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Chiropractic Benefits...................................................80~ Maximum payment limited to $20.00 per visit, and one visit per week. Calendar year maximum is $1,000. ALL OTHER COVERED CHARGES.................................................. 80% .COST CONTAINMENT BENEFITS (Deduotible Waived) Pre-Admission Testing..................................................100% Outpatient Surgery Facility Charges.....................................................1 00% Surgeon, Asst. Surgeon, and Anesthesiologist Charges Second Opinion NOT Required or Required and Obtained.............100~ Second Opinion Required and NOT Obtained.'........................50% Second Surgical Opinion................................................100% Home Health Care (one visit per day, 100 visits per calendar year)......80% Generic Prescription Drugs.............................................100% OTHER BENEFIT PROVISIONS Maximum Payable for Pre-Existing Conditions............................$500 (limitation waived for individuals covered under the prior plan who were not subject to the prior plan's pre-existing conditions limitations.) Waiver of Co-Payment Percentage After an individual has incurred $500 in eligible out-of-pocket expenses (Maximum per family is $1,500) in a calendar year....................100% This provisions does not apply to covered Medical Charges incurred for treatment of Mental & Emotional Conditions, or Chemical Dependency. The lifetime maximums for Mental & Emotional conditions, Chemical Dependency, and Chiropractic Care are part of and not in addition to the $1,000,000 Lifetime Maximum Benefit Per Person. Weekend Hospital Admissions Non-Emergency Admissions to a hospital between 5:00 p.m. Friday and 7:00 a.m. Monday are Dot covered. EXCEPTION: Participants scheduled for surgery to be performed Monday morning will be covered for Hospital Admission after 1:00 p.m. Sunday. ACCIDENT PROVISION Eligible charges incurred within 90 days following accidental injury are covered 100% to a maximum of $500. After 90 days or the $500 maximum have been reached regular benefits will apply. PREADMISSION CERTIFICATION REQUIRED The utilization review organziation must be notified prior to elective hospital confinements or within two business days following an emergency admission. If all or any part of the confinement is not certified as medically necessary, the first $400 of the hospital charges will not be considered an eligible expense and will not apply to any out of pocket maximums. 3