Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

MEDICARE AND OTHER GOVERNMENT PLANS

A. MEDICARE

Generally, anyone age 65 or older is eligible for Medicare coverage. Anyone under age 65 who is entitled to Social Security Disability Income Benefits is also eligible for Medicare coverage after a waiting period. If you, your covered Spouse or Dependent Child becomes covered by Medicare, either because of disability or age, you may either retain or cancel your coverage through this Fund.

If you, your Spouse and/or your Dependent Child are covered by this Fund and by Medicare, as long as you remain actively employed, this Fund pays first and Medicare pays second. However, if you become entitled to Medicare because of your disability, you will no longer be considered to have current employment status. As a result, once you become entitled to Medicare because of your disability, Medicare pays first and this Fund pays second. Nevertheless, the Fund continues to pay first if your Spouse and/or Dependent Child is entitled to Medicare because of their disability as long as you maintain current employment status.

If, while you are actively employed, you or any of your covered dependents becomes entitled to Medicare because of end-stage renal disease (ESRD), this Fund pays first and Medicare pays second for a limited period of time.

Medicare imposes a three-month period at the onset of end stage renal disease before Medicare becomes effective. Medicare waives this waiting period if the patient enrolls in a self-dialysis training program within the first three months of the diagnosis of end stage renal disease or receives a kidney transplant within the first three months of being hospitalized for the transplant.

If there is a waiting period, this Fund continues to be the primary payer for the three- month waiting period. Whether or not there is a waiting period, this Fund will remain the primary payer for the 30-month period after Medicare becomes effective. Medicare is the primary payer after the 30-month period.

B. MEDICAID

If you are covered by both this Fund and Medicaid, this Fund pays first and Medicaid pays second.

C. TRICARE

If you are covered by both this Fund and TRICARE, this Fund pays first and TRICARE pays second.

D. MOTOR VEHICLE NO-FAULT COVERAGE REQUIRED BY LAW

If you are covered for medical and/or dental benefits by both this Fund and any motor vehicle no-fault coverage that is required bylaw, the motor vehicle no-fault coverage pays first, and this Fund pays second.

If you are covered for loss of earnings by both this Fund and any motor vehicle no-fault coverage that is required by law, the benefits payable by this Fund on account of disability will be reduced by the benefits available to you for loss of earnings pursuant to the motor vehicle no-fault coverage.

E. OTHER COVERAGE PROVIDED BY STATE OR FEDERAL LAW

If you are covered by both this Fund and any other coverage provided by any other state or federal law, the coverage provided by any other state or federal law pays first and this Fund pays second.

F. WORKERS COMPENSATION

This Fund does not provide benefits if the medical or dental expenses are covered by workers' compensation or occupational disease law.

If your employer contests the application of workers' compensation law for the Illness of Injury for which expenses are incurred, this Fund will pay benefits, subject to its right to recover those payments if and when it is determined that they are covered under a workers' compensation or occupational disease law. However, before such payment will be made, you and/or your covered Dependent must execute a subrogation and reimbursement agreement acceptable to the Fund Administrator or its designee in its sole and absolute discretion.