iv Table of Contents Schedule of Benefits ................................ ................................ ................................ ....... 1 Eligibility Provisions ................................ ................................ ................................ ......... 6 Termination and Continuation of Health Coverage ................................ ........................ 13 Continuation Coverage (Self - Pay) ................................ ................................ ................. 16 Comprehensive Medical Coverage ................................ ................................ ................ 24 Preferred Provider Organization ................................ ................................ .................... 27 PHS+ Precertification Program ................................ ................................ ...................... 29 Case Management ................................ ................................ ................................ ........ 31 Disease Mana gement Program ................................ ................................ ..................... 32 Employee Assistance Program ................................ ................................ ..................... 33 Covered Medical Charges List ................................ ................................ ...................... 34 Areas of Limited Coverage ................................ ................................ ............................ 37 Ex clusions ................................ ................................ ................................ ..................... 54 Prescription Drug Coverage — CVS Caremark ................................ ............................... 57 Coordination of Benefits ................................ ................................ ................................ 63 Third - Party Liability and Right of Recovery ................................ ................................ .... 68 Claims Filing and Appeal Procedures ................................ ................................ ............ 72 Miscellaneous Provisions and Cost Savings Advice ................................ ...................... 87 General Benefit Provisions ................................ ................................ ............................ 96 General Information ................................ ................................ ................................ ....... 97 Glossary ................................ ................................ ................................ ...................... 102 Statement of ERISA Rights ................................ ................................ ......................... 109