SECTION VI: HEALTH MAINTENANCE ORGANIZATIONS

In place of the medical benefits provided by the Indemnity Plan, as described above, you may select an HMO. An HMO consists of a network or health care providers who have contracted with Kaiser (“Kaiser”) or PacifiCare of California (“PacifiCare”) to provide medical services to eligible Participants. Each HMO has descriptive literature, which explains the services and benefits provided, as well as the plans’ limitations and exclusions.

The HMO you select (Kaiser or PacifiCare) will provide you with complete descriptive literature after you enroll, including an identification card. The medical facilities you must use are listed in the HMO packet you receive. Importantly, you must use the Physicians and hospitals associated with the HMO you select.

To enroll in an HMO, you must live or work within the HMO’s service area. For Kaiser, your home or principal place of work zip code must be included within Kaiser’s zip code listing. For PacifiCare, you must live or work within a 30-mile radius of the Medical Group selected.

Under the HMO plans, covered services are generally provided for a fixed co-payment.

Not all of these plans are available to all Participants because their service areas may not include the area in which the Participant lives. Participants who wish to elect or discontinue coverage in any of the HMO plans may do so during the plan’s open enrollment period, which will occur during the months preceding the month plan changes are to be implemented. Plan changes are effective from and after August 1st of the year in which the election is made (or after such other enrollment periods that the plan offers).

If you elect an HMO, none of the medical benefits described in this booklet will apply to you with the exception of the supplemental benefits described below in Section VII. Because each HMO has its own appeal procedures, the claims review procedures described in this booklet will also not apply to you for benefit claims. You must refer to the applicable HMO’s individual plan descriptions to determine what benefits are available and, in the event of a full or partial denial, its specific appeal procedures. Further, you should be aware that any claim for malpractice under these plans is generally subject to the arbitration procedures set forth in the contract between the Trustees and the HMO. Further information may be obtained from the Plan Office or directly from the HMO provider.

Supplemental benefits that are available to you regardless of which plan you select include, dental (including orthodontia), vision, mental health and chemical dependency treatment, and death benefits. These are benefits described in Section VII below.

The following HMO options are presently available: