a member of the Fund office staff, acting with the consent of the full Board of Trustees, may provide interpretations of Plan provisions.

THE PLAN MAY BE CHANGED

The Trustees are endowed with the authority to change the Plan, subject to any collective bargaining agreement that applies to it.

Although the Trustees expect to maintain and to improve benefits, this can only be done within the limits of available financial resources. The Trustees have an

(78) obligation to make whatever Plan changes are necessary to assure the financial stability of this Plan.

The Trustees also may change the Plan in any way to protect its tax exempt status under Internal Revenue Service rules. From time to time, these rules may change and the Trustees may have to alter certain Plan provisions in order to preserve the tax exempt status of your Plan.

YOUR PLAN IS TAX EXEMPT

The Internal Revenue Code provides that your employers’ contributions to the Trust are not taxable to you nor are most of the benefits paid on your behalf taxable as personal income. Also, investment earnings on Plan assets are excluded as taxable income of the Trust since they are specifically set aside for the purpose of providing benefits to participants.

Obviously, such tax exemption works to the benefit of both employer and employee. In effect, it means that money which otherwise might be payable as taxes can be used to purchase benefits and to cover administrative expenses.

The Trustees are well aware of these advantages and will take whatever steps are necessary to keep your Plan “qualified” as a tax exempt trust under Internal Revenue Service rules.

PAYMENT AND ASSIGNMENT OF BENEFITS

Benefits which are payable under this Plan and which have not been assigned to a provider of covered services will be paid to you, whether the claim is made on behalf of yourself or one of your dependents, unless benefits are being provided under a Qualified Medical Child Support Order, as that term is defined in the Omnibus Budget Reconciliation Act of 1993. In such case, benefits otherwise payable to you will generally be paid to the custodial parent or legal guardian of the dependent child on behalf of whom the benefits are provided.

You may assign benefits which are payable to you under this Plan, but only to a medical service provider. If benefits are provided under a Qualified Medical Child Support Order, benefits may also be assigned by the custodial parent or legal guardian of the dependent child on whose behalf the benefits are provided. Benefit assignments made in accordance with any state Medicaid law will also be honored by the Plan.

(79) QUALIFIED MEDICAL CHILD SUPPORT ORDERS

As explained under the previous heading, the Fund will honor the provisions of a Qualified Medical Child Support Order. The Fund office has established procedures for determining whether such an order meets all of the legal requirements. A copy of these procedures will be furnished to you, without charge, upon written request filed with the Fund office.

MEDICAL EXAMINATION

Although you will not be required to undergo a physical examination to attain eligibility or to remain eligible for benefits under this Plan, the Trustees may require a medical examination of you or any one of your dependents in determining coverage for a claim under the Plan. They may also require an autopsy in the event of death, where it is not forbidden by law.

NOTICE AND PROOF OF CLAIMS

1. A written notice of the injury or of the illness for which a Covered Family Member is making claim must be given to the Trustees as soon as possible, and all forms, bills and information necessary to pay the claim must be provided within 180 days of the end of the calendar year in which the claim was incurred.

2. If the individual does not furnish notice and data within the time provided by the Plan, such lack of notice will not jeopardize the claim if it is shown that it was not reasonably possible to furnish such notice when required and such notice was furnished as soon as it was reasonably possible.

INCURRED DATE

A claim will be considered to be incurred on the date on which the services or supplies are rendered or obtained. For inpatient Hospital claims this means that the incurred date for any particular charge is the date of admission. For benefits payable due to death or dismemberment, the claim will be considered to be incurred on the date of the death or dismemberment. Claims for Loss of Time Benefits will be considered to be incurred on each day for which those benefits are payable.

(80) PAYMENT OF BENEFITS

1. Except in the case of Death Benefits and Accidental Death Benefits, benefits are payable to the Eligible Employee whether the claim is on the Eligible Employee or on one of the employee’s Eligible Dependents. If benefits are assigned, however, benefits will be paid to the assignee instead of directly to the Eligible Employee. Benefits are payable when the required forms have been submitted to the Plan.

2. If an individual, in the Trustees’ opinion, is not capable of giving a valid receipt for payments due and no guardian has been appointed for such person, the Trustees may make payment to the individual or individuals who, in their opinion, has assumed the care and principal support of the individual. If the individual should die before all amounts that are due have been paid, the Trustees may, at their option, make payment to the executor or administrator of the estate of the individual or to his surviving spouse, parent, child or children or to any individual who, in the Trustees’ opinion, is entitled to the benefits.

3. Any payments that are made by the Trustees in accordance with these provisions shall fully discharge the liability of the Trustees to the extent of the payments.

NO CONVERSION PRIVILEGE

These benefits cannot be converted to individual coverage.

CONSTRUCTION BY TRUSTEES

The Trustees have full authority and discretion to construe the provisions of this Plan and any construction placed upon the Plan by the Trustees shall be final and binding upon all parties.

TERMINATION OF FUND

The information regarding the conditions under which the Fund may be terminated, and disposition of the assets of the Fund on termination, are furnished in accordance with Federal Laws and Regulations.

(81) The Fund will be terminated upon the termination of the Trust Agreement establishing the Fund. The Trust Agreement will terminate upon the occurrence of either of the following events:

1. In the event the Union and the contributing employers agree in writing to terminate the Trust; or

2. In the event the Trustees decide to terminate the Trust when there is no longer a written agreement requiring employers to contribute to the Fund.

In the event the Trust is terminated, any remaining funds available, after meeting all outstanding obligations, will be used in such a manner as will, in the opinion of the Trustees, best effectuate the purposes of the Trust including, but not limited to, the purchase of insurance benefits or the transfer of such remaining funds to another health and welfare trust. In no event shall any of the funds revert to or be recovered by any employee (except as benefits payable under the Fund), employer or union.

STATEMENT OF RIGHTS UNDER THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT

Under federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (for example, your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier.

Also, under federal law, plans and issuers may not set the level of benefits or out- of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.

In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours).

(82) IMPORTANT NOTICE REGARDING THE WOMEN’S HEALTH AND CANCER RIGHTS ACT

Under federal law, group health plans and insurance issuers offering group health insurance coverage that includes medical and surgical benefits with respect to a mastectomy shall include medical and surgical benefits for breast reconstructive surgery as part of a mastectomy procedure. Breast reconstructive surgery in connection with a mastectomy shall at a minimum provide for: (1) reconstruction of the breast on which the mastectomy has been performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) prostheses and physical complications for all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the patient. As part of the Plan’s Schedules of Benefits, such benefits are subject to the Plan’s appropriate cost control provisions such as deductibles and copayments.

NOTICE TO ACTIVE PARTICIPANTS AND THEIR SPOUSES WHO ARE ELIGIBLE FOR MEDICARE

This notice is required by federal law. It is addressed to active participants only and does not apply to Retirees. It concerns your health care benefits once you reach age 65 if you or your spouse are eligible for Medicare and are also eligible for coverage under this Fund. In accordance with that law, coverage under this Fund is made available to all active participants age 65 or older and their spouses under the same conditions as coverage is made available to active eligible participants and spouses of eligible participants under age 65. In addition, federal statutes currently provide that any persons age 65 or older are entitled to select Medicare for their primary health insurance coverage in place of any group health plan offered by their employer. We would therefore urge you, if you are an active eligible participant under the Plan and eligible for Medicare benefits, to read the following:

If you are eligible for coverage under the Plan, federal law requires that the Plan pay first up to the maximum amounts provided for under the Plan and then Medicare coverage be applied up to the maximum limits provided under Medicare. This applies to active participants age 65 or older as well as the dependent spouses age 65 or older of active participants.

Federal law does permit an active participant who is age 65 or older, or the dependent spouse age 65 or older of an active participant, to reject the group health care plan

(83) as the primary payer of his or her benefits and to elect Medicare as the primary payer of benefits. Although such an election will reduce the Plan’s expenses, it will generally not work to the advantage of a participant or his spouse. In fact, if Medicare is elected as the primary payer, a participant or spouse is likely to incur higher out-of-pocket medical expenses than would be the case if the Plan is the primary payer of benefits. The reason for this is that if you or your spouse elect Medicare as the primary payer, the Plan is not permitted under federal law to provide any supplemental coverage for hospital or surgical expenses. The Plan is permitted, however, to provide and will continue to provide death benefits, accidental death and dismemberment benefits, loss of time benefits, prescription drug coverage and vision and dental benefits, as applicable, even if you or your spouse select Medicare as the primary payer.

Also, if Medicare is elected as the primary payer, the Plan is not permitted to pay any of the deductibles or co-insurance required for Medicare services. If for some reason, you or your spouse would rather have Medicare as the primary payer, you each have the right to indicate this preference in writing to the Fund office. Such election can be made upon becoming eligible for Medicare, or at any time thereafter. If you do not make a written election, this Fund will continue to be your primary provider of health coverage.

In making this decision, we urge you and your spouse to carefully compare the benefits provided under this Plan, as outlined in this booklet, and the benefits available under Medicare. A description of Medicare benefits can be obtained from your local Social Security office or the Fund office will provide you with a description of those benefits upon your request. Since the Plan’s benefits are usually more generous than Medicare benefits, it generally will not be advantageous for you or your spouse to elect Medicare as the primary payer of benefits. Remember, if you select Medicare as the primary payer, the Plan may not supplement Medicare coverage in any way and you will be totally responsible for any medical expenses not covered by Medicare.

As you probably know, Part A Medicare coverage is provided at no charge to all individuals who are age 65 and older. However, in order to be entitled to Part A Medicare, it is necessary that you enroll for such coverage. It is therefore extremely important that you enroll for Medicare at least three months before your 65th birthday, even if you intend to continue working beyond age 65. If you have already reached your 65th birthday and have not applied for Medicare, we would encourage you to determine the date the next Medicare enrollment period begins and make arrangements to apply at that time.

(84) These provisions do not apply to Retirees.

Please contact the Fund office for assistance and information regarding this notice.

PROTECTED HEALTH INFORMATION

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a comprehensive set of rules for handling and disclosing confidential health information (called protected health information or “PHI”). PHI is any information relating to your health, the provision of health care to you, payment of your health claims and your eligibility for health claims.

The Atlanta Plumbers and Steamfitters Health and Welfare Fund is bound by HIPAA to protect your PHI, and that of your dependents, by treating all such information as confidential. While such treatment will generally prove beneficial to you, it may sometimes inconvenience you when calling or corresponding with the Fund office to check on or discuss the health claims of other family members. Federal law will not allow us to divulge PHI on other adult family members, such as your husband or wife, without their written permission. Generally, parents will have access to the PHI of their minor children.

Authorization forms are available in the Fund office that are designed to allow you or your spouse to designate another individual or individuals, such as each other, to have access to your PHI. The information required for this authorization is very specific, and no forms other than the one furnished by the Fund office will be honored.

Remember, the Fund office is bound by federal law to restrict access to your PHI. If you want to allow such access by another person, you must complete an approved authorization form.

NOTICE REGARDING THE AFFORDABLE CARE ACT (HEALTH CARE REFORM)

This group health plan believes that it is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer

(85) protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the address and telephone numbers listed on the inside front cover of this booklet. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

(86) RIGHTS OF PLAN PARTICIPANTS

As a participant in this Fund, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:

RECEIVE INFORMATION ABOUT YOUR PLAN AND BENEFITS

Examine, without charge, at the Plan administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the Plan, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.

Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

CONTINUE GROUP HEALTH PLAN COVERAGE

Continue health care coverage for yourself, spouse or dependent if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan for the rules governing your COBRA continuation coverage rights.

Reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without

(87) evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.

PRUDENT ACTIONS BY PLAN FIDUCIARIES

In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

ENFORCE YOUR RIGHTS

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in a Federal court. If it should happen that Plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

(88) ASSISTANCE WITH YOUR QUESTIONS

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

(89) INFORMATION OF INTEREST AS REQUIRED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA)

You most likely have heard about ERISA. ERISA stands for the Employee Retirement Income Security Act which was signed into law in 1974.

This federal law establishes certain minimum standards for the operation of employee benefit plans including the Atlanta Plumbers and Steamfitters Health and Welfare Fund. The Trustees of your Plan, in consultation with their professional advisors, have reviewed these standards carefully and have taken whatever steps are necessary to assure full compliance with ERISA.

ERISA requires that plan participants and beneficiaries be provided with certain information about their benefits, how they may qualify for benefits, and the procedure to follow when filing a claim for benefits. This information is presented to you in this booklet.

ERISA also requires that participants and beneficiaries be furnished with certain information about the operation of the Plan and about their rights under the Plan. This information follows:

NAME OF THIS PLAN

The legal and common name of this Plan is the Atlanta Plumbers and Steamfitters Health and Welfare Fund.

TYPE OF PLAN

This plan provides death, accidental death and dismemberment, loss of time, comprehensive major medical, dental and vision benefits.

For specific coverage see the Schedules of Benefits outlined in this booklet.

NAME AND ADDRESS OF THE PLAN ADMINISTRATOR AS DEFINED BY ERISA

Your Health Plan is maintained and administered by a Board of Trustees on which labor and management are equally represented.

(90) There are five labor Trustee and five management Trustee positions on the Board. A list of all of the Trustees as of the date this booklet was prepared is contained in the front of this booklet.

This Board has the primary responsibility for decisions regarding eligibility rules, types of benefits, administrative policies, management of Plan assets and interpretation of Plan provisions.

Any communication with the Board of Trustees should be addressed to the Fund office at: Board of Trustees Atlanta Plumbers and Steamfitters Health and Welfare Fund 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 30340

TYPE OF ADMINISTRATION

Although the Trustees are legally designated as the Plan Administrator, they have delegated the performance of the day-to-day administrative duties to a professional administrative manager, Southern Benefit Administrators, Incorporated.

The Fund office staff maintains the eligibility records, accounts for employer contributions, processes claims, informs participants of Plan changes and performs other routine administrative functions in accordance with Trustee decisions.

COLLECTIVE BARGAINING AGREEMENTS

This Plan is maintained pursuant to one or more collective bargaining agreements. Copies of any or all of these agreements will be made available to you for your inspection and a copy of any or all of these agreements may be examined at the Plan office during normal business hours or at your local union office during normal business hours. Further, should you so request, a copy of the agreements will be made available at your place of employment within 10 days of your request if you will advise your employer of your desire to examine the agreements. If you request a copy of the agreements, a reasonable charge for them will be made by the administrator, the amount of which will be stated to you before you order.

PLAN SPONSORS

The Board of Trustees is the Plan sponsor. The Board of Trustees consists of an

(91) equal number of employer and union representatives, selected by the employers and the unions that have entered into collective bargaining agreements that relate to the Fund. The names and addresses of the current members of the Board of Trustees are listed on pages 1 and 2 of this booklet. If you wish to contact the Board of Trustees, you may use the address and telephone number below:

Board of Trustees Atlanta Plumbers and Steamfitters Health and Welfare Fund 3835 Presidential Parkway, Suite 123 Atlanta, Georgia 30340 Phone: (770) 455-3802, Toll-Free: (800) 382-6926

Participants and beneficiaries may receive from the Fund office, upon written request, information as to whether a particular employer or union has entered into a collective bargaining agreement that relates to the Fund and thus is a sponsor of the Fund and, if the particular employer or union is a sponsor, the employer’s or union’s address.

SOURCE OF CONTRIBUTIONS

The primary source of financing for the benefits provided under this Plan is employer contributions. The rate of contribution is spelled out in the collective bargaining agreements negotiated by the unions with participating employers.

No money is ever deducted from your paycheck to pay for Plan benefits. However, under the terms of this Plan, a participant may make self-contributions in order to retain his eligibility if he does not work sufficient hours.

A portion of the Plan assets are invested and this produces additional Fund income.

FUNDING MEDIUM FOR THE ACCUMULATION OF PLAN ASSETS

All contributions and investment earnings are accumulated in a trust fund. Benefits are provided directly from the trust fund. Some plan assets are invested.

CIRCUMSTANCES THAT MAY RESULT IN LOSS OF ELIGIBILITY OR BENEFITS

Throughout this booklet those circumstances that might lead to a loss of your

(92) eligibility and a description of the limitations, exclusions or restrictions applicable to specific benefits are explained to you.

Please familiarize yourself with this information, especially as it relates to the requirements which must be met in order to maintain your eligibility or make up the difference by timely self-payments. If at any time you are uncertain about how specific circumstances might affect your eligibility or benefit coverage, please contact the Fund office and, if possible, do so before the circumstances arise.

AGENT FOR SERVICE OF LEGAL PROCESS

Every effort will be made by the Trustees of this Plan to resolve any disagreements with participants promptly and equitably. It is recognized, however, that on occasion, some participants may feel that it is necessary for them to take legal action. Be advised that the following has been designated as agent for service of legal process:

Mr. Charles Elrod Parker, Hudson, Rainer & Dobbs, LLP 1500 Marquis Two Tower 285 Peachtree Center Avenue, N.E. Atlanta, Georgia 30303

Or legal papers may be served on the Board of Trustees collectively or individually as well as the Fund office manager.

PLAN IDENTIFICATION NUMBERS

When filing various reports with the Department of Labor and the Internal Revenue Service, certain numbers are used to properly identify the Atlanta Plumbers and Steamfitters Health and Welfare Fund including:

Employer Identification Number (EIN) assigned by the Internal Revenue Service ...... 58-0625978 Plan Number ...... 501

FISCAL YEAR

The accounting records of this Plan are kept on the basis of a fiscal year which ends on December 31.

(93) This Booklet

SOUTHERN BENEFIT

ADMINISTRATORS, INCORPORATED