You can choose one of three levels of coverage under the Medical Plan:

• Single - you only.
• Double - you and one dependent.
• Family - you and two or more dependents.

For the Medical Plan, your eligible dependents are:

• Your legally married spouse.
• Your unmarried children up to the end of the calendar year in which they turn age 19.
• Your unmarried children up to the end of the month in which they turn age 25 if they are enrolled as full-time students.

Children include natural children, step-children, adopted children, and children for whom you (or your spouse) are the legal guardian. To qualify as an eligible dependent, the child must also be your

Coverage under the Medical Plan is voluntary. If you want medical coverage, you have a choice of two options:

• Alliance Exclusive.
• Alliance Plus.

Alliance Exclusive is an exclusive provider organization, similar to an HMO. It requires you to select a network doctor to serve as your primary care physician (PCP). Your PCP is responsible for providing care, referring you to specialists, admitting you to the hospital and coordinating all of your care.

Alliance Plus is a point-of-service plan, which works like an HMO with an out-of-network feature. The out-of-network feature allows you to receive coverage at reduced levels if you use a provider who is not part of the Health Alliance Plus network.

There is no preexisting conditions limitation under the Medical Plan. Additionally, the Medical Plan permits participants to visit a participating ophthalmologist, physical therapist or OB/GYN without a PCP referral.

Under Alliance Exclusive, you must select a primary care physician (PCP) from a list of network doctors. Whenever you need medical care, you must go to your PCP for treatment or a referral. If you go to another doctor for care without first getting a referral from your PCP, you pay the full cost of any service. There is an exception for emergency care. An emergency is a situation that threatens life or could produce permanent disability if not treated immediately.

Under Alliance Exclusive, you don't have to meet a deductible. The plan immediately begins paying its share of the eligible expense. You pay a $10 copayment for office visits; then the plan pays 100% of eligible expenses. Hospital care is provided at Health Alliance Hospitals and Children's Hospital and is covered at 100%. Benefit limits or day limits may apply to specific services.

Under Alliance Plus, you must select a PCP to provide and coordinate care within the network – this is called "PCP referral." However, you can also go on your own to any doctor to receive care – this is known as "self-referral":

• Alliance Plus PCP referral: When you use your PCP to coordinate your care, you don't have to meet an annual deductible. The plan begins paying its share of covered expenses right away. Under PCP referral, the plan pays 100% of covered hospital expenses at Health Alliance hospitals and Children's Hospital Medical Center; it pays 80% of covered expenses at Mercy Hospitals. It pays 100% of office visits after you pay a $20 copayment. Many additional services are covered on a PCP referral basis that are not covered under self-referral such as routine physicals, home health care and chiropractic services.
• Alliance Plus Self-Referral: You must first meet an annual deductible; then the plan begins paying its share of covered expenses. The plan pays 60% of the network rate of most covered office visits, physician services, and hospital expenses. You are responsible for your 40% coinsurance plus any amount above the network rate.

You and the Health Alliance share the cost of coverage under the Medical Plan; the Health Alliance pays most of the cost.

If you enroll in the Medical Plan, your cost for the level of coverage (single, double, or family) under the option you choose will be deducted on a before-tax basis from every bi-weekly paycheck during the period of coverage. Refer to the cost sheet insert for current bi-weekly premiums.