2013

CMC EMPLOYEE BENEFIT PL ANS

SUMMARY PL AN DESCRIP TION
HANDBOOK
Table of Contents
Introduction.................................. 1
Your CMC Benefits................................................. 1
Core and Optional Benefits.................................... 1
Phone Numbers and Websites............................... 2
Eligibility and Enrollment
Eligibility................................................................. 3
Enrollment.............................................................. 4
Effective Date of Coverage..................................... 6
Contributions ......................................................... 7
Making Changes During the Year........................... 8
Termination of Coverage .......................................11
Plan Benefits and
Claim Information
Medical Benefits .................................................. 13
Medical Preauthorization Requirements............... 26
Prescription Drug Benefits ................................... 28
Medical and Prescription Drug
Limitations and Exclusions................................... 31
Circumstances That May Affect
Medical and Prescription Drug Benefits................ 33
Medical/Prescription Drug Identification Cards..... 35
Medical/Prescription Drug Customer Service....... 36
Medical and Prescription Drug Claims.................. 37
Vision Benefits...................................................... 46
Vision Claims ....................................................... 50
Dental Benefits .................................................... 51
Dental Claims ...................................................... 58
STD Benefits........................................................ 61
Partial Disability ................................................... 62
Other Circumstances Affecting STD Benefits ...... 63
STD Limitations and Exclusions............................ 64
General STD Provisions........................................ 64
STD Claims.......................................................... 64
LTD Benefits......................................................... 67
Partial Disability and
Other Special LTD Benefits .................................. 69
Other Circumstances Affecting LTD Benefits........ 70
LTD Limitations and Exclusions ........................... 72
General LTD Provisions........................................ 72
LTD Conversion.................................................... 72
LTD Claims........................................................... 73
Life Insurance Benefits ........................................ 75
Life Insurance Continuation Coverage.................. 79
General Life Insurance Provisions......................... 79
Life Insurance Claims........................................... 80
AD&D Benefits..................................................... 83
General AD&D Provisions..................................... 86
AD&D Claims....................................................... 86
BTA Benefits ........................................................ 89
BTA Claims........................................................... 92
Health Care FSA Benefits..................................... 94
Health Care FSA Reimbursement (Claims).......... 100
Dental/Vision FSA Benefits................................. 103
Dependent Day Care FSA Benefits......................110
Dependent Day Care FSA
Reimbursement (Claims)......................................115
EAP Benefits ......................................................117
Plan Administration
Administrative Information...................................119
COBRA Continuation Coverage......................... 122
Your Rights Under the Plans............................... 127
Important Notices............................................... 128
Glossary of Terms...................131
 Introduction
Introduction
Your CMC Benefits Core and Optional
The Commercial Metals Company (CMC) benefit Benefits
plans provide access to meaningful benefit choices at The Company provides certain core benefits to you
competitive rates. Because benefits are a key component automatically – you do not need to enroll for coverage.
of our total compensation package, CMC continually CMC pays the full cost of these core benefits.
researches competitive benefit practices to provide All other benefits are optional. To be covered under
a comprehensive benefits program. This enables the optional benefits, you must enroll for coverage and pay
Company to attract and retain the talent that makes CMC contributions.
successful.
Plans Who Pays
This handbook is the Summary Plan Description (SPD)
for the Welfare Benefit Plan for Employees of Commercial Core • Basic Life CMC pays the full
Benefits cost
Metals Company and its component plans in effect on • Basic Accidental Death &
January 1, 2013, unless otherwise stated in this book. Dismemberment (AD&D)
Although the SPD summarizes your coverage under the • Short Term Disability (STD)
plans, the information provided does not cover all terms • Long Term Disability (LTD)
and conditions. In all cases, the applicable insurance • Business Travel Accident
policy, contract, agreement, and/or plan document will (BTA)
govern benefits paid under the component plans. • Employee Assistance
You are encouraged to take the time to read and Program (EAP)
familiarize yourself with the information contained in this Optional • Medical You and CMC
Benefits share the cost
handbook and other benefit materials that are provided • Vision
to you. • Dental
Important Information • Optional Life You pay the full
cost
Keep this handbook in a convenient location in the event • Dependent Life
you need to reference information regarding your benefit • Optional AD&D
plans. You will be provided with updates from time to time • Health Care Flexible
as modifications are made to the plans. Spending Account (FSA)
• Dental/Vision FSA
CMC reserves the right at any time and from time to time • Dependent Day Care
to amend or terminate any of the plans described in this Flexible Spending Account
handbook, with or without prior notice. This handbook is (FSA)
not a contract for, nor a guarantee of, present or continued
employment between you and CMC. Non-company Benefits Who Contributes
• Health Savings Account If you open an account with
(HSA) ACS|BNY Mellon, the company
may contribute to your account
(determined prior to the beginning
of each plan year). You may also
contribute additional funds to your
HSA.

If you’re looking for a brief overview of the CMC benefit

plans, refer to the Employee Benefit Highlights brochure.

1
Introduction

Phone Numbers and Websites

If you have questions or need additional information about your benefit plans, contact the resources shown below:

Plan Contact Information

Insurance Company/
Plan Claim Administrator Phone/Website Claims Address
Medical Blue Cross and Blue 1-877-262-7977 Medical Claims
Shield of Texas www.bcbstx.com Blue Cross and Blue Shield of Texas
Customer Service Helpline Claims Division
Monday - Friday P.O. Box 660044
8 a.m. – 8 p.m. Central Time Dallas, TX 75266-0044
1-877-262-7977 Prescription Drug Claims
Medical Preauthorization Helpline Blue Cross and Blue Shield of Texas
Monday - Friday c/o Prime Therapeutics LLC
7:30 a.m. – 6 p.m. Central Time P.O. Box 64812
1-800-441-9188 St. Paul, MN 55164-0812

Mail Order Prescription Drug Automated Refill

www.myrxhealth.com
1-877-262-7977 (select option #2)
Nurse Helpline
24 hours a day/7 days a week
1-800-581-0368
Mental Health Helpline
24 hours a day/7 days a week
1-800-528-7264
Kaiser Permanente HMO 1-800-464-4000 Kaiser Foundation Health Plan, Inc.
(CA only) www.kaiserpermanente.org Claims Department
P.O. Box 7004
Downey, CA 90242-7004
Although the Eligibility and Enrollment and Plan Administration sections of this handbook apply to
coverage under Kaiser Permanente HMO, information on plan benefits is not included. If you are enrolled
in Kaiser, you will receive information about your plan benefits directly from Kaiser.
Vision Vision Service Plan 1-800-877-7195 VSP
www.vsp.com Out-of-Network Provider Claims
P.O. Box 997105
Sacramento, CA 95899-7105
Dental Delta Dental 1-800-521-2651 Delta Dental Insurance Company
www.deltadentalins.com P.O. Box 1809
Alpharetta, GA 30023-1809
Short Term Disability The Standard 1-877-262-8050 Contact CMC Employee Services
Long Term Disability The Standard 1-877-262-8050 Contact CMC Employee Services
Life, AD&D ING 1-877-262-8050 Contact CMC Employee Services
Business Travel MetLife 1-877-262-8050 Contact CMC Employee Services
Accident
Health Care FSA, WageWorks 1-877-924-3967 WageWorks Claims Administrator
Dental/Vision FSA www.wageworks.com P.O. Box 14053
Dependent Day Care Lexington, KY 40512
FSA Or via facsimile to:
1-877-353-9236
Employee Assistance Horizon 1-866-486-4334 Not applicable
Program www.horizoncarelink.com
User ID - CMC, Password - eap
COBRA Administrator CMC Employee Services 1-877-262-8050 COBRA Premium Payments
PO Box 139031
Dallas, TX 75313-9031
CMC Employee Services | 1-877-262-8050 | employeeservices@cmc.com

Other Contact Information

Health Savings Account ACS|BNY Mellon 1-877-635-5472 ACS|Mellon HSA Solution
(HSA) www.hsamember.com PO Box 4038
Woburn, MA 01888-4038

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Eligibility and Enrollment
Eligibility
Eligible Employees
You are eligible to participate in the plans if:
■■ You are employed by Commercial Metals Company or
another participating company, and
■■ You are a domestic employee who:
• Is regularly scheduled as a full-time employee,
• Is on the Company’s United States payroll, and
• Resides in the United States.
You are not eligible to participate in the plans if you are:
■■ A casual or common law employee who is not
classified as a regular full-time employee.
■■ An individual who has signed an agreement, or has
otherwise agreed, to provide services to the Company
as an independent contractor, regardless of the tax or
other legal consequences of such an arrangement.
■■ A leased employee compensated through a leasing
entity, whether or not you fall within the definition of
leased employee as defined in Section 414(n) of the
Internal Revenue Code (IRC).
■■ Represented by a collective bargaining agent, unless
the agent has an agreement with the Company that
provides for your participation in the plan.
Notwithstanding the above, certain international
employees working in the United States who are on
special assignment for Commercial Metals Company are
eligible for the medical, vision and dental plans that are
described in this booklet.
Eligible Dependents
Certain plans also permit you to cover your eligible
dependents. Eligible dependents are your:
■■ Spouse or common law spouse (if you reside in a state
that recognizes a common law spouse).
■■ For medical, dental, and vision coverage: Your
eligible children under age 26.
■■ For life insurance and AD&D: Your unmarried
dependent children who are under 19 years of age or
your unmarried dependent children who are age 19,
but less than age 25, who attend school on a full-time
basis and depend primarily on you for financial support.
Your unmarried dependent children who are age 26
or over and physically or mentally incapable of self-
support may continue coverage beyond age 26 if
they are medically certified as disabled and remain
unmarried, totally incapacitated, and dependent on you
Eligibility and
Enrollment
for support. Notice of the incapacity must be provided to
the Company within 31 days of the date coverage would
otherwise terminate.
In addition to your natural child, a child also includes a
stepchild, legally adopted child, a child who has been
placed with you in anticipation of adoption, a child for
whom you have legal custody or for whom you are the
legal guardian, or a child of your common law spouse.
Special guidelines apply when covering a common law
spouse or the child of a common law spouse. Generally,
you and your common law spouse must both be age 18
or over, not related by blood in a way that would prevent
you from being married to each other, have a relationship
that would require a divorce to dissolve, and otherwise
meet common law marriage criteria of the state in which
you reside. Contact Employee Services to obtain a
copy of the Common Law Spouse Qualifications and
Guidelines.
With respect to the component benefit programs, the
Plan extends benefits to an employee’s non-custodial
child, as required by any qualified medical child support
order (QMCSO), under ERISA §609(a). The Plan has
procedures for determining whether an order qualifies
as a QMSCO. Participants and beneficiaries can obtain,
without charge, a copy of such procedures from CMC
Employee Services.
Dependents are not eligible if they are on active duty
in the military service of any country or if you are not
enrolled for coverage.
Dependents Who Also Work for CMC
With the exception of life insurance, no one may be
covered under a plan as both an employee and a
dependent. For example, if your spouse is covered as
an employee under basic life insurance, you may cover
your spouse as your dependent under dependent life
insurance. However, if your spouse works for CMC,
either of you, but not both of you, can elect to cover your
eligible dependent children.
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 Enrollment
Enrollment is required only for optional benefits as shown in the following table. If you wish to be covered under any of
the optional benefits, you must enroll by the enrollment deadline as summarized in this section.
Eligibility and
Enrollment

Plans Enrollment
Core Benefits Basic Life If you are eligible, you are automatically enrolled in
Basic Accidental Death & Dismemberment (AD&D) these core benefits
Short Term Disability (STD)
Long Term Disability (LTD)
Business Travel Accident (BTA)
Employee Assistance Program (EAP)
Optional Medical If you wish to participate in any of these optional
Benefits Vision benefits, you must enroll for coverage by
Dental completing an Employee Benefit Enrollment/Change
Optional Life Form
Dependent Life
Optional AD&D
Health Care Flexible Spending Account (FSA)
Dental/Vision Flexible Spending Account (FSA)
Dependent Day Care Flexible Spending Account (FSA)
Additional Health Savings Account (HSA) If you are enrolled in the Consumer Choice Medical
Contributions Plan, you may elect to contribute to funds your HSA
account via payroll deduction.

Certain plans allow you to elect coverage for yourself only or for yourself and your eligible dependents as follows:

Coverage Options
Medical, Dental, and Vision
• Employee only
• Employee plus one dependent
• Employee plus two or more dependents
Optional and Dependent Life Optional AD&D
• Optional life for you • Employee only
• Dependent life for your spouse • Employee plus family
• Dependent life for your children

Preexisting Condition Exclusion

The CMC medical plan administered by Blue Cross and Blue Shield of Texas imposes a preexisting condition exclusion for
individuals age 19 and older. This means that benefits for eligible expenses incurred for treatment of a preexisting condition
may not be available during the first 12 months a participant is covered under the plan.

A preexisting condition is a condition for which medical advice, diagnosis, care, or treatment has been recommended or
received during the three months before the effective date of coverage. Refer to the Medical section of this handbook for
further information.

You may choose different coverage options under each of the plans. For example, you may elect medical coverage for
you and your dependents, but cover just yourself under optional AD&D insurance. However, you may not cover any
dependent under the medical, dental, vision or AD&D insurance plans if you do not also elect coverage for yourself.

4
How to Enroll (New Hire/Status Change)
Benefit Plan Enrollment/Change Forms are available from
Employee Services, or your local Human Resources
office. Once you have completed your form, make a copy
for your records and submit the signed form to Employee
Services by the enrollment deadline.
If your form is not received by the enrollment deadline,
your enrollment will be subject to the information
summarized in Making Changes During the Year.
Enrollment Deadline (Initial Eligibility Period)
You have a certain timeframe during which you can enroll
yourself and your eligible dependents for coverage under
the optional benefits. This period is referred to as your
initial eligibility period. Your initial eligibility period begins
on your first day of employment and ends on the first
day of the month immediately following your 30th day of
employment.
For example, if you are hired on September 1, your initial
eligibility period is September 1 through October 1 and
your Benefit Plan Enrollment/Change Form must be
received by Employee Services no later than October 1.
Initial Optional
Employment EligibilityEnrollment Benefits
Begins Period Begins
Deadline Begin*
1st day of 1st day of 1st of month 1st of month
employment employment after 30 days of after 30 days of
employment employment
September 1 September 1 October 1 October 1
* Coverage may be delayed as summarized in Effective
Date of Coverage Delays.
The initial eligibility period is your only opportunity to enroll
for optional benefits. It is important that you consider
your choices thoroughly and make your benefit elections
carefully. You will not be allowed to change your benefit
elections until the next Open Enrollment period except as
summarized in Making Changes During the Year.
Enrollment Rules for Rehired Employees
Special enrollment rules apply if you terminate
employment and are then rehired. Generally, your benefit
elections in effect on the date of your termination will be
Eligibility and
Enrollment
reinstated if you are rehired:
■■ Within 30 days following your termination date, and
■■ During the same calendar year in which your
termination occurred.
You may not change your previous benefit elections until
the next Open Enrollment period unless during the period
between your termination date and your rehire date:
■■ An Open Enrollment was held. In this event, you would
be able to make new elections. Your previous elections
would be reinstated through the remainder of the
current calendar year and your new elections would
take effect on the following January 1.
■■ You experienced a qualified status change. For
example, if you married, you would be able to add
coverage for your new spouse.
■■ You experienced an event that would make you
eligible for special enrollment. For example, if you had
previously declined CMC medical coverage because
you had other health coverage and that coverage
ended.
Refer to Making Changes During the Year for information
on limitations that apply to Open Enrollment, qualified
status changes, and special enrollments.
If your rehire occurs more than 30 days following your
termination date or in a subsequent calendar year,
your enrollment will be subject to the same enrollment
provisions that apply to enrollment for new hires.
5
 Effective Date of Coverage
The following table shows the dates coverage under the benefit plans begins based on events that provide
opportunities to enroll for coverage or change benefit elections. Coverage may be delayed as summarized in Effective
Date of Coverage Delays.
Eligibility and
Enrollment

Effective Date of Coverage for Selected Events

New Hire Qualified Status Change Open Enrollment
For plans that require
Benefit Plan You must make your elections You must make your elections
enrollment, you must enroll
within 31 days of your during an Open Enrollment
within your initial eligibility
qualified status change period
period
Medical, Vision, Dental First of month following 30 days of First of month following date of January 1 following Open
employment qualified status change Enrollment period
Health Care FSA, Dental/Vision First of month following 30 days of First of month following date of January 1 following Open
FSA Dependent Day Care FSA employment qualified status change Enrollment period
Basic Life, Basic AD&D First of month following 30 days of Not applicable Not applicable
employment
Short Term Disability First of month following 30 days of Not applicable Not applicable
employment
Long Term Disability Salaried employees Not applicable Not applicable
• First of month following 30 days
of employment
Hourly employees
• First of month following one year
of employment
Optional Life, First of month following 30 days of First of month following date of January 1 following Open
Dependent Life employment qualified status change Enrollment period
Optional AD&D First of month following 30 days of First of month following date of January 1 following Open
employment qualified status change Enrollment period
Business Travel Accident First day of employment Not applicable Not applicable
Employee Assistance Program First of month following 30 days of Not applicable Not applicable
employment
Note: If your election requires evidence of insurability, coverage will not become effective until approval is received from the insurance company. Newborn or
newly-adopted children who are enrolled timely will have their coverage effective date coincide with the date of the event.

Effective Date of Coverage Delays
Coverage will not become effective unless you are
otherwise eligible for coverage under the plan. For
example, medical coverage would not be effective on the
date of a qualified status change if the change occurs
before you have completed your initial eligibility period. In
no event will your dependent’s coverage become effective
until you become covered under the applicable plan.
Actively At Work and Confined For Care
Requirements
For all component plans except the Medical Plan, an
effective date of coverage will also be delayed in the
following circumstances:
■■ For you, if you are not actively at work on the day your
coverage would otherwise become effective.
■■ For your dependent, if he/she is confined for care on
the day his/her coverage would otherwise become
effective.
Actively at Being actively at work means that you are performing
Work the essential duties of your regular occupation at
the time and place duties are normally performed,
as assigned by the Company. The actively at work
requirement does not apply if the effective date of
coverage coincides with a scheduled day off, including
a vacation day or a Company-recognized holiday, if
you are actively at work immediately preceding and
immediately following the scheduled day off.
Confined for Except in the case of a newborn child, confined for
Care care refers to a dependent who is:
• An inpatient in a hospital, hospice, rehabilitation
center, convalescence center, or custodial care
facility, or
• Confined at home under the care of a physician.
If you are not actively at work, your effective date of
coverage will be delayed until you return to work for one
full day. If your dependent is confined for care, his/her
effective date of coverage will be delayed until he/she
is released from confinement. However, in no event will
your dependent’s coverage become effective until you
become covered under the applicable plan.

6
These delays also apply to increases in insurance amounts
under the long term disability, life, and accident plans.
Evidence of Insurability
The Life Insurance Plan further restricts effective dates
of coverage for certain insurance amounts based on
evidence of insurability. Refer to the Life Insurance
section of this handbook for further information.
Contributions
Your contributions for optional benefits depend on your
benefit elections and the number of eligible dependents
you enroll. Current contribution information is available
from Employee Services and in the Employee Benefit
Highlights brochure.
Your contributions are withheld from your pay as soon
as administratively practical after your coverage under a
plan becomes effective. This means that deductions from
your pay will occur on your next paycheck following your
effective date of coverage. For example, if your coverage
becomes effective on March 1, your deductions will start
on the first paycheck you receive on or after March 1.
Contribution rates are subject to periodic adjustment
based on, but not limited to, claims experience, reserve
requirements, and expenses charged against the plans.
Pretax Contributions
CMC administers plans in accordance with IRS regulations
that allow you to pay for certain coverage on a pretax
basis. This means that your contributions are deducted
from your pay before federal income taxes and Social
Security taxes are calculated and withheld. If you live in a
state that recognizes the federal tax treatment of pretax
contributions, your state income tax will also be calculated
and withheld after your contributions are deducted.
• If you are paid weekly, contributions will be deducted
from your first four pay checks each month. When there
are five pay periods in a month, contributions will not
be deducted from your fifth pay check.
• If you are paid biweekly, contributions will be deducted
from your first two pay checks each month. When there
are three pay periods in a month, contributions will not
be deducted from your third pay check.
Your contributions are deducted from your pay on a
pretax or after-tax basis as follows:
Pretax Contributions After-Tax Contributions
• Medical • Optional Life
Eligibility and
• Vision • Dependent Life
Enrollment
• Dental • Optional AD&D
• Health Care FSA
• Dental/Vision FSA
• Dependent Day Care FSA
• Health Savings Account (HSA)
The advantage of paying contributions on a pretax basis
is clear – it can result in lower taxes and increase your
spendable income. In exchange for this tax advantage,
the IRS imposes restrictions such as:
■■ Irrevocable Elections (except Health Savings
Account (HSA)) - Your benefit elections under plans that
allow pretax contributions are irrevocable for the entire
calendar year. You cannot change your elections unless
you experience a qualified status change as summarized
in Making Changes During the Year.
The IRS imposes additional restrictions under the Health
Care FSA, Dental/Vision FSA, and Dependent Day
Care FSA plans. For example, any amounts you elect to
contribute to those plans are forfeited if you do not use
those amounts to reimburse yourself for eligible expenses
incurred during the same calendar year. It is important
that you carefully review Health Care FSA and Dependent
Day Care FSA, Dental/Vision FSA, plan information before
you elect to participate in those plans.
Pretax contributions may also affect other benefits for
which you may become eligible as follows:
■■ Effect on Social Security - Pretax contributions
reduce the amount of your earnings that are reported
for Social Security purposes. Therefore, if you earn
less than the Social Security wage base or if pretax
contributions reduce your earnings below the Social
Security wage base, your Social Security withholding
will be reduced. Because Social Security benefits are
based on your career earnings history, this reduced
withholding could decrease any Social Security
benefits you may receive.
■■ Effect on Other Statutory Benefits - Pretax
contributions may affect other statutory benefits (such
as unemployment insurance, workers’ compensation,
and state disability insurance) for the same reasons
that they affect Social Security benefits. Because
statutory benefits are also based on taxable earnings,
benefits for which you may become eligible could be
reduced as a result of pretax contributions.
7
 If you have questions regarding the effect of pretax
contributions, you are encouraged to contact your tax
advisor or the IRS.
Effect of Pretax Contributions
Eligibility and
Enrollment
on Other CMC Benefits
Pretax contributions do not affect any CMC benefits that are
based on pay, such as life and disability insurance. These
benefits continue to be based on your salary before pretax
contributions are deducted.
Making Changes
During the Year
You make your benefit elections (enrolling for coverage,
electing dependent coverage, insurance amounts,
declining coverage, etc.) when you are first eligible to
enroll. Once you make your elections, you may change
them only during Open Enrollment periods unless you
experience a qualified status change or become eligible
for special enrollment.
Certain changes are subject to the Effective Date of
Coverage Delays provision.
Open Enrollment Periods
The Company schedules Open Enrollment periods once
each year (usually in the Fall). During an Open Enrollment
period, you may make the following elections:
■■ Medical, Vision and Dental
• Enroll for coverage.
• Cancel coverage.
• Add or remove qualified dependents.
■■ Life
• Enroll for an optional life insurance amount of one
times annual pay.
• Increase your optional life insurance amount by
one level (i.e., one time annual pay) as long as
the increase does not cause your total amount of
coverage to exceed seven times annual pay.
• Enroll your spouse for a dependent life insurance
amount of $25,000.
• Increase your spouse’s dependent life insurance
amount by one level (i.e., $25,000) as long as
the increase does not cause the total amount of
coverage to exceed $250,000.
• Enroll your child for dependent life insurance.
8
• Increase your child’s dependent life insurance
amount by one level (i.e., $5,000) as long as the
increase does not cause the total amount of
coverage to exceed $20,000.
• Cancel optional and dependent life insurance.
Evidence of insurability is required if you increase
coverage more than one level, or elect coverage more
than 31 days after the date you become eligible for
insurance.
■■ AD&D
• Enroll for optional AD&D insurance.
• Increase or decrease optional AD&D insurance
amounts.
• Cancel optional AD&D insurance.
■■ Health Care FSA, Dental/Vision FSA, and
Dependent Day Care FSA
• Elect to participate in the Health Care FSA, Dental/
Vision FSA, and/or the Dependent Day Care FSA for
the following calendar year.
Participation in flexible spending accounts is not
automatically renewed at year end. If you are currently
participating in the Health Care FSA, Dental/Vsion FSA,
or the Dependent Day Care FSA and you do not elect to
participate during an Open Enrollment period, your current
participation will end on the December 31 following that
Open Enrollment period.
Your Open Enrollment elections become effective on the
January 1 following the Open Enrollment period subject to
the Effective Date of Coverage Delays provision.
Qualified Status Changes
You make your benefit elections (enrolling for coverage,
electing dependent coverage, insurance amounts,
declining coverage, etc.) when you are first eligible to
enroll. Once you make your elections, you may change
them only during Open Enrollment periods unless you
experience a qualified status change or become eligible
for special enrollment.
If you decline enrollment for yourself or your dependents
(including your spouse) because of other health insurance
or group health plan coverage, you may be able to later
enroll yourself and your dependents in a CMC plan if you
or your dependents lose eligibility for that other coverage
(or if the employer stops contributing toward your or your
dependents’ other coverage).
If you have a new dependent due to marriage, birth,
adoption, or placement for adoption, you may be able to
enroll yourself and your dependents. You must request
this new enrollment within 31 days of the marriage, birth,
adoption, or placement for adoption.
Your status change must result in becoming newly
eligible or losing eligibility for coverage under a plan by
you or your dependents. In addition, your new benefit
elections must correspond to and be consistent with the
change. For example, if you terminate coverage under
a CMC plan because you become eligible for coverage
under another plan, you must actually become covered
under the other plan.
Benefit election changes are allowed for the following
qualified status changes.
Qualified Status Changes
Status Change
A change in legal marital status including marriage, divorce, death of
spouse, or annulment.
A change in number of dependents including birth, adoption,
placement for adoption, or death of your dependent.
A change in employment status including termination or
commencement of employment, strike or lockout, commencement
or return from an unpaid leave of absence, change in worksite, or
any other change in employment status that affects an individual’s
eligibility for coverage such as a change between full-time and part-
time status.
Your dependent satisfies or ceases to satisfy the requirements for
dependent children (attainment of age limitation).
A judgment, decree or order is issued as the result of divorce,
annulment, or change in legal custody (including a qualified medical
child support order).
Entitlement to Medicare or Medicaid.
A significant change in the health coverage or cost that is
attributable to your spouse’s employment.
Your spouse’s employer offers a new health plan.
Your spouse’s employer implements Open Enrollment changes at a
different time than CMC and makes a change to employer-provided
coverage.
Additional Qualified Status Changes
for Dependent Day Care FSA Only
Status Change
Your dependent no longer meets eligibility requirements for care
covered under the Dependent Day Care FSA.
A significant change in your dependent care provider.
A significant change in the hours or services of your dependent care
provider.
A significant change in the cost of your dependent care provider’s
services (except services provided by a relative).
You must provide information and documentation that
is necessary to verify your qualified status change as
required by the Company. Examples of documentation
that may be required are:
■■ A birth, marriage or death certificate.
Eligibility and
Enrollment
■■ Declaration of informal marriage or current joint tax
return satisfactory to the Company that verifies your
eligibility for your common law spouse.
■■ Written certification regarding changes made under
another employer’s plan (e.g., a certificate of coverage).
■■ Verification of an eligible dependent’s change in
employment status.
■■ Court orders for adoption, legal guardianship, or
divorce.
■■ Written confirmation of a significant change in a
dependent care provider’s services or charges.
Life Insurance Change Limitations
If your qualified status change allows you to change life
insurance amounts, those changes will be subject to the
following limitations:
■■ Without Evidence of Insurability If your qualified
status change allows you to enroll yourself or a
dependent who was previously eligible for coverage,
the enrollment is limited to the first level of coverage
(i.e., one times pay for you, $25,000 for your spouse,
and $5,000 for your child).
■■ With Evidence of Insurability If your qualified status
change allows you to increase insurance amounts, you
may increase those amounts by any level greater than
one, subject to plan maximums.
■■ If your qualified status change allows you to enroll
a newly eligible dependent, evidence of insurability
requirements apply to insurance amounts in excess of
$25,000 for a spouse.
In addition, insurance increases elected due to a qualified
status change may require evidence of insurability if you
have previously been denied coverage.
Qualified Status Change Procedure
You may change your coverage by submitting a Benefit
Plan Enrollment/Change Form (along with supporting
documentation) to Employee Services. If you submit your
form and any required documentation within 31 days (or
60 days, see Special Enrollment for Assistance-Eligible
Individuals) of the qualified status change, your election
changes will generally be effective on the first day of the
month following the date of the change. However:
9
 ■■ For optional and dependent life insurance enrollments
that require evidence of insurability, the effective date
will be the date the insurance company approves the
evidence of insurability.
■■ In the event of loss of eligibility for coverage (e.g.,
Eligibility and
Enrollment
divorce or age limitation), coverage will end as indicated
in Termination of Coverage. No credit or refund
of contributions will be made in the event that
coverage terminates prior to the end of a calendar
month. Further restrictions are summarized in the box
below.
If your form or supporting documentation is not
received within 31 days of the date the status change
occurs, you must wait until the next Open Enrollment
period before making any changes to your elections.
Promptly Report a Dependent’s Loss of Eligibility
No credit or refund of contributions will be made in the
event of failure to notify the Company of a dependent’s
loss of eligibility. It is important that you always notify
Employee Services office promptly when a dependent
no longer meets eligibility requirements (e.g., due to
divorce). Failure to do so may result in your payment of
contributions for a dependent that is not covered, as
the dependent’s coverage will be cancelled retroactive
to the date he/she was no longer eligible. In addition, if
any benefit payments are made for or on behalf of that
dependent after he/she is no longer eligible, you will be
responsible for reimbursement.
Special Enrollment for Medical, Vision,
and Dental Coverage
You may be eligible for special enrollment under the
medical, vision, and dental plans if you experience one of
the following events:
■■ Termination of Other Health Coverage
If you declined medical, vision, and/or dental coverage
for you or your dependents because you had other
health coverage, you may enroll yourself and your
eligible dependents if the other coverage terminates for
one of the following reasons:
• The other coverage was COBRA and your COBRA
period has now ended.
• The other coverage was not COBRA and either
the coverage terminated due to loss of eligibility
or employer contributions toward that coverage
terminated. Loss of eligibility may include divorce,
death, termination of employment, reduction in the
number of hours of employment.
10
This special enrollment provision does not apply
if the other coverage was terminated for cause
(including failure to timely pay required premiums).
■■ New Dependent
If you acquire a new dependent due to marriage, birth,
adoption or placement for adoption, you may enroll
yourself and certain dependents as follows:
• If the new dependent is a spouse who is newly
eligible because of marriage, you may enroll yourself
and your spouse.
• If the new dependent is a child who is newly eligible
because of birth, adoption, placement for adoption,
or marriage you may enroll yourself, your spouse,
and new child(ren). For example: If you and your
spouse previously declined coverage, you may
enroll yourself, your spouse, and your newborn
child immediately following the birth of the child.
(You normally may not enroll other children at this
time unless another qualifying event makes them
eligible for coverage, such as gaining legal custody
of another eligible child. Contact Employee Services
for information.)
Special Enrollment Procedure
You must enroll for coverage within 31 days of the special
enrollment event by submitting a Benefit Plan Enrollment/
Change Form (along with supporting documentation) to
Employee Services.
If your form is not received within 31 days of the
special enrollment event, you may not enroll until the
next Open Enrollment period.
Special Enrollment for Assistance-
Eligible Individuals
If you are eligible for CMC health coverage, but are unable
to afford the premiums, some States have premium
assistance programs that can help pay for coverage.
These States use funds from their Medicaid or CHIP
programs to help people who are eligible for employer-
sponsored health coverage, but need assistance in
paying their health premiums.
If you or your dependents are already enrolled in Medicaid
or CHIP, you can contact your State Medicaid or CHIP
office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled
in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these
programs, you can contact your State Medicaid or
CHIP office, call 1-877-KIDS NOW, or go online to
If coverage terminates during your leave of absence, you
may be able to continue certain coverage through COBRA
or conversion and portability provisions as permitted
under the plans.

www.insurekidsnow.gov to find out how to apply. If
you qualify, you can ask the State if it has a program
that might help you pay the premiums for an employer-
sponsored plan.
Once it is determined that you or your dependents
are eligible for premium assistance under Medicaid or
CHIP, our health plan is required to permit you and your
dependents to enroll in the plan – as long as you and your
dependents are eligible, but not already enrolled in this
plan. This is called a “special enrollment” opportunity, and
you must request coverage within 60 days of being
determined eligible for premium assistance.
Termination of
Eligibility and
Enrollment
If coverage terminates during your leave of absence,
special enrollment rules apply when you return to work.
Generally, your benefit elections in effect on the day your
coverage terminated will be reinstated if you return to work:
■■ Within 30 days following the date your leave of absence
began, and
■■ During the same calendar year in which your leave of
absence began.
You may not change your previous benefit elections until
the next Open Enrollment period unless during your leave
of absence:
■■ An Open Enrollment was held. In this event, you would
be able to make new elections. Your previous elections

Coverage
would be reinstated through the remainder of the
current calendar year and your new elections would
Coverage During Leaves of Absence take effect on the following January 1.
You may be eligible to continue coverage under certain ■■ You experienced a qualified status change. For
health and welfare plans during a leave of absence example, if you married, you would be able to add
by paying any required contributions as shown in the coverage for your new spouse.
■■ You experienced an event that would make you eligible
following table.
for special enrollment. For example, if you had previously
Plans Continuation of Coverage
During Leave of Absence declined CMC medical coverage because you had other
health coverage and that coverage ended.
Medical Coverage may be continued for
Vision up to six months. Refer to Making Changes During the Year for information
Dental on limitations that apply to Open Enrollment, qualified
Life status changes, and special enrollments.
AD&D
Health Care FSA If you return to work more than 30 days following the date
Dental/Vision FSA your leave of absence began or in a subsequent calendar
Dependent Day Care FSA
Employee Assistance Program year, you will be required to make new enrollment
elections when you return to work.
Short Term Disability If you are on approved Leave
Long Term Disability of Absence, coverage may be If you need to take a leave of absence, contact Employee
Business Travel Accident continued for up to six months. Services for current information regarding continuing
coverage during your leave and reinstatement of
Coverage for a dependent will terminate on the date your
coverage when you return to work.
coverage terminates.

11
 Voluntary Cancellation of Coverage
You may cancel coverage only during an Open Enrollment
period unless you experience a qualified status change,
as summarized in Qualified Status Changes. If you
elect cancellation within 31-days following the date of a
Eligibility and
Enrollment
■■ The last day of the month in which your employment
ends for any reason including a strike, work slowdown,
or lockout. (Exceptions apply for certain leaves of
absence as summarized in Coverage During Leaves of
Absence.) Please see the Short and Long Term Disability

qualified status change, the effective date of cancellation plan certificates for specific information regarding when
will be as summarized in that provision. Otherwise, coverage ends.
the effective date of cancellation will be the January 1 ■■ The end of the last month for which you make any
immediately following the Open Enrollment period during required contribution for coverage.
■■ The date coverage for your employee group or class is
which you elect to cancel your coverage.
discontinued.
■■ The date the plan or the insurance policy terminates.
Certain benefits are provided by the Company at no cost
to you and you may not voluntarily cancel coverage.
These benefits are short term disability, long term Coverage for a dependent will terminate immediately on
disability, basic life insurance, basic accidental death & the earliest of:
dismemberment insurance, and business travel accident ■■ The date your coverage terminates.
■■ The end of the last month for which you make any
insurance.
required contribution for coverage.
Termination of Coverage ■■ The date the plan no longer provides dependent
The following table shows the dates your coverage coverage.
terminates under the plans:
Plans When Coverage Terminates No credit or refund of contributions will be made in the
Medical Last day of the month in which you are event that coverage terminates prior to the end of a
Vision no longer employed by CMC calendar month or for failing to notify the Company of a
Dental dependent’s loss of eligibility.
Employee Assistance Program
Life Last day you are actively employed The Consolidated Omnibus Budget Reconciliation Act
AD&D by CMC
(COBRA) allows you and your enrolled dependents
Short Term Disability
Long Term Disability the opportunity to continue Medical, Vision, Dental,
Business Travel Accident Health Care Fsa, and Dental/Vision FSA coverage
Health Care FSA when certain events occur that would otherwise cause
Dental/Vision FSA you or your dependents to lose coverage. COBRA
Dependent Day Care FSA
continuation coverage information is provided in the Plan
Your coverage under the plans will also terminate Administration section of this handbook.
immediately on the earliest of:
Portability and/or conversion to an individual policy may
■■ The date you no longer meet plan eligibility also be available for certain life insurance amounts as
requirements. summarized in the Life Insurance section of this handbook.

12
Plan Benefits and
Claim Information
Introduction You can participate in the HSA if you enroll in the
CMC medical coverage is designed to help protect you Consumer Choice Plan. However, you are not eligible to
and your covered dependents against financial loss contribute to an HSA if:
by paying for a substantial portion of eligible expenses ■■ You are enrolled in Medicare (Part A, Part B or Part D).
■■ You are covered by another medical plan (such as your
incurred for medically necessary care and treatment.
spouse’s) that is not a high-deductible health plan.
■■ You or your spouse participates in a health care flexible
The medical plan summarized in this section of the handbook
is administered by Blue Cross and Blue Shield of Texas
spending account. You can participate in either a Health
(claim administrator). When you need assistance or have
Care FSA or an HSA – but not both. (However, you can
specific questions regarding this plan, contact the claim
enroll in an HSA and the CMC Dental/Vision FSA.)
administrator at 1-877-262-7977 or www.bcbstx.com.

Information about benefits under the Kaiser Permanente

HMO plan is not included in this handbook. If you are Medical Benefits
enrolled in Kaiser, you will receive information about your

Medical
plan benefits directly from Kaiser. Deductible
The deductible is the amount you must pay each
Refer to the glossary at the end of this handbook for calendar year for eligible expenses you incur before plan
definitions of key terms. benefits become available. The deductible amounts
that apply to you and your covered dependents depend
Medical Plan Options on whether you are enrolled for Premium or Consumer
When you enroll for coverage, you may choose Choice coverage and whether you use network or non-
among the following options for you and your eligible network providers as follows.
dependents:
■■ Premium Plan
Premium Plan:
Annual Deductible
■■ Consumer Choice Plan Premium Plan
■■ No medical coverage Network Non-Network
Your elections remain in effect for the entire calendar Individual $500 $1,000
Employee + 1 dependent $1,000 $2,000
year. You generally cannot make changes until the next
Employee + 2 or more dependents $1,500 $3,000
Open Enrollment period unless you experience a qualified
status change or become eligible for special enrollment, Consumer Choice Plan:
as summarized in the Eligibility and Enrollment section of Annual Deductible
this handbook. Consumer Choice Plan
Health Savings Account (HSA) Network Non-Network
Individual $2,500 $5,000
The Consumer Choice Plan is a High Deductible Health
Employee + 1 dependent $5,000 $10,000
Plan (HDHP).
Employee + 2 or more dependents $7,500 $15,000
If you participate in the Consumer Choice Medical Plan, Unless otherwise indicated, the deductible must be
you can also contribute to a Health Savings Account satisfied before benefits become payable under the plan.
(HSA). With an HSA, you can pay for eligible out-of- Amounts applied to the non-network deductible are also
pocket medical expenses with tax-free dollars up to limits applied to the network deductible. However, amounts
established by the IRS. Your account balance can carry applied to the network deductible are not applied to the
over year to year, and you can take your account with you non-network deductible.
if you leave CMC.
If you have dependents who are covered under the plan,
Please note: You are responsible for setting up, charges that are applied to the individual deductible are
maintaining, and keeping accurate records for your HSA. also applied to the family deductible. When the family
CMC does not administer (or have access to information deductible amount is reached, no further individual
about) your account. However, Mellon Bank has online deductibles will have to be satisfied for the remainder
resources to assist you with setting up your account. of that calendar year. However, no participant may
For more details on using an HSA, please see the HSA contribute more than his/her individual deductible amount
materials provided by Mellon Bank or your preferred bank to the family deductible amount.
or credit union.

13
 Expenses That Do Not Apply to the Deductible
The following expenses do not apply to the deductible:
■■ Copay and coinsurance amounts.
■■ Amounts paid for charges in excess of the allowable
amount.
■■ Expenses for services or supplies that are not covered
under the plan.
■■ Additional charges you incur for failure to obtain
preauthorization as required under the plan.
■■ Premium plan only - copay or coinsurance amounts you
pay for prescriptions.

Medical Schedule of Benefits

The plan provides benefits for four categories of eligible
Medical

expenses:
■■ Inpatient hospital expenses
■■ Medical-surgical expenses
■■ Extended care expenses
■■ Other covered expenses

14
Plan Comparison
The following table provides a summary of the medical benefits under the plan. (Outpatient prescription drug
benefits are provided in the Prescription Drug Schedule of Benefits.) The benefits that apply to you and your covered
dependents depend on whether you are enrolled for Premium or Consumer Choice coverage and whether you use
network or non-network providers as shown in the table. All benefits are subject to plan limitations and exclusions.
Medical Schedule of Benefits
Premium Plan Consumer Choice Plan
Network Non-Network Network Non-Network
Annual Deductible
• Individual $500 $1,000 $2,500 $5,000
• Employee + 1 $1,000 $2,000 $5,000 $10,000
• Employee + 2 or more $1,500 $3,000 $7,500 $15,000
Annual Out-of-Pocket Maximum (including
deductible)
• Individual $2,000 $4,000 $10,000

Medical
• Employee + 1 $4,000 $8,000 Not Applicable $20,000
• Employee + 2 or more $6,000 $12,000 $30,000
CMC HSA Contribution If HSA set up with Mellon:
Individual: $500
N/A
Employee + 1 /
Employee + 2 or more: $1,000
You pay You pay
Inpatient Hospital Expenses
Usual hospital services and supplies including 20% after deductible 40% after deductible $0 after deductible 40% after deductible
semiprivate room, intensive care, and coronary (50% penalty for (50% penalty for
care units failure to preauthorize failure to preauthorize
services) services)
Medical-Surgical Expenses
• Inpatient visits
• Certain diagnostic procedures (e.g., cardiac
stress tests and CT scans)
• Office visit/consultation including
lab & x-rays
• Home infusion therapy
20% after deductible 40% after deductible $0 after deductible 40% after deductible
• Physician surgical services in any setting
• Independent lab & x-ray
• Allergy injections
• Durable medical equipment
• Other eligible medical-surgical expenses not
included in this schedule
TMJ appliances 20% after deductible $0 after deductible
Travel/lodging/meals in connection with a
covered organ or tissue transplant (subject to No charge No charge after deductible
lifetime maximum of $10,000)
Extended Care Expenses
• Skilled nursing facility (limited to 100 visits
per calendar year)
• Home health care (limited to 100 visits per 20% after deductible 40% after deductible $0 after deductible 40% after deductible
calendar year)
• Hospice care
Please note: There are important differences in the accrual of deductible and out-of-pocket expenses between the Premium and Consumer
Choice Plans. These differences are detailed in the Deductible and Out-of-Pocket Maximum sections of this handbook.

15
 Medical Schedule of Benefits , continued
Premium Plan Consumer Choice Plan
Network Non-Network Network Non-Network
You pay You pay
Other Covered Expenses
Emergency Care – accidental injury &
emergency care within first 48 hours
Facility charges
• Emergency Room (ER), treatment room, 20% after deductible and $250 copay (copay $0 after deductible
ancillary waived if admitted)
• Lab & x-ray without ER/treatment room 20% after deductible $0 after deductible
Physician charges 20% after deductible $0 after deductible
Emergency Care – accidental injury &
emergency care after first 48 hours
Facility charges
• ER/treatment room, ancillary 20% after deductible 40% after deductible $0 after deductible 40% after deductible
Medical

and $250 copay and $250 copay

(copay waived if (copay waived if
admitted) admitted)
• Lab & x-ray without ER/treatment room 20% after deductible 40% after deductible $0 after deductible 40% after deductible
Physician charges 20% after deductible 40% after deductible $0 after deductible 40% after deductible
Ground & Air Ambulance Services 20% after deductible $0 after deductible
Speech & Hearing Services
20% after deductible 40% after deductible $0 after deductible 40% after deductible
(excluding hearing aids)
Preventive Care
• Office Setting Routine physical No charge Not covered No charge Not covered
examinations, well baby care,
immunizations, routine lab & x-ray, vision
and hearing exams, and chromosome
testing
• Outpatient Setting Lab & x-ray including No charge Not covered No charge Not covered
independent lab & x-ray
Chiropractic Services (limited to 24 visits per
20% after deductible 40% after deductible $0 after deductible 40% after deductible
calendar year)
Physical Medicine Services (including physical
20% after deductible 40% after deductible $0 after deductible 40% after deductible
& occupational therapy)
Mental Health & Substance Abuse
• Inpatient Care 20% after deductible 40% after deductible $0 after deductible 40% after deductible
• Outpatient Care

Allowable Amount As defined in the glossary at the end of this handbook,

The allowable amount is the maximum charge for a
particular service or supply that will be considered
for purposes of benefit payments under the plan. For
example, if you have met your deductible and the Medical
Schedule of Benefits indicates that your coinsurance
amount for a covered service is 20%, the plan will pay
80% of the allowable amount for that service. If for any
reason the charge for that service is in excess of the
allowable amount, you may be responsible for paying the
excess amount.
the claim administrator has established allowable
amounts for medically necessary services and supplies
for network providers and non-network providers.
Network providers agree to accept the allowable amount
for services and supplies provided. When you choose to
receive services or supplies from a non-network provider,
you will be responsible for paying any difference between
the plan’s allowable amount and the amount charged by
the non-network provider.
Whether you visit a network or non-network provider, you
are responsible for paying your deductible, applicable
copay/coinsurance amounts, and any charges for
services and supplies that are limited or not covered
under the plan.

16
Copay and Coinsurance Amounts
As shown in the Medical Schedule of Benefits, you are required to pay a copay and/or coinsurance amount for most
services and supplies.
■■ Copay – the flat dollar amount you are required to pay at the time you receive certain services and supplies. For example,
if you have the Premium Plan, you may pay a $100 copay toward your emergency care services.
■■ Coinsurance amount – the percentage of covered expenses you are required to pay for certain services and supplies.
For example, if you have the Premium Plan, you pay 20% of the eligible expenses for network chiropractic services.

Deductible and Copay/Coinsurance Example

If you are enrolled in the Premium Plan and your first medical expense for the year is for medically necessary outpatient
surgery, you would be responsible for paying your deductible and coinsurance amounts as follows:

Non-Network
Network Billed Charges/
Allowable Amount Allowable Amount Comments

Medical
Outpatient surgery expenses $1,250 $2,000 billed charges Network discounts usually result in an allowable
$1,250 allowable amount amount that is lower than billed charges
You pay your annual deductible $500 $1,000 You must satisfy your deductible before plan
benefits apply
Remaining eligible expenses $750 $250 Outpatient surgery charge minus deductible
You pay your coinsurance $150 (20%) $100 (40%) You pay coinsurance amounts after your deductible
amount has been met
Your cost for eligible expenses $650 $1,100 Deductible plus coinsurance
Additional cost Not applicable $800 Non-network billed charges in excess of the
allowable amount
Your total cost $650 $1,900 In this example, you save $1,250 by using a network
provider
Plan pays $600 $100 The plan pays the remaining covered expenses

Out-of-Pocket Maximum
The out-of-pocket maximum feature of the plan helps to protect you against catastrophic medical expenses. When
you reach your annual out-of-pocket maximum, the plan pays 100% of most eligible expenses for the remainder of the
calendar year.

The out-of-pocket maximum that applies to you and your covered dependents depends on whether you are enrolled for
Premium or Consumer Choice coverage and whether you use network or non-network providers as follows.

Premium Plan
Annual Out-of-Pocket Maximum (including Deductible)
Premium Plan
Network Non-Network
Individual $2,000 $4,000
Employee + 1 dependent $4,000 $8,000
Employee + 2 or more dependents $6,000 $12,000
Consumer Choice Plan
Annual Out-of-Pocket Maximum (including Deductible)
Consumer Choice Plan
Network Non-Network
Individual $2,500 $10,000
Employee + 1 dependent $5,000 $20,000
Employee + 2 or more dependents $7,500 $30,000

17
 Most of the amounts you pay toward eligible expenses are applied to the annual out-of-pocket maximum. However,
amounts you pay for the following are not included:
■■ Services, supplies, or charges limited or excluded under the plan.
■■ Expenses not covered because a benefit maximum has been reached.
■■ Outpatient prescription drug expenses (Premium Plan only)
■■ Any eligible expenses paid by a primary plan when this plan is secondary, as summarized in the Coordination of
Benefits provision.
■■ Penalties applied for failure to obtain preauthorization, as summarized in the Medical Preauthorization Requirements
provision.

If you have dependents who are covered under the plan, charges that are applied to the individual out-of-pocket
amount are also applied to the family out-of-pocket amount. When the family out-of-pocket maximum is reached, no
further individual out-of-pocket amounts will have to be satisfied for the remainder of that calendar year. However, no
participant may contribute more than his/her individual out-of-pocket amount toward the family out-of-pocket amount.
Medical

When the out-of-pocket maximum is satisfied, benefit percentages automatically increase to 100% for eligible expenses
except (in the Premium Plan only):
■■ Copay amounts for facility charges for network or non-network outpatient hospital emergency room visits, as well as
prescription drug copays or coinsurance, continue to be required.
■■ Any copay amounts paid for medical services or supplies or for drugs obtained from the mail service pharmacy or
the specialty drug pharmacy under the plan’s prescription drug benefits.

Amounts applied to non-network out-of-pocket maximums are also applied to network out-of-pocket maximums.
However, amounts applied to network out-of-pocket maximums are not applied to non-network out-of-pocket maximums.

Meeting the Family Out-of-Pocket Maximum

In both the Premium Plan and the Consumer Choice Plan, eligible expenses incurred by any two or more covered family
members are combined to meet the family out-of-pocket maximum. Only the amounts that are applied to the individual
out-of-pocket maximum are applied to the family maximum. In other words, the amounts that may be counted from any
one family member cannot exceed his/her individual out-of-pocket maximum.

Premium Plan Example:

■■ Mary’s family is enrolled in the Premium Plan and receives all of their care from network providers. Therefore, they
have an annual out-of-pocket maximum (including deductible) of $2,000 per individual and $6,000 per family.
■■ Mary’s family members - Mary, Steve, Cindy, and Jim - have met their deductible and have incurred network out-of-
pocket expenses that total $6,550.

The following table shows how the individual out-of-pocket amounts are applied to meet the family out-of-pocket
maximum in the Premium Plan.
Family Out-of-Pocket Maximum (OOPM) – Premium Plan Example
Family Eligible Network
Amount Applied to Family OOPM
Member Out-of-Pocket Amounts
Feb April May OOPM
Mary $2,000 $2,000 The full amount applies to the family OOPM.
Steve $2,200 $2,000 Steve has $2,200 of eligible out-of-pocket expenses; however, only $2,000
will be applied toward the family OOPM because the most that can be
applied from any one family member is limited to the individual OOPM
amount.
Cindy $1,200 $1,200 The full amount applies to the family OOPM.
Jim $1,800 $800 Jim has $1,800 of eligible out-of-pocket expenses; however, only $800
needs to be applied for this family to reach their OOPM.
Total applied to family OOPM = $6,000 Family OOPM has been reached

18
Since the family out-of-pocket maximum has been reached, the Premium Plan will pay 100% of the $1,000 in eligible
expenses incurred by Jim ($1,800 minus the $800 applied to the family out-of-pocket maximum). In addition, if any
other covered family member incurs network eligible expenses later in the year, the plan will also pay 100% of many of
those expenses until the end of that calendar year.

Consumer Choice Plan Example:

■■ John’s family is enrolled in the Consumer Choice plan and receives all of their care from network providers.
Therefore, when they reach their $7,500 family deductible they have also satisfied the annual network out-of-pocket
maximum.
■■ John’s family members - John, Sandra, Robert, and Patricia - have incurred network out-of-pocket expenses that
total $25,000.

The following table shows how the individual out-of-pocket amounts are applied to meet the family network out-of-
pocket maximum.

Family Out-of-Pocket Maximum (OOPM) – Consumer Choice Plan Example

Medical
Family Eligible Network
Amount Applied to Family OOPM
Member Out-of-Pocket Amounts
March June August OOPM
Sandra $2,500 $2,500 The full amount applies to the family OOPM.
Robert $2,000 $2,000 The full amount applies to the family OOPM.
Patricia $5,000 $2,500 Patricia has $5,000 of eligible out-of-pocket expenses; however, only
$2,500 will be applied toward the family OOPM because the most that can
be applied from any one family member is limited to the individual OOPM
amount.
John $15,500 $500 John has $15,500 of eligible out-of-pocket expenses; however, only $500
needs to be applied for this family to reach their OOPM.
Total applied to family OOPM = $7,500 Family OOPM has been reached
Since the family out-of-pocket maximum has been reached, the Consumer Choice Plan will pay 100% of the $15,000 in
eligible network expenses incurred by John ($15,500 minus the $500 applied to the family out-of-pocket maximum). In
addition, if any other covered family member incurs network eligible expenses later in the year, the plan will pay 100% of
those expenses until the end of that calendar year.

Benefit Maximums
The plan will not pay benefits in excess of any of the benefit maximums under the plan.

Network and Non-Network Providers

Each time you need medical care, you can choose to visit a network or non-network provider.

Network Providers Non-Network Providers

A strictly defined network of providers for this plan
In Texas – Blue Choice Providers that do not participate in the network
Other States – Blue Card
• You receive the higher level of benefits (network benefits). • You receive the lower level of benefits (non-network benefits).
• You are not required to file claim forms. • You are required to file your own claim forms.
• You will not be billed for charges exceeding the plan’s allowable • You may be billed for charges exceeding the plan’s allowable
amount for covered services. amount for covered services.
• Your provider completes any required preauthorization process. • You must complete any required preauthorization process
Using Network Providers
To receive network benefits, you must use network providers (except in the event of emergency). The network has been
established by the claim administrator and consists of physicians, specialty care providers, hospitals, and other health
care facilities to provide services to plan participants.

To find providers in your area, call the Customer Service Helpline or visit www.bcbstx.com. Since network providers
change occasionally, it is important to confirm that the providers you select are still network providers at the time you
receive services. Call the Customer Service Helpline or access the website at any time for the most current listing of
network providers.

19
 The network includes a wide range of specialty care
providers and network benefits are generally available
only if you use a specialist within the network. However,
there may be occasions when you need the services of a
non-network provider. In this event, network benefits may
be authorized for services provided by a non-network
provider. Contact the claim administrator for further
information.
If you choose a network provider, the provider will bill the
claim administrator – not you – for services provided. You
do not need to submit a claim form.
Network providers have agreed to accept as payment in
full the lesser of the following:
■■ The billed charges.
Medical
■■ The allowable amount established under the plan.
■■ Other contractually determined payment amounts.
You are responsible for paying your deductible and
copay/coinsurance amounts. You are also required to pay
for limited or non-covered services and supplies.
Centers of Excellence
The claim administrator, in partnership with the Blue
Cross and Blue Shield Association, has developed Blue
Distinction Centers. Each center has been selected
through a rigorous evaluation of clinical data that provides
insight into the facility’s structures, processes, specialty
care capabilities, and outcomes of care. Currently, three
Blue Distinction Center programs are offered:
■■ Blue Distinction Centers for Cardiac Care SM
■■ Blue Distinction Centers for Transplants SM
■■ Blue Distinction Centers for Bariatric Surgery SM
More information is available at
www.bcbs.com/innovations/bluedistinction/centers.
Using Non-Network Providers
If you choose a provider who does not participate in the
plan’s network, non-network benefits will be available for
the services and supplies provided and you will need to
submit claim forms.
You will receive non-network benefits and be responsible
for paying:
■■ Your deductible and copay/coinsurance amounts.
■■ Charges in excess of the plan’s allowable amount.
■■ Failure to preauthorize penalties.
■■ Charges for limited or non-covered services and
supplies.
20
Participant/Provider Relationship
The choice of health care providers is made solely by you
and your covered dependents. The claim administrator
does not furnish services or supplies; rather, it makes
payment for eligible service and supply expenses you incur.
The claim administrator is not liable for any act or
omission by any provider and is not responsible for a
provider’s failure or refusal to provide services or supplies
to you or your dependents. The care and treatment you
receive are subject to the rules and regulations of the
provider you select.
The claim administrator, network providers, and/or other
providers who contract with the claim administrator
are independent contractors with respect to each other.
The claim administrator does not control, influence, or
participate in health care treatment decisions made by
providers. The claim administrator does not furnish medical,
surgical, hospitalization, or similar services or supplies,
or practice medicine or treat patients. The providers, their
employees, their agents, and/or their representatives do
not act on behalf of the claim administrator nor are they
employees of the claim administrator.
Eligible Expenses
The plan provides coverage for four categories of eligible
expenses:
■■ Inpatient hospital expenses
■■ Medical-surgical expenses
■■ Extended care expenses
■■ Other covered expenses
Certain expenses are subject to preauthorization and
all benefits are subject to the deductibles, copays,
coinsurance amounts, limitations, and exclusions under
the plan.
To be eligible, an expense must be incurred for a
medically necessary service or supply that is prescribed
by a physician or other provider recognized under the
plan. To be considered medically necessary, the service
or supply must be:
■■ Essential to, consistent with, and provided for
the diagnosis or the direct care and treatment of
the condition, sickness, disease, injury, or bodily
malfunction,
■■ Provided in accordance with and consistent with
generally accepted standards of medical practice in the
United States,
■■ Not primarily for the convenience of the participant, his/
her physician, the hospital, or other provider, and
■■ The most economical supplies or levels of service that
are appropriate for the safe and effective treatment
of the participant. When applied to hospitalization,
this further means that the participant requires acute
care as a bed patient due to the nature of the services
provided for the participant’s condition, and the
participant cannot receive safe or adequate care as an
outpatient.
The claim administrator’s medical staff determines
whether a service or supply is medically necessary and
considers the views of the state and national medical
communities, the guidelines and practices of Medicare,
Medicaid, or other government-financed programs, and
peer reviewed literature. Although a physician or other
professional provider may have prescribed treatment, the
treatment may not be considered medically necessary
under the plan.
Inpatient Hospital Expenses
The plan provides coverage for inpatient hospital
expenses. Each inpatient hospital admission requires
preauthorization as summarized in the Medical
Preauthorization Requirements provision.
Medical-Surgical Expenses
The plan provides coverage for medical-surgical
expenses. Some services require preauthorization
as summarized in the Medical Preauthorization
Requirements provision. Medical-surgical expenses
include:
■■ Anesthetics and their administration when performed
by someone other than the operating physician or other
professional provider.
■■ Appliances used in connection with the treatment of
conditions affecting the temporomandibular joint.
■■ Blood, including the cost of blood, blood plasma, and
blood plasma expanders that is not replaced by or for
the patient.
■■ Certain diagnostic procedures (limited to bone scan,
cardiac stress test, CT scan, MRI [magnetic resonance
imaging], myelogram, PET scan [positron emission
tomography], and ultrasound).
■■ Certified registered nurse-anesthetist (CRNA) services.
■■ Consultation services of a physician or other
professional provider.
■■ Diagnostic x-ray and laboratory procedures.
■■ Educational therapy services.
■■ Elective sterilizations.
■■ Foot care in connection with an illness, disease,
or condition such as, but not limited to, peripheral
neuropathy, chronic venous insufficiency, and diabetes.
■■ Home infusion therapy.
■■ Injectable drugs (except intramuscular injectable
specialty drugs) that are administered by or under
the direction or supervision of a physician or other
professional provider.
■■ Intramuscular injectable specialty drugs. (Must be
provided and administered by a physician/other
professional provider or purchased through the plan’s
specialty drug pharmacy.) To purchase a drug through
the specialty drug pharmacy, contact the Customer
Service Helpline.
■■ Orthopedic braces (i.e., an orthopedic appliance used
to support, align, or hold bodily parts in a correct
position) and crutches including rigid back, leg or neck
Medical
braces; casts for treatment of any part of the legs,
arms, shoulders, hips or back; special surgical and
back corsets; and physician-prescribed, directed, or
applied dressings, bandages, trusses, and splints that
are custom designed for the purpose of assisting the
function of a joint.
■■ Orthoptics and visual training rendered by an
optometrist or orthoptic technician.
■■ Outpatient contraceptive services, including
consultations, examinations, procedures, or medical
services that are related to the use of a drug or device
intended to prevent pregnancy, and contraceptive
devices obtained by prescription. (Prescription oral
contraceptive medications are covered under the plan’s
prescription drug benefits.)
■■ Oxygen and its administration provided the oxygen is
actually used.
■■ Professional local ground ambulance service or air
ambulance service to the nearest hospital appropriately
equipped and staffed for treatment of the patient’s
condition.
■■ Prosthetic appliances, including replacements
necessitated by growth to maturity of the patient.
■■ Radiation therapy.
■■ Rental of durable medical equipment required for
therapeutic use unless purchase of the equipment is
required under the plan. Durable medical equipment
does not include equipment primarily designed for
alleviation of pain/patient comfort or home air fluidized
bed therapy. Examples of equipment that is not
covered include, but are not limited to, air conditioners,
air purifiers, humidifiers, physical fitness equipment,
and whirlpool bath equipment.
■■ Services or supplies used by a participant during an
outpatient visit to a hospital, a therapeutic center, or a
chemical dependency treatment center, or scheduled
services in the outpatient treatment room of a hospital.
21
 ■■ Travel, lodging and meal expenses in connection with a
covered organ or tissue transplant.
■■ Wigs and toupees when prescribed by a physician or
other professional provider and necessary due to injury,
disease or treatment of an injury or disease (e.g., hair
loss resulting from alopecia, chemotherapy or radiation
treatment). Wigs and toupees purchased for cosmetic
reasons are not covered.
Extended Care Expenses
The plan provides coverage for extended care expenses.
All extended care expenses require preauthorization
as summarized in the Medical Preauthorization
Requirements provision.
Any charges incurred for prescription drugs (including
Medical
• Physical, occupational, speech, and respiratory
therapy services provided by licensed therapists.
• Supplies and equipment routinely provided by a
home health agency.
For purposes of home health care frequency
limitations, each period of care lasting four hours or
less is considered one visit.
Expenses for the following home health care services
are not covered:
• Food or home delivered meals.
• Social case work or homemaker services.
• Services provided primarily for custodial care.
• Transportation services.
• Home infusion therapy.

antibiotic therapy) and laboratory services as part • Durable medical equipment.

of home health care or home hospice care are not ■■ Home hospice care expenses including:
considered extended care expenses; instead they are • Part-time or intermittent nursing care provided by an
covered as medical-surgical expenses. RN, APN, or LVN.
• Part-time or intermittent home health aide services
Extended care expenses include:
that consist primarily of caring for the patient.
■■ Skilled nursing facility expenses including: • Physical, speech, and respiratory therapy services
• Usual nursing care provided by a registered nurse provided by licensed therapists.
(RN), advanced practice nurse (APN), or a licensed • Homemaker and counseling services routinely
vocational nurse (LVN). provided by a hospice agency, including
• Room and board. bereavement counseling.
■■ Facility hospice care expenses including:
• Routine services, supplies, and equipment provided
by a skilled nursing facility.
• Usual nursing care by an RN, APN, or LVN.
• Physical, occupational, speech, and respiratory
• Room and board.
therapy services provided by licensed therapists.
• Routine services, supplies, and equipment provided
■■ Home health care expenses including: by a hospice facility.
• Part-time or intermittent nursing care provided by an • Physical, speech, and respiratory therapy services
RN, APN, or LVN. provided by licensed therapists.
• Part-time or intermittent home health aide services
that consist primarily of caring for the patient.
Other Covered Expenses
Other covered expenses are generally covered on the same basis as inpatient hospital expenses, medical-surgical
expenses, and extended care expenses, except as otherwise indicated. Certain services and supplies require
preauthorization as summarized in the Medical Preauthorization Requirements provision.

Other covered expenses include:

Other Covered Expenses
Service/Supply Summary/Limitations
Acquired Brain Medically necessary treatment of an acquired brain injury including cognitive communication and rehabilitation therapy,
Injury community reintegration services, neurobehavioral testing and treatment, neurocognitive rehabilitation and therapy,
neurofeedback therapy, neurophysiological testing and treatment, neuropsychological testing and treatment, post-acute
transition services, psychophysiological testing and treatment, and remediation. For purposes of acquired brain injury
coverage, therapy refers to the scheduled remedial treatment provided through direct interaction with the patient to improve
a pathological condition resulting from the injury.
Chiropractic Services or supplies provided by or under the direction of a doctor of chiropractic. All benefit payments made for
Services chiropractic services, whether under the network or non-network benefit level, are applied toward the 24 visits per calendar
year benefit maximum.

22
 Other Covered Expenses
Service/Supply Summary/Limitations
Colorectal Diagnostic, medically recognized screening examinations for the detection of colorectal cancer for participants age 50 or
Cancer older and who are at normal risk for developing colon cancer for:
Detection Tests • A fecal occult blood test performed annually and a flexible sigmoidoscopy performed every five years, or
• A colonoscopy performed every ten years.
Complications • Conditions (when the pregnancy is not terminated) for which the diagnoses are distinct from pregnancy but are adversely
of Pregnancy affected by pregnancy or are caused by pregnancy, such as nephritis, nephrosis, cardiac decompensation, missed
Treatment abortion, and similar medical and surgical conditions of comparable severity. They do not include false labor, occasional
spotting, physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, pre-
eclampsia, eclampsia, and similar conditions associated with the management of a difficult pregnancy not constituting a
nosologically distinct complication of pregnancy.
• Termination of pregnancy by non-elective cesarean section, termination of ectopic pregnancy, and spontaneous
termination of pregnancy occurring during a period of gestation in which a viable birth is not possible.
Cosmetic, • Treatment provided for the correction of defects incurred in an accidental injury sustained by the participant.
Reconstructive, • Treatment provided for reconstructive surgery following cancer surgery.

Medical
or Plastic • Surgery performed on a newborn child for the treatment or correction of a congenital defect.
Surgery
• Surgery performed on a dependent child (other than a newborn child) under the age of 19 for the treatment or correction
of a congenital defect other than conditions of the breast.
• Services and supplies for reduction mammoplasty when medically necessary and in accordance with the medical policy
guidelines of the claim administrator.
• Reconstruction of the breast on which a mastectomy has been performed; surgery and reconstruction of the other breast
to achieve a symmetrical appearance; and prostheses and treatment of physical complications, including lymphedemas,
at all stages of the mastectomy.
• Reconstructive surgery performed on a dependent child under age 19 due to craniofacial abnormalities to improve
the function of, or attempt to create a normal appearance of an abnormal structure caused by congenital defects,
developmental deformities, trauma, tumors, infections, or disease.
Dental Services • Oral surgery for only the following maxillofacial surgical procedures:
■■ Excision of non-dental related neoplasms, including benign tumors and cysts and all malignant and premalignant
lesions and growths.
■■ Incision and drainage of facial abscess.
■■ Surgical procedures involving salivary glands and ducts and non-dental related procedures of the accessory sinuses.
■■ Surgical and diagnostic treatment of conditions affecting the temporomandibular joint (including the jaw and the
craniomandibular joint) as a result of an accident, a trauma, a congenital defect, a developmental defect, or a
pathology.
• Appliances used in the treatment of conditions affecting the temporomandibular joint.
• Services provided to a newborn child that are necessary for treatment or correction of a congenital defect.
• The correction of damage caused solely by external, violent accidental injury to healthy, un-restored natural teeth and
supporting tissues only if treatment is provided within 24 months of the initial treatment. An injury sustained as a result
of biting or chewing is not considered an accidental injury.
Any other dental services, except as excluded under General Limitations and Exclusions, for which a participant incurs
inpatient hospital expenses for a medically necessary inpatient hospital admission will be determined as summarized in
Inpatient Hospital Expenses.
Diabetes Treatment of a participant who has been diagnosed with diabetes, elevated blood glucose levels induced by pregnancy, or
another medical condition associated with elevated blood glucose levels.
Covered equipment includes blood glucose monitors, insulin pumps, and podiatric appliances, including up to two pairs of
therapeutic footwear per calendar year for the prevention of complications associated with diabetes.
Covered supplies include test strips for blood glucose monitors; visual reading and urine test strips and tablets for glucose,
ketones, and protein; lancets and lancet devices; insulin and insulin analog preparations; injection aids, including devices
used to assist with insulin injection and needleless systems; biohazard disposable containers; insulin syringes; prescriptive
and non-prescriptive oral agents for controlling blood sugar levels; and glucagon emergency kits.
As new or improved treatment and monitoring equipment or supplies become available and are approved by the FDA, the
equipment or supplies may be covered if determined to be medically necessary and appropriate by the treating physician or
other professional provider who issues the written order for the supplies or equipment.
Diabetic management services and diabetes self-management training that is prescribed by a physician or other
professional provider are also covered.

23
 Other Covered Expenses
Service/Supply Summary/Limitations
Emergency Care Coverage is provided for medical emergencies wherever they occur. Examples of medical emergencies are unusual or
and Treatment excessive bleeding, broken bones, acute abdominal or chest pain, unconsciousness, convulsions, difficult breathing,
of Accidental suspected heart attack, sudden persistent pain, severe or multiple injuries or burns, and poisonings.
Injury If reasonably possible, a network physician should be contacted before going to a hospital emergency room to help
determine if the patient needs emergency care. If not reasonably possible, the patient should go to the nearest emergency
facility whether or not the facility is a network facility.
Whether hospitalization is required or not, a network physician should be notified within 48 hours of the emergency
treatment, or as soon as reasonably possible, to obtain a recommendation for the continuation of any necessary medical
services.
On the Premium Plan, copays are required for facility charges for each outpatient hospital emergency room visit; however, if
the patient is admitted for the emergency condition immediately following the visit, the copay is waived. Preauthorization of
the inpatient hospital admission is required.
All treatment received during the first 48 hours following the onset of a medical emergency is eligible for network benefits.
Medical

After 48 hours, network benefits are available only if services are received from network providers unless the patient cannot
be safely transferred to the care of a network provider.
Hearing Services for a dependent child as follows:
Impairment • A screening test for hearing loss from birth through the date the child is 30 days old, and
Screening Tests • Necessary diagnostic follow-up care related to the screening tests from birth through the date the child is 24 months old.
Mammography Screenings by low-dose mammography are available and are limited to one routine mammography screening per calendar
Screening year.
Maternity Care Expenses incurred for the delivery of a child are considered maternity care expenses. Coverage is provided for inpatient
care for the mother and newborn child in a health care facility for a minimum of:
• 48 hours following an uncomplicated vaginal delivery.
• 96 hours following an uncomplicated delivery by caesarean section.
Charges for well-baby nursery care, including the initial examination, of a newborn child during the mother’s hospitalization
for the delivery are considered inpatient hospital expenses of the child.
Maternity care benefits are not available for dependent children.
Mental Health Mental health care, treatment of serious mental illness, and treatment of substance abuse (also referred to as chemical
and Substance dependency). Preauthorization is required for all inpatient services as summarized in the Medical Preauthorization
Abuse Requirements provision.
Substance abuse is the abuse of, psychological or physical dependence on, or addiction to alcohol or a controlled
substance. Serious mental illness is any of the following psychiatric illnesses defined by the American Psychiatric
Association in the Diagnostic and Statistical Manual (DSM): bipolar disorders (hypomanic, manic, depressive, and mixed),
depression in childhood and adolescence, major depressive disorders (single episode or recurrent), obsessive-compulsive
disorders, paranoid and other psychotic disorders, pervasive developmental disorders, schizo-affective disorders (bipolar or
depressive), and schizophrenia.
Medically necessary treatment in a psychiatric day treatment facility, a crisis stabilization unit or facility, or a residential
treatment center for children and adolescents in lieu of hospitalization is considered an inpatient hospital expense.
Morbid Obesity Medically necessary treatment of morbid obesity, including bariatric surgery.

24
 Other Covered Expenses
Service/Supply Summary/Limitations
Organ and • Services and supplies provided to a participant by a hospital, physician, or other provider related to an organ or tissue
Tissue transplant only if all the following conditions are met:
Transplants ■■ The transplant procedure is not experimental or investigational in nature.
■■ Donated human organs or tissue or an FDA approved artificial device are used.
■■ The recipient is covered under the plan.
■■ The transplant procedure is preauthorized as required under the plan.
■■ The participant meets all of the criteria established by the claim administrator in pertinent written medical policies.
■■ The participant meets all of the protocols established by the hospital in which the transplant is performed.
Covered services and supplies related to an organ or tissue transplant include, but are not limited to, x-rays, laboratory
testing, chemotherapy, radiation therapy, prescription drugs, procurement of organs or tissues from a living or deceased
donor, and complications arising from the transplant.
• Benefits are available for a recipient who is covered under the plan and for a donor who is covered under the plan.
• Covered services and supplies include services and supplies provided for:
■■ Evaluation of organs or tissues including, but not limited to, the determination of tissue matches.
■■ Removal of organs or tissues from living or deceased donors.

Medical
■■ Transportation and short-term storage of donated organs or tissues.
■■ Travel, lodging and/or meal expenses of the recipient or a live donor, provided all case management criteria is
followed by the patient.
• No benefits are available for the following services or supplies:
■■ Donor search and acceptability testing of potential live donors.
■■ Expenses related to maintenance of life of a donor for purposes of organ or tissue donation.
■■ Purchase of the organ or tissue.
■■ Organs or tissue (xenograft) obtained from another species.
• Preauthorization is required for any organ or tissue transplant as summarized in the Medical Preauthorization
Requirements provision. Preauthorization is required even if the patient is already in a hospital under another
preauthorization authorization.
• No benefits are available for any organ or tissue transplant procedure (or the services performed in preparation for,
or in conjunction with, such a procedure) if the claim administrator considers the transplant to be experimental or
investigational.
Osteoporosis Medically accepted bone mass measurement for the detection of low bone mass and to determine a participant’s risk of
Detection and osteoporosis and fractures associated with osteoporosis. However, to be eligible for benefits, a participant must be:
Prevention • A postmenopausal woman not receiving estrogen replacement therapy,
• An individual with vertebral abnormalities, primary hyperparathyroidism, or a history of bone fractures, or
• An individual who is receiving long-term glucocorticoid therapy or being monitored to assess the response to or efficacy
of an approved osteoporosis drug therapy.
Papillomavirus Pap smear screenings or screenings using liquid-based cytology methods, as approved by the FDA, for the early detection
and Cervical of cervical cancer alone or in combination with a test approved by the FDA for the detection of the human papillomavirus for
Cancer women who are or have been sexually active or who have reached 18 years of age.
Detection Tests

Physical Modalities, procedures, tests, and measurements listed in the Physicians’ Current Procedural Terminology Manual
Medicine (Procedure Codes 97010–97799), whether the service or supply is provided by a physician or other professional provider,
Services including, but not limited to, physical therapy, occupational therapy, hot or cold packs, whirlpool, diathermy, electrical
(including stimulation, massage, ultrasound, manipulation, muscle or strength testing, and orthotics or prosthetic training.
physical and Physical medicine services, whether under the network or non-network benefit level, are applied toward any applicable
occupational calendar year visit limits under each level of benefits.
therapy)

25
 Other Covered Expenses
Service/Supply Summary/Limitations
Preventive Care • Preventive Care Services (office visit), • Routine Lab Procedures
• Immunizations Routine • Routine Mammograms
• Bone Density Test • Health Education/Counseling Services
• Routine Breast Exam • Routine Pap Smears
• Routine Colonoscopy • Routine Physical
• Routine Colorectal Cancer Screening-Lab • Routine Prostate Test
• Routine Digital Rectal Exam • Smoking Cessation Counseling Services
• Routine Gynecological Exam • Well Baby Care
• Women’s Preventive Care
■■ Gestational diabetes screening
■■ Human Papillomavirus (HPV) DNA testing
■■ STI Counseling and HIV screening and counseling
■■ Contraception (certain drugs only) and contraceptive
counseling
■■ Domestic violence screening
Medical

Benefits are not available for inpatient hospital expenses or medical-surgical expenses for routine physical examinations
performed on an inpatient basis, except for the initial examination of a newborn child.
Prostate Cancer Annual medically recognized diagnostic examinations for the detection of prostate cancer. Benefits are provided only for:
Detection Tests • Physical examinations for the detection of prostate cancer, and
• Prostate-specific antigen tests used for the detection of prostate cancer for a male who is at least:
■■ Age 50 and asymptomatic, or
■■ Age 40 with a family history of prostate cancer or another prostate cancer risk factor.
Speech and Services of a physician or other professional provider to restore loss of or correct an impaired speech or hearing function,
Hearing including but not limited to services in connection with cochlear implants, when provided in accordance with the medical
Services policy guidelines of the claim administrator.
Case Management (Eligible Expense Exceptions) ■■ Benefits are cost effective, and
Under limited circumstances, the claim administrator ■■ The claim administrator anticipates that future costs for
may choose to offer benefits for expenses that would not eligible expenses incurred by the participant may be
otherwise be eligible. The claim administrator, at its sole reduced by these benefits.
discretion, may offer these benefits if:
■■ The participant, his/her family, and the physician agree,
Any decision to provide benefits under this provision will be
made on a case-by-case basis.

Medical Preauthorization Requirements

Preauthorization Services Requiring Preauthorization
The plan requires you to obtain preauthorization before The following services require preauthorization:
certain services are provided. This process allows you ■■ Inpatient hospital admissions.
■■ Extended care, including skilled nursing, home health,
to know in advance if those services will be considered
medically necessary for purposes of coverage under
and hospice care.
the plan. However, preauthorization does not guarantee
payment of benefits. Coverage is always subject to ■■ Home infusion therapy.
applicable plan requirements, such as preexisting ■■ Inpatient mental health and substance abuse treatment.
conditions, limitations and exclusions, payment of ■■ Transfer from one facility to another or transfer to or from
contributions, and eligibility at the time services are a specialty unit within a facility.
■■ Organ transplants.
provided.

Requesting Preauthorization
Although network providers will normally complete the
preauthorization process for you, you are responsible
for ensuring that all preauthorization requirements are
satisfied. Failure to complete preauthorization requirements
may result in reduced/denied benefits or penalties as
summarized in the Failure to Preauthorize provision.

26
To request preauthorization, you, your provider, or a family member must call 1-800-441-9188 between 7:30 a.m.
and 6:00 p.m. Central Time on business days. Calls made after working hours or on weekends will be recorded and
returned the next working day.
Service Preauthorization Requirement
Inpatient Hospital Admissions Request preauthorization at least two working days before admission. In an emergency, request
preauthorization within two working days following admission, or as soon thereafter as reasonably
possible.
When a hospital admission is preauthorized, a length-of-stay is assigned. If you require a longer stay than
the preauthorized length-of-stay, your provider may request an extension for the additional days. Room
and board charges for days of confinement that are not medically necessary are not covered under the
plan.
Minimum lengths-of-stay are provided for:
• Maternity care for the mother and newborn child
■■ 48 hours following an uncomplicated vaginal delivery
■■ 96 hours following an uncomplicated delivery by caesarean section

Medical
• Treatment of breast cancer
■■ 48 hours following a mastectomy
■■ 24 hours following a lymph node dissection
Extended Care and Home The agency or facility providing the services must contact the claim administrator to request
Infusion Therapy preauthorization:
• Prior to initiating extended care or home infusion therapy. (If services are to be provided in less than one
week, the agency or facility should call the medical preauthorization helpline shown on you ID card.)
• When an extension of the initially preauthorized service is required.
• When the treatment plan is altered.
The claim administrator will send a written notice of authorization or denial of benefits to you and the
agency/facility.
Mental health and substance Request preauthorization prior to receiving any inpatient treatment for these conditions.
abuse treatment
Transfer from one facility to Request preauthorization prior to transfer.
another or transfer to or from a
specialty unit within a facility.
Organ transplants Request preauthorization prior to any organ or tissue transplant. This applies even if the patient is already
in a hospital under another preauthorization authorization.
Preauthorization of services does not affect your benefit level. For example, if you elect to use non-network providers
for services that are available from network providers, non-network benefits will be paid. However, if the claim
administrator determines that medically necessary services are not available from a network provider during the
preauthorization process, you may receive authorization to receive services from a non-network provider and receive
network benefits for those specifically authorized services.

Preauthorization Appeal Procedure

If you or your physician disagrees with the preauthorization decision prior to or while receiving services, you may appeal
that decision by contacting the claim administrator.

In some instances, the resolution of the appeal process will not be completed until your inpatient admission or service
has occurred and/or your assigned length of stay/service has elapsed. If you disagree with a decision after claim
processing has taken place or upon receipt of the notification letter from the claim administrator, you may request
a review of that decision by having your physician call the contact person indicated in the notification letter or by
submitting a written request to:
Claim Review Section
Blue Cross and Blue Shield of Texas
P.O. Box 660044
Dallas, TX 75266-0044

You may submit additional information and comments on the preauthorization decision to the claim administrator
within the 30-day period following the date you request review. During this 30-day period, you may also review any
documents relevant to your preauthorization decision held by the claim administrator.

27
 The claim administrator will send you its decision within
30 days of receiving your request for review. In unusual
situations, an additional 15 days may be needed for
the review. In this event, you will be notified of the delay
during the initial 30-day period.
Failure to Preauthorize
If you do not obtain preauthorization when required, any
claim for benefits for the applicable services or supplies
will be subject to the following:
■■ If preauthorization was requested and benefits were
denied during the preauthorization process, the claim
will be denied.
■■ If the claim administrator determines the treatment or
service was not medically necessary, benefits will be
reduced or denied.
■■ If the claim is in connection with an inpatient hospital
admission, a 50% penalty will be applied to any benefit
payable for your hospitalization.
■■ If an inpatient hospital admission or extension for
any service that requires preauthorization was not
preauthorized and it is determined that the admission
or extension was not medically necessary, benefits will
be reduced or denied.

Prescription Drug Benefits

Medical

The plan provides benefits for covered drugs that are medically necessary and prescribed to treat a condition,
sickness, disease, injury, or bodily malfunction. To be covered, the drug must be approved by the FDA and recognized
by one of the following for treatment of the condition for which the drug is prescribed:
■■ A prescription drug reference approved by the appropriate state agency.
■■ Substantially accepted peer-reviewed medical literature.

When a new drug is approved by the FDA, it becomes eligible for benefits unless the intended use is specifically
excluded under the plan.

Prescription Drug Schedule of Benefits

Benefits are available for prescription drugs as shown below:
Prescription Drug Schedule of Benefits
Premium Plan Consumer Choice Plan
Network Non-Network Mail Service Network Non-Network Mail Service
Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy
Maximum supply 30 days N/A 90 days 30 days N/A 90 days
You pay
Generic drugs 15% Not Covered 15% $0 Not Covered $0
(minimum $5, (minimum $5, after deductible after deductible
maximum $20) maximum $20) is met is met
Preferred brand 25% Not Covered 25% $0 Not Covered $0
name drugs* (minimum $20, (minimum $20, after deductible after deductible
maximum $75) maximum $75) is met is met
Non-preferred 35% Not Covered 35% $0 Not Covered $0
brand name (minimum $35, (minimum $35, after deductible after deductible
drugs* maximum $100) maximum $100) is met is met
* Mandatory generic substitution applies.

If your prescription drug purchase is covered under the Covered Drugs

plan and the actual cost of the drug is less than your
copay amount, you will pay the actual cost of the drug.
Drugs purchased at non-network pharmacies are not
covered under the plan.
To be covered, a drug must be a legend drug (including
insulin, insulin analogs, insulin pens, and prescription and
non-prescription oral agents for controlling blood sugar
levels, with disposable syringes and needles needed for
self-administration):
■■ That is medically necessary and ordered by a physician
or other professional provider,
■■ For which a prescription is provided by a physician or
other professional provider,

28
■■ For which a separate charge is customarily made,
■■ That is not entirely consumed at the time and place that
the prescription is written,
■■ For which the FDA has given approval for at least one
indication, and
■■ That is dispensed by a pharmacy, except when received
from a provider’s office or during confinement while a
patient in a hospital or other facility. (Drugs received in a
provider’s office or while a patient in a hospital or other
facility may be covered under the plan’s medical benefits.)
Mandatory Generic Substitution
The plan will require you to fill prescriptions with a generic
if one is available.
■■ For the Premium Plan, if you choose to purchase a
brand name drug when a generic is available, you will
pay the coinsurance for the preferred brand name plus
the difference in price between the brand name drug
and the generic drug.
■■ For the Consumer Choice Plan, you pay the full cost of
the prescription until you meet your deductible. Once
you’ve met the deductible, if you choose to purchase
a brand name drug when there is a generic available,
the plan will cover only the cost of the generic and you
will pay any difference in cost between the brand name
drug and generic drug.
Pharmacies
When you need a prescription filled, you may purchase the
drug at a network pharmacy, the specialty drug pharmacy
(for specialty drugs), or through the mail service pharmacy.
Network Pharmacy
Network pharmacies have agreed to accept as payment
in full the lesser of:
■■ The billed charges.
■■ The allowable amount determined by the claim
administrator.
■■ Other contractually determined payment amounts.
You can find a network pharmacy by visiting
www.bcbstx.com or by calling the Customer Service
Helpline at the telephone number shown on your ID card.
When you purchase a drug at a network pharmacy:
■■ Present your ID card to the pharmacist along with your
prescription.
■■ Provide the pharmacist with the patient’s birth date and
relationship to the employee.
■■ Sign the insurance claim log.
■■ Pay the appropriate deductible, copay, or coinsurance
amount for each prescription filled or refilled, any
applicable pricing difference, and any amounts
necessary for limited or non-covered drugs.
Generally, you are not required to complete a claim form.
However, if the pharmacy cannot process your claim
for you (e.g., if you do not present your ID card), pay the
pharmacy the full amount for your purchase and submit a
claim for reimbursement, as summarized in Medical and
Prescription Drug Claims.
Specialty Drug Pharmacy
If your prescription is for a specialty, high-dollar injectable
drug, it must be filled through the plan’s specialty drug
pharmacy. You or your prescribing physician can obtain
information on this pharmacy by calling the Customer
Service Helpline at the telephone number shown on your
ID card.
Your physician will be asked to complete a Specialty Drug
Medical
Prescription Form, which provides the pharmacy with the
information needed to process your request. The specialty
drug pharmacy will fill your prescription, mail it to you, and
bill you for your share of the cost.
Mail Service Pharmacy
The mail service pharmacy is available for maintenance
drug purchases, such as those that are prescribed on a
long-term basis for high blood pressure or diabetes.
To have a prescription filled through the mail service
pharmacy, send your prescription and payment to the
address shown on the Mail Order Prescription Form. The
form is available at www.bcbstx.com or by calling the
Customer Service Helpline. Amounts owed are shown in
the Prescription Drug Schedule of Benefits. If you need
assistance in determining your copay amount, call the
Customer Service Helpline.
If you send an incorrect amount, you will receive a credit
for any excess amount or be billed for any balance due.
You may order refills from the mail service pharmacy at
www.myrxhealth.com or by calling 1-877-262-7977 and
selecting option two.
Preferred Brand Name Drug List
As shown in the Prescription Drug Schedule of Benefits,
you pay different deductible, copay, or coinsurance
amounts for preferred brand name drugs and non-
preferred brand name drugs. To be considered preferred,
the drug must be included on the preferred brand name
drug list that is maintained by the claim administrator.
The list is developed using information published by the
American Medical Association, Academy of Managed Care
Pharmacies, and other pharmacy and medical related
organizations. The published information describes clinical
outcomes, drug efficacy, and side effect profiles.
The list is regularly reviewed and updated and is available
at www.bcbstx.com or by calling the Customer Service
Helpline.
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 Drugs that do not appear on the preferred brand name
drug list are subject to the non-preferred brand name
drug deductible, copay, or coinsurance amount plus any
applicable pricing differences.
Injectable Drugs
Self-administered injectable drugs, such as insulin, are
also covered under the plan. You are responsible for
your deductible, copay, or coinsurance amount and any
applicable pricing differences. Supplies required for self-
administered injections are limited to 100 syringes and
needles per 30-day period.
Prescription Drug Preauthorization
To ensure that a drug is safe, effective, and part of a specific
treatment plan, certain drugs require preauthorization
Medical
and the evaluation of additional clinical information
before they are dispensed. A list of the drugs that require
preauthorization is available at www.bcbstx.com.
When you present a prescription to a network pharmacy
or the mail service pharmacy for one of these designated
drugs, your physician or other professional provider will
be required to submit a Preauthorization Request Form
before the drug can be dispensed.
Right of Appeal
If preauthorization is requested and denied for your
prescription, you have the right to appeal the claim
administrator’s decision as summarized in Medical and
Prescription Drug Claims.
Prescription Drug Limitations and
Exclusions
Prescription drug benefits are not available for the items
listed below. Additional limitations and exclusions are
summarized in Medical and Prescription Drug Limitations
and Exclusions.
■■ Administration or injection of any drugs.
■■ Allergy serum and allergy testing materials.
■■ Athletic performance enhancement drugs.
■■ Brand-name proton pump inhibitor drugs, which are
commonly used to treat acid reflux and heartburn.
Examples include: Nexium, Prevacid, and Protonix.
■■ Compound drugs that do not meet all of the following
requirements: the drugs in the compounded product
must be FDA approved, the approved product must
have an assigned National Drug Code (NDC), and
the primary active ingredient must be a covered drug
under the plan.
30
■■ Contraceptive devices, non-prescription contraceptive
materials, (except prescription contraceptive drugs that
are legend drugs.) Note: coverage for contraceptive
devices may be provided under the plan’s medical
benefits.
■■ Cosmetic drugs used primarily to enhance appearance
including, but not limited to, correction of skin wrinkles
and skin aging.
■■ Covered drugs, devices, or other pharmacy services or
supplies for which benefits are, or could upon proper
claim be, provided under any local, state, or federal
laws, regulations, or procedures, except any program
that is a state plan for medical assistance (Medicaid)
or any prescription drug that may be properly obtained
without charge under local, state, or federal programs,
unless the exclusion is expressly prohibited by law.
This exclusion does not apply to coverage held by a
participant for prescription drugs under an automobile
casualty insurance policy.
■■ Covered drugs, devices, or other pharmacy services
or supplies provided or available in connection with
an occupational sickness or an injury sustained in the
scope of and in the course of employment whether
or not benefits are, or could upon proper claim be,
provided under workers’ compensation law.
■■ Covered drugs for which a pharmacy’s usual and
customary charge to the general public is less than or
equal to the participant’s copay amount under the plan.
■■ Devices or durable medical equipment of any type
(even if the device/equipment requires a prescription)
such as, but not limited to, therapeutic devices, artificial
appliances, or similar devices (except disposable
hypodermic needles and syringes for self-administered
injections). Note: coverage for certain devices and
durable medical equipment may be provided under the
plan’s medical benefits.
■■ Drugs dispensed in a physician’s or other professional
provider’s office or during confinement while a patient
is in a hospital or other acute care institution or facility,
including take-home drugs, and drugs dispensed by
a nursing home or custodial or chronic care institution
or facility. Note: coverage for these drugs may be
provided under the plan’s medical benefits.
■■ Drugs dispensed in quantities in excess of the supply
limits shown in the Prescription Drug Schedule of
Benefits, refills of any prescriptions in excess of the
number of refills specified by the physician or other
authorized professional provider or by law, or any drugs
or medicines dispensed more than one year following
the prescription date.
■■ Drugs for which the use or intended use would be
illegal, unethical, imprudent, abusive, not medically
necessary, or otherwise improper.
■■ Drugs obtained by unauthorized, fraudulent, abusive,
or improper use of the ID card.
■■ Drugs required by law to be labeled: “Caution – Limited
by Federal Law to Investigational Use” or experimental
drugs, even though a charge is made for the drugs.
■■ Drugs that do not by law require a prescription from a
provider (except insulin, insulin analogs, insulin pens,
and prescriptive and non-prescriptive oral agents for
controlling blood sugar levels), and drugs or covered
devices for which no valid prescription is obtained.
■■ Drugs used or intended to be used for the treatment
of a condition, sickness, disease, injury, or bodily
malfunction that is not covered under the plan.
■■ Fluids, solutions, nutrients, or medications (including all
additives and chemotherapy) used or intended to be
used by intravenous or gastrointestinal (enteral) infusion
or by intravenous, intramuscular (in the muscle),
intrathecal (in the spine), or intraarticular (in the joint)
injection in the home setting. This exclusion does not
apply to dietary formula necessary for the treatment of
phenylketonuria (PKU) or other heritable diseases, or
to intramuscular injectable specialty drugs purchased
through the plan’s specialty drug pharmacy.
■■ Intramuscular injectable specialty drugs unless
obtained through the plan’s specialty drug pharmacy,
or any other injectable drugs, except Depo Provera
or injectable drugs that are self-administered
subcutaneously.
■■ Legend drugs that are not approved by the FDA for a
particular use or purpose or when used for a purpose
other than the purpose approved by the FDA, except
as required by law or regulation.
■■ Oral and injectable infertility and fertility medications.
■■ Prescription antiseptic or fluoride mouthwashes, mouth
rinses, or topical oral solutions or preparations.
■■ Prescriptions for which there is an over-the-counter
product available with the same active ingredients.
■■ Prescriptions that do not meet preauthorization
requirements.
■■ Retin A or pharmacologically similar topical drugs for
participants age 35 or over unless the drugs have
received preauthorization.
■■ Rogaine, minoxidil, or any other drugs, medications,
solutions, or preparations used or intended for use in
the treatment of hair loss, hair thinning, or any related
condition, whether to facilitate or promote hair growth,
to replace lost hair, or otherwise.
■■ Smoking cessation and nicotine addiction treatment
services and supplies.
■■ Special services provided by a pharmacy, including but
not limited to, counseling and delivery.
■■ Vitamins except those that by law require a prescription
and for which there is no non-prescription alternative.
Medical and
Medical
Prescription Drug
Limitations and
Exclusions
Preexisting Condition Exclusion
Benefits for eligible expenses incurred for treatment of a
preexisting condition will not be available during the first
12 months a participant age 19 or older is covered under
the plan.
A preexisting condition is a condition for which
medical advice, diagnosis, care, or treatment has been
recommended or received during the three months
before the effective date of coverage.
The preexisting condition exclusion does not apply to
an individual who has been continuously covered under
creditable coverage if the creditable coverage was in
effect:
■■ For a cumulative period of at least 12 months.
■■ Up to a date not more than 63 days before the
individual became covered under this plan, excluding
the waiting period.
The claim administrator credits the time an individual was
covered under creditable coverage if his/her previous
coverage was in effect under a health benefit plan at
any time during the 12 months prior to his/her effective
date of coverage under this plan. Any waiting period that
applied before coverage became effective under that
health benefit plan is also credited.
The following are not considered preexisting conditions:
■■ Pregnancy
■■ Conditions resulting from domestic violence
31
 ■■ Genetic information without a diagnosis of a specific
condition
All other terms, provisions, limitations, and exclusions
under the plan apply to a participant even if the
preexisting condition exclusion does not apply.
General Limitations and Exclusions
Benefits are not available under the plan for the items
listed below. Additional limitations and exclusions that
apply to prescription drugs are summarized under
Prescription Drug Benefits.
■■ Any portion of a charge for a service or supply that is in
excess of the allowable amount as determined by the
claim administrator.
■■ Cancelled appointment, completion of insurance forms,
Medical
or acquisition of medical records charges.
■■ Charges for services received as a result of injury or
sickness caused by or contributed to by engaging in an
illegal act or occupation; by committing or attempting
to commit any crime, criminal act, assault or other
felonious behavior; or by participating in a riot or public
disturbance.
■■ Chelation therapy services or supplies except for
treatment of acute metal poisoning.
■■ Cosmetic, reconstructive, or plastic surgery services
or supplies, except as provided for those services or
supplies in the Other Covered Expenses provision.
■■ Custodial care services and supplies.
■■ Dental care and treatment, oral surgery, or dental
appliance expenses, except as provided for dental
services in the Other Covered Expenses provision.
■■ Dietary and nutritional services and supplies except as
provided under the plan for:
• An inpatient nutritional assessment program
provided in and by a hospital and approved by the
claim administrator, or
• Benefits for treatment of diabetes as summarized in
the Other Covered Expenses provision.
■■ Donor expenses for a participant in connection with
an organ and tissue transplant if the recipient is not
covered under the plan.
■■ Except as specifically included as an eligible expense,
medical social services, outpatient family counseling
and/or therapy, bereavement counseling, vocational
counseling, or marriage and family therapy and/or
counseling.
■■ Expenses for a covered service, supply or procedure
after any specified day/visit or calendar year limit or
maximum has been paid.
■■ Experimental or investigational services and supplies.
32
■■ Foot care services and supplies for flat feet, fallen
arches, and chronic foot strain.
■■ Items that include, but are not limited to, an orthodontic
or other dental appliance; splints or bandages provided
by a physician in a non-hospital setting or purchased
over-the-counter for support of strains and sprains;
orthopedic shoes that are a separable part of a
covered brace, specially ordered, custom-made or
built-up shoes, cast shoes, shoe inserts designed
to support the arch or affect changes in the foot or
foot alignment, arch supports, and garter belts. This
exclusion does not apply to podiatric appliances when
provided as diabetic equipment.
■■ Occupational therapy services that do not consist
of traditional physical therapy modalities and which
are not part of an active multi-disciplinary physical
rehabilitation program designed to restore lost or
impaired body function.
■■ Outpatient prescription or nonprescription drugs,
except those specifically included under the plan.
■■ Prescription antiseptic or fluoride mouthwashes, mouth
rinses, or topical oral solutions or preparations.
■■ Prescription drugs purchased at non-network
pharmacies.
■■ Private duty nursing services, except for covered
extended care expenses.
■■ Prosthetic appliance replacements, except those
necessitated by growth due to maturity of the
participant.
■■ Room and board charges incurred during a hospital
admission for diagnostic or evaluation procedures
unless the tests could not have been performed on
an outpatient basis without adversely affecting the
patient’s physical condition or the quality of medical
care provided.
■■ Routine foot care services and supplies including the
removal of warts, corns, or calluses, or the cutting and
trimming of toenails in the absence of severe systemic
disease.
■■ Services or supplies for which a participant is not
required to make payment or for which he/she would
have no legal obligation to pay in the absence of this
or any similar coverage, except services or supplies
for treatment of mental illness or mental retardation
provided by a Texas tax supported institution.
■■ Services or supplies for which benefits are available
under any laws or regulations except Medicaid. This
exclusion does not apply to any coverage held by a
participant for medical expenses under an automobile
casualty insurance policy.
■■ Services or supplies not specifically defined as eligible
expenses under the plan.
■■ Services or supplies provided before the participant
is covered under the plan or services or supplies
provided after the participant’s coverage terminates.
■■ Services or supplies provided by a person who is
related to the participant by blood or marriage.
■■ Services or supplies provided for injuries sustained:
• As a result of war, declared or undeclared, or any
act of war, or
• While on active or reserve duty in the armed forces
of any country or international authority.
■■ Services or supplies provided for or in conjunction with:
• Sterilization reversal.
• Transsexual surgery.
• Sexual dysfunctions.
• In vitro fertilization.
• Promotion of fertility through extra-coital
reproductive technologies including, but not limited
to, artificial insemination, intrauterine insemination,
super ovulation uterine capacitation enhancement,
direct intra-peritoneal insemination, trans-uterine
tubal insemination, gamete intra-fallopian transfer,
pronuclear oocyte stage transfer, zygote intra-
fallopian transfer, and tubal embryo transfer.
■■ Services or supplies provided for the following types of
treatment:
• Acupuncture.
• Video fluoroscopy.
• Intersegmental traction.
• Surface EMGs.
• Manipulation under anesthesia.
• Muscle testing through computerized kinesiology
machines such as Isostation, Digital Myograph and
Dynatron.
■■ Services or supplies provided for:
• Treatment of myopia and other errors of refraction,
including refractive surgery.
• Eyeglasses or contact lenses, except intraocular
lenses.
• Examinations for the prescription or fitting of
eyeglasses or contact lenses, except as provided
for preventive care in the Other Covered Expenses
provision.
• Restoration of loss or correction to an impaired
speech or hearing function, including hearing aids,
except as provided for speech and hearing services
in the Other Covered Expenses provision.
■■ Services or supplies provided in connection with a
routine physical examination if charges for the services or
supplies exceed the preventive care calendar year limit.
■■ Services or supplies provided in connection with
an occupational sickness or an injury sustained in
the scope of and in the course of any employment
whether or not benefits are available under workers’
compensation law.
■■ Services or supplies provided primarily for:
• Environmental sensitivity.
• Clinical ecology or any similar treatment not
recognized as safe and effective by the American
Academy of Allergists and Immunologists.
• Inpatient allergy testing or treatment.
■■ Services or supplies provided to a participant outside
the United States if the participant traveled to the
location for the purpose of receiving medical services,
Medical
supplies, or drugs.
■■ Services or supplies that are not medically necessary
and essential to the diagnosis or direct care and
treatment of a sickness, injury, condition, disease, or
bodily malfunction.
■■ Smoking cessation and nicotine addiction treatment
services and supplies.
■■ Travel or ambulance services because they are
more convenient for the patient than other types of
transportation whether or not recommended by a
physician or other professional provider.
In addition, if a network facility furnishes covered services
or supplies that it has not been specifically approved to
furnish under a written contract or agreement with the
claim administrator, benefits for those services or supplies
will be paid at the non-network benefit level.
Circumstances That
May Affect Medical
and Prescription
Drug Benefits
Coordination of Benefits
When you are covered under this plan and another plan
that provides benefits for an eligible expense, one plan
pays benefits first, and the other pays second.
Certain rules are used to determine which plan pays
first – the primary plan, and which pays second – the
secondary plan. When this plan’s benefits are secondary,
benefits are coordinated so that the total benefits from all
plans are no more than the maximum payable under this
plan. In no event will this plan pay more than it would pay
if it were the primary plan.
33
 For purposes of this provision, a plan means any group
insurance or group-type coverage, whether insured or
uninsured, including:
■■ Group or blanket insurance.
■■ Franchise insurance that terminates upon cessation of
employment.
■■ Group hospital or medical service plans and other
group prepayment coverage.
■■ Any coverage under labor-management trustee
arrangements, union welfare arrangements, or
employer organization arrangements.
■■ Governmental plans or coverage required or provided
by law.
Medical
The term “plan” does not include:
■■ Any coverage held by the participant for hospitalization
and/or medical-surgical expenses that is written as a
part of or in conjunction with any automobile casualty
insurance policy.
■■ A policy of health insurance that is individually
underwritten and individually issued.
■■ School accident type coverage.
■■ A state plan under Medicaid.
Each contract or other arrangement for coverage is a
separate plan. Also, if an arrangement has two parts and
coordination of benefit rules apply only to one part, each
of the parts is considered a separate plan.

Determining Primary and Secondary Plans

A plan without a coordination of benefits provision is always the primary plan. Other coordination of benefit rules are
shown in the following table.

Coordination of Benefits Rules

Non-dependent/ Dependent The plan that covers the participant as an employee, member or subscriber is primary to the plan that covers
the participant as a dependent. However, the order of benefits between the two plans is reversed and the plan
that covers the person as a dependent is primary if the participant is also a Medicare beneficiary, and as a
result of federal law or regulations, Medicare is:
• Secondary to the plan covering the person as a dependent, and
• Primary to the plan covering the person as other than a dependent (e.g., a retired employee).
Child – Parents Are Not When this plan and another plan cover the same child as the dependent of two or more parents, the primary
Separated or Divorced plan is the plan of the parent whose birthday falls earlier in the year. If both parents have the same birthday, the
plan that has covered either of the parents for a longer period of time is the primary plan. However, if the other
plan does not have this rule but instead has a rule based on the gender of the parent and, as a result, the plans
do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.
Child – Parents Are When this plan and another plan cover the same child as the dependent of two or more parents, the primary
Separated or Divorced plan is the first of the following:
• The plan of the parent with custody of the child.
• The plan of the spouse of the parent with custody of the child.
• The plan of the parent who does not have custody of the child.
However, if the specific terms of a court decree state that one of the parents must provide health coverage or
pay for the child’s health care expenses, that parent’s plan is primary if the plan has been notified of the court
decree. This rule does not apply to any calendar year in which benefits have been paid for that child before the
plan is notified of the court decree.
Joint Custody If the terms of a court decree state that the parents share joint custody, but do not specify which parent is
responsible for health care expenses, the rule applying to parents who are not separated or divorced (above)
applies.
Active or Inactive Employee A plan that covers a person as an employee who is neither laid off nor retired is primary to a plan that covers
the person as a laid-off or retired employee (or as that person’s dependent). If the other plan does not have this
rule and, as a result, the plans do not agree on the order of benefits, this rule does not apply.
Continuation Coverage The plan that covers a person as an active employee, member or subscriber (or as that person’s dependent)
is primary to a plan that covers that person under a right of continuation pursuant to federal law (e.g., COBRA)
or state law. If the other plan does not have this rule and, as a result, the plans do not agree on the order of
benefits, this rule does not apply.
Longer/Shorter Length of If none of the above rules determine which plan is primary, the plan that has covered the person for the longer
Coverage period of time will be primary to a plan that has covered the person for a shorter period of time.

34
Effect on Plan Benefits
When this plan’s benefits are secondary, benefits are
reduced so that the total benefits from all plans pay no
more than the maximum payable under this plan. Benefits
payable under other plans include all benefits that would
be payable if proper claims had been submitted in a
timely manner.
Information Sharing
You are responsible for notifying the claim administrator
of any other plans under which you or your dependents
are covered, the benefits available under those plans,
and any other information needed for claim processing.
The claim administrator determines what information is
needed to apply coordination of benefit rules and may
obtain information from or release information to any
other organization or person for this purpose without your
consent.
Payments
If a payment made under another plan includes an
amount that should have been paid under this plan, the
claim administrator may pay that amount to that plan.
This will be considered a benefit payment and will satisfy
this plan’s obligation for that benefit amount.
If the benefit amount paid by this plan exceeds
the amount that should have been paid under this
coordination of benefits provision, the claim administrator
may recover the excess from one or more of:
■■ The person that has been paid or for whom benefits
were paid.
■■ Insurance companies.
■■ Hospitals, physicians, or other providers.
■■ Any other person or organization.
Subrogation
If it is determined that another party may have caused or
contributed to an injury or condition that requires services
or supplies for which the plan has paid benefits, the plan
is subrogated to all rights of recovery that you or your
dependent have against the other party for the amount of
benefits the plan has paid. Subrogation is the substitution
of one person or entity (the plan) in the place of another
(you or your dependent) with reference to a lawful claim,
demand or right. This means the plan may use your
rights to recover money through judgment, settlement, or
otherwise from the other party.
Right of Reimbursement
In jurisdictions where subrogation rights are not
recognized or not available due to other circumstances,
the plan has a right of reimbursement. This means that
if you or your dependent recovers money from another
party for an injury or condition for which the plan has paid
benefits, the plan must be reimbursed from the recovered
money for the amount of benefits paid or provided under
the plan.
For example, assume that your injuries in a car accident
have been determined to be the fault of the other driver
and his insurance company has agreed to a settlement
in the amount of your medical expenses. When you
receive payment from his insurance company, you must
Medical
reimburse the plan for any expenses the plan has paid for
treatment of your injuries.
Right to Recovery by Subrogation or
Reimbursement
You or your dependent must promptly furnish to the
plan all information that you have concerning your
rights of recovery and fully assist and cooperate with
the plan in protecting and obtaining its subrogation and
reimbursement rights. You, your dependent, or your
attorney must notify the plan before settling any claim or
suit to allow the plan to enforce its rights by participating
in the settlement of the claim or suit.
You or your dependent may not allow the subrogation
and reimbursement rights of the plan to be limited or
harmed by any acts or failure to act on your part.
Medical/Prescription
Drug Identification
Cards
Your identification (ID) card tells providers that you are
eligible for benefits under the plan. The card offers
a convenient way of providing important information
specific to your coverage including, but not limited to, the
following:
■■ Your subscriber identification number. This unique
identification number is preceded by a three-character
alpha prefix that identifies your claim administrator.
■■ Your group number. This number identifies the plan
with the claim administrator.
■■ Deductible, copay, or coinsurance amounts that apply
to your coverage.
■■ Important telephone numbers.
35
 Medical/Prescription
Always carry your ID card with you and present it to
providers and pharmacies when you receive health care
services or supplies. Drug Customer
If a change in your family takes place, an updated ID card Service
may be necessary. In this event, the claim administrator
will provide a new ID card to you upon receipt of the Important Contact Information
updated information. Accessible Hours
Resource Contact Central Time
Unauthorized, Fraudulent, Improper, or Abusive Customer Service 1-877-262-7977 Monday – Friday
Use of ID Cards Helpline 8:00 a.m. – 8:00 p.m.
Fraudulent or intentionally unauthorized, abusive or other Website www.bcbstx.com 24 hours a day
improper use of ID cards issued to you and your covered 7 days a week
dependents includes, but is not limited to: Medical 1-800-441-9188 Monday – Friday
■■ Use of the ID card prior to the effective date of Preauthorization 7:30 a.m. – 6:00 p.m.
Helpline
coverage or after coverage terminates.
Medical

■■ Obtaining prescription drugs or other benefits that are

not covered under the plan or for persons who are not
covered under the plan.
■■ Obtaining covered drugs for resale or for use by any
person other than the person for whom the prescription
is written, even if the person is otherwise covered
under the plan.
■■ Obtaining covered drugs without a prescription or
through the use of a forged or altered prescription.
■■ Obtaining quantities of prescription drugs in excess of
medically necessary or prudent standards of use or in
excess of quantity limitations under the plan.
■■ Obtaining prescription drugs by using prescriptions for
the same drugs from multiple providers.
■■ Obtaining prescription drugs from multiple pharmacies
through use of the same prescription.
The fraudulent or intentionally unauthorized, abusive or
other improper use of ID cards by any participant can
result in, but is not limited to, the following sanctions
being applied to you and your covered dependents:
■■ Denial of benefits.
■■ Termination of coverage for you and all of your covered
dependents.
■■ Limitation on the use of the ID card to one designated
physician, other provider, or network pharmacy of your
choice.
Mental Health 1-800-528-7264 24 hours a day
Helpline 7 days a week
Nurse Helpline 1-800-581-0368 24 hours a day
7 days a week
Customer Service Helpline
Call the Customer Service Helpline to speak to a
customer service representative. Customer service
representatives can:
■■ Identify your plan service area.
■■ Give you information about network providers.
■■ Distribute claim forms.
■■ Answer your questions on claims.
■■ Assist you in identifying a network provider (but will not
recommend specific network providers).
■■ Provide information on the features of the plan.
■■ Record comments about providers.
■■ Assist you with questions regarding the prescription
drug program.
Claim Administrator’s Website
Visit the claim administrator’s website at
www.bcbstx.com for information about the plan, access
to forms, and much more.
Medical Preauthorization Helpline
Call the Medical Preauthorization Helpline to request
medical preauthorization for inpatient hospital

■■ Recovery from you or any of your covered dependents

of any benefit payments made.
■■ Preauthorization of drug purchases and medical
services for you and all of your covered dependents.
■■ Notice to proper authorities of potential violations of law
or professional ethics.
admissions, extended care expenses, home infusion
therapy, and other services listed in the Services
Requiring Preauthorization provision. (Failure to obtain
preauthorization may result in reduction or denial of
benefits.)

36
Mental Health Helpline
You, your physician, provider of services, or a family
member may call the Mental Health Helpline at any time
to request preauthorization for treatment of mental health
or substance abuse. (Failure to obtain preauthorization
may result in reduction or denial of benefits.)
CLAIM FILING
AND APPEALS
PROCEDURES
CLAIM FILING PROCEDURES
Filing of Claims Required
Claim Forms
When the Claim Administrator receives notice of claim,
it will furnish to you, or to your Employer for delivery to
you, the Hospital, or your Physician or Professional Other
Provider, the claim forms that are usually furnished by it
for filing Proof of Loss.
The Claim Administrator for the Plan must receive claims
prepared and submitted in the proper manner and form,
in the time required, and with the information requested
before it can consider any claim for payment of benefits.
Who Files Claims
Providers that contract with the Claim Administrator
and some other health care Providers (such as ParPlan
Providers) will submit your claims directly to the Claim
Administrator for services provided to you or any of your
covered Dependents. At the time services are provided,
inquire if they will file claim forms for you. To assist
Providers in filing your claims, you should carry your
Identification Card with you.
Contracting Providers
When you receive treatment or care from a Provider
or Covered Drugs dispensed from a Pharmacy that
contracts with the Claim Administrator, you will generally
not be required to file claim forms. The Provider
will usually submit the claims directly to the Claim
Administrator for you.
Non-Contracting Providers
When you receive treatment or care from a health care
Provider or Covered Drugs dispensed from a Pharmacy
that does not contract with the Claim Administrator,
you may be required to file your own claim forms. Some
Providers, however, will do this for you. If the Provider
does not submit claims for you, refer to the subsection
entitled Participant- filed claims below for instruction on
how to file your own claim forms.
Mail-Order Program
When you receive Covered Drugs dispensed through the
Mail-Order Program, you must complete and submit the
mail service prescription drug claim form to the address
on the claim form. Additional information may be obtained
from your Employer, from the Claim Administrator, from
the BCBSTX website at www.bcbstx.com/pharmacy, or
by calling the Customer Service Helpline.
Participant- filed claims
■■ Medical Claims
If your Provider does not submit your claims, you will
need to submit them to the Claim Administrator using
a Subscriber-filed claim form provided by the Plan.
Your Employer should have a supply of claim forms
Medical
or you can obtain copies from the BCBSTX website.
Follow the instructions on the reverse side of the form to
complete the claim. Remember to file each Participant’s
expenses separately because any Copayment Amounts,
Deductibles, maximum benefits, and other provisions are
applied to each Participant separately. Include itemized
bills from the health care Providers, labs, etc., printed
on their letterhead and showing the services performed,
dates of service, charges, and name of the Participant
involved.
■■ Prescription Drug Claims
When you receive Covered Drugs dispensed from a non-
Participating Pharmacy, a Prescription Reimbursement
Claim Form must be submitted. This form can be
obtained from the Claim Administrator or your Employer.
This claim form, accompanied by an itemized bill obtained
from the Pharmacy showing the prescription services you
received, should be mailed to the address shown below
or on the claim form.
Instructions for completing the claim form are provided on
the back of the form. You may need to obtain additional
information, which is not on the receipt from the
pharmacist, to complete the claim form.
Bills for Covered Drugs should show the name, address
and telephone number of the Pharmacy, a description
and quantity of the drug, the prescription number, the
date of purchase and most importantly , the name of the
Participant using the drug.
VISIT THE BCBSTX WEBSITE FOR SUBSCRIBER
CLAIM FORMS AND OTHER USEFUL INFORMATION
www.bcbstx.com
37
 Where to Mail Completed Claim Forms
Medical Claims
Blue Cross and Blue Shield of Texas
Claims Division
P. O. Box 660044
Dallas, TX 75266-0044
Prescription Drug Claims
Blue Cross and Blue Shield of Texas
c/o Prime Therapeutics LLC
P. O. Box 14624
Lexington, KY 40512-4624
Mail-Order Program
Blue Cross and Blue Shield of Texas
c/o Prime Mail Pharmacy
Medical
P. O. Box 650041
Dallas, TX 75265-0041
Who Receives Payment
Benefit payments will be made directly to contracting
Providers or Pharmacies when they bill the Claim
Administrator. Written agreements between the Claim
Administrator and some Providers or Pharmacies may
require payment directly to them.
Any benefits payable to you, if unpaid at your death, will
be paid to your surviving spouse, as beneficiary. If there is
no surviving spouse, then the benefits will be paid to your
estate.
Except as provided in the section Assignment and
Payment of Benefits, rights and benefits under the Plan
are not assignable, either before or after services and
supplies are provided.
Benefit Payments to a Managing Conservator
Benefits for services provided to your minor Dependent
child may be paid to a third party if:
■■ the third party is named in a court order as managing
or possessory conservator of the child; and
■■ the Claim Administrator has not already paid any
portion of the claim.
In order for benefits to be payable to a managing or
possessory conservator of a child, the managing or
possessory conservator must submit to the Claim
Administrator, with the claim form, proof of payment of the
expenses and a certified copy of the court order naming
that person the managing or possessory conservator.
The Claim Administrator may deduct from its benefit
payment any amounts it is owed by the recipient of the
payment. Payment to you or your Provider, or deduction
by the Plan from benefit payments of amounts owed to it,
will be considered in satisfaction of its obligations to you
under the Plan.
38
An Explanation of Benefits summary is sent to you so you
will know what has been paid.
When to Submit Claims
All claims for benefits under the Plan must be properly
submitted to the Claim Administrator within twelve (12)
months of the date you receive the services or supplies.
Claims submitted and received by the Claim Administrator
after that date will not be considered for payment of
benefits except in the absence of legal capacity.
Receipt of Claims by the Claim Administrator
A claim will be considered received by the Claim
Administrator for processing upon actual delivery to the
Administrative Office of the Claim Administrator (see
address above) in the proper manner and form and with
all of the information required. If the claim is not complete,
it may be denied or the Claim Administrator may contact
either you or the Provider for the additional information.
After processing the claim, the Claim Administrator will
notify the Participant by way of an Explanation of Benefits
summary.
Review of Claim Determinations
Claim Determinations
When the Claim Administrator receives a properly
submitted claim, it has authority and discretion under the
Plan to interpret and determine benefits in accordance
with the Health Benefit Plan provisions. The Claim
Administrator will receive and review claims for benefits
and will accurately process claims consistent with
administrative practices and procedures established in
writing between the Claim Administrator and the Plan
Administrator.
You have the right to seek and obtain a full and fair review
by the Claim Administrator of any determination of a
claim, any determination of a request for Preauthorization,
or any other determination made by the Claim
Administrator of your benefits under the Plan.
If a Claim Is Denied or Not Paid in Full
On occasion, the Claim Administrator may deny all or
part of your claim. There are a number of reasons why
this may happen. We suggest that you first read the
Explanation of Benefits summary prepared by the Claim
Administrator; then review this Benefit Booklet to see
whether you understand the reason for the determination.
If you have additional information that you believe could
change the decision, send it to the Claim Administrator
and request a review of the decision as described in
Claim Appeal Procedures below.
If the claim is denied in whole or in part, you will receive
a written notice from the Claim Administrator with the
following information, if applicable:
■■ The reasons for determination;
■■ A reference to the provisions on which the
determination is based, or the contractual,
administrative or protocol for the determination;
■■ A description of additional information which may be
necessary to perfect an appeal and an explanation of
why such material is necessary;
■■ Subject to privacy laws and other restrictions, if any, the
identification of the claim, date of service, health care
provider, claim amount (if applicable), and a statement
describing denial codes with their meanings and the
standards used. Upon request, diagnosis/treatment
codes with their meanings and the standards used are
also available;
■■ An explanation of the Claim Administrator’s internal
review/appeals and external review processes (and
how to initiate a review/appeal or external review) and
a statement of your right, if any, to bring a civil action
under Section 502(a) of ERISA following a final denial
on internal review/appeal;
■■ In certain situations, a statement in non-English
language(s) that written notices of claim denials and
certain other benefit information may be available (upon
request) in such non-English language(s);
■■ In certain situations, a statement in non-English
language(s) that indicates how to access the language
services provided by the Claim Administrator;
■■ The right to request, free of charge, reasonable access
to and copies of all documents, records and other
information relevant to the claim for benefits;
■■ Any internal rule, guideline, protocol or other similar
criterion relied on in the determination, and a statement
that a copy of such rule, guideline, protocol or other
similar criterion will be provided free of charge upon
request;
■■ An explanation of the scientific or clinical judgment
relied on in the determination as applied to claimant’s
medical circumstances, if the denial was based on
medical necessity, experimental treatment or similar
exclusion, or a statement that such explanation will be
provided free of charge upon request;
■■ In the case of a denial of an urgent care clinical claim,
a description of the expedited review procedure
applicable to such claims. An urgent care claim
decision may be provided orally, so long as a written
notice is furnished to the claimant within three days of
oral notification
■■ Contact information for applicable office of health
insurance consumer assistance or ombudsman.
Timing of Required Notices and Extensions
Separate schedules apply to the timing of required
notices and extensions, depending on the type of Claim.
There are three types of Claims as defined below.
1. Urgent Care Clinical Claim is any pre-service
Claim that requires Preauthorization, as described
in this Benefit Booklet, for benefits for medical care
or Treatment with respect to which the application
of regular time periods for making health Claim
decisions could seriously jeopardize the life or health
of the claimant or the ability of the claimant to regain
maximum function or, in the opinion of a Physician
with knowledge of the claimant’s medical condition,
would subject the claimant to severe pain that
cannot be adequately managed without the care or
Medical
Treatment.
2. Pre-Service Claim is any non-urgent request for
benefits or a determination with respect to which
the terms of the benefit plan condition receipt of
the benefit on approval of the benefit in advance of
obtaining medical care.
3. Post-Service Claim is notification in a form
acceptable to the Claim Administrator that a
service has been rendered or furnished to you. This
notification must include full details of the service
received, including your name, age, sex, identification
number, the name and address of the Provider,
an itemized statement of the service rendered or
furnished, the date of service, the diagnosis, the Claim
charge, and any other information which the Claim
Administrator may request in connection with services
rendered to you.
Urgent Care Clinical Claims*
Type of Notice or Extension Timing
If your Claim is incomplete, the Claim 24 hours**
Administrator must notify you within:
If you are notified that your Claim is incomplete, 48 hours after
you must then provide completed Claim receiving
information to the Claim Administrator within: notice
The Claim Administrator must notify you of the Claim determination
(whether adverse or not):
if the initial Claim is complete as soon as 72 hours
possible (taking into account medical exigencies),
but no later than:
after receiving the completed Claim (if the initial 48 hours
Claim is incomplete), within:
* You do not need to submit appeals of Urgent Care Clinical Claims
in writing. You should call the Claim Administrator at the toll-free
number listed on the back of your Identification Card as soon as
possible to appeal an Urgent Care Clinical Claim.
** Notification may be oral unless the claimant requests written
notification.
39
 Pre-Service Claims
Type of Notice or Extension
If your Claim is filed improperly, the Claim
Administrator must notify you within:
If your Claim is incomplete, the Claim
Administrator must notify you within:
If you are notified that your Claim is
incomplete, you must then provide
completed Claim information to the Claim
Administrator within:
The Claim Administrator must notify you of the Claim determination
(whether adverse or not):
if the initial Claim is complete, within:
after receiving the completed Claim (if
Medical
Concurrent Care
For benefit determinations relating to care that is being
Timing
received at the same time as the determination, such
5 days* notice will be provided no later than 24 hours after receipt
of your Claim for benefits.
15 days
Claim Appeal Procedures
45 days after Claim Appeal Procedures - Definitions
receiving notice
An “Adverse Benefit Determination” means a denial,
reduction, or termination of, or a failure to provide or make
payment (in whole or in part) for, a benefit, including any
such denial, reduction, termination, or failure to provide or
make payment for, a benefit resulting from the application of
15 days**
any utilization review, as well as a failure to cover an item or
30 days service for which benefits are otherwise provided because

the initial Claim is incomplete), within:

it is determined to be experimental or investigational or not
If you require post-stabilization care after an the time medically necessary or appropriate. If an ongoing course of
Emergency within: appropriate to
treatment had been approved by the Claim Administrator
the circumstance
not to exceed one or your Employer and the Claim Administrator or your
hour after the Employer reduces or terminates such treatment (other than
time of request by amendment or termination of the Employer’s benefit
* Notification may be oral unless the claimant requests written plan) before the end of the approved treatment period,
notification. that is also an Adverse Benefit Determination. A rescission
** This period may be extended one time by the Claim Administrator of coverage is also an Adverse Benefit Determination. A
for up to 15 days, provided that the Claim Administrator both (1) rescission does not include a termination of coverage for
determines that such an extension is necessary due to matters
reasons related to non-payment of premium.
beyond the control of the Plan and (2) notifies you, prior to the
expiration of the initial 15-day period, of the circumstances A “Final Internal Adverse Benefit Determination”
requiring the extension of time and the date by which the Claim
means an Adverse Benefit Determination that has been
Administrator expects to render a decision.
upheld by the Claim Administrator or your Employer at
Post-Service Claims the completion of the Claim Administrator’s or Employer’s
internal review/appeal process.
Type of Notice or Extension Timing
If your Claim is incomplete, the 30 days Expedited Clinical Appeals
Claim Administrator must notify you If your situation meets the definition of an expedited clinical
within: appeal, you may be entitled to an appeal on an expedited
If you are notified that your Claim is 45 days after basis. An expedited clinical appeal is an appeal of a
incomplete, you must then provide receiving notice clinically urgent nature related to health care services,
completed Claim information to the including but not limited to, procedures or treatments
Claim Administrator with in: ordered by a health care provider, as well as continued
hospitalization. Before authorization of benefits for an
The Claim Administrator must notify you of the Claim
ongoing course of treatment/continued hospitalization is
determination (whether adverse or not):
terminated or reduced, the Claim Administrator will provide
if the initial Claim is complete, within: 30 days* you with notice at least 24 hours before the previous
after receiving the completed Claim 45 days benefits authorization ends and an opportunity to appeal.
(if the initial Claim is incomplete),
within:
* This period may be extended one time by the Claim Administrator
for up to 15 days, provided that the Claim Administrator both (1)
determines that such an extension is necessary due to matters
beyond the control of the Plan and (2) notifies you in writing, prior
to the expiration of the initial 30-day period, of the circumstances
requiring the extension of time and the date by which the Claim
Administrator expects to render a decision.

40
For the ongoing course of treatment, coverage will
continue during the appeal process. Upon receipt of
an expedited pre-service or concurrent clinical appeal,
the Claim Administrator will notify the party filing the
appeal, as soon as possible, but no more than 24 hours
after submission of the appeal, of all the information
needed to review the appeal. Additional information
must be submitted within 24 hours of request. The Claim
Administrator shall render a determination on the appeal
within 24 hours after it receives the requested information,
but no later than 72 hours after the appeal has been
received by the Claim Administrator.
How to Appeal an Adverse Benefit Determinations
You have the right to seek and obtain a full and fair review
of any determination of a claim, any determination of a
request for Preauthorization, or any other determination
made by the Claim Administrator in accordance with the
benefits and procedures detailed in your Health Benefit
Plan.
An appeal of an Adverse Benefit Determination may
be filed by you or a person authorized to act on your
behalf. In some circumstances, a health care provider
may appeal on his/her own behalf. Your designation of
a representative must be in writing as it is necessary
to protect against disclosure of information about you
except to your authorized representative. To obtain
an Authorized Representative Form, you or your
representative may call the Claim Administrator at the
number on the back of your ID card.
If you believe the Claim Administrator incorrectly denied
all or part of your benefits, you may have your claim
reviewed. The Claim Administrator will review its decision
in accordance with the following procedure:
■■ Within 180 days after you receive notice of a denial
or partial denial, you may call or write to the Claim
Administrator’s Administrative Office. The Claim
Administrator will need to know the reasons why you
do not agree with the denial or partial denial. Send your
request to:
Claim Review Section
Blue Cross and Blue Shield of Texas
P. O. Box 660044
Dallas, Texas 75266-0044
■■ You may also designate a representative to act for
you in the review procedure. Your designation of a
representative must be in writing as it is necessary to
protect against disclosure of information about you
except to your authorized representative.
■■ The Claim Administrator will honor telephone requests
for information. However, such inquiries will not
constitute a request for review.
■■ In support of your claim review, you have the option
of presenting evidence and testimony to the Claim
Administrator. You and your authorized representative
may ask to review your file and any relevant documents
and may submit written issues, comments and
additional medical information within 180 days after you
receive notice of an Adverse Benefit Determination or
at any time during the claim review process.
The Claim Administrator will provide you or your
authorized representative with any new or additional
evidence or rationale and any other information and
documents used in the review of your claim without
regard to whether such information was considered
in the initial determination. No deference will be given
Medical
to the initial Adverse Benefit Determination. Such new
or additional evidence or rationale will be provided to
you or your authorized representative sufficiently in
advance of the date a final decision on appeal is made
in order to give you a chance to respond. The appeal
determination will be made by a Physician associated
or contracted with the Claim Administrator and/or
by external advisors, but who were not involved in
making the initial denial of your claim. Before you or
your authorized representative may bring any action
to recover benefits the claimant much exhaust the
appeal process and must raise all issues with respect
to a claim and must file an appeal or appeals and
the appeals must be finally decided by the Claim
Administrator or your Employer.
■■ If you have any questions about the claims procedures
or the review procedure, write to the Claim
Administrator’s Administrative Office or call the toll-
free Customer Service Helpline number shown in this
Benefit Booklet or on your Identification Card.
Timing of Appeal Determinations
Upon receipt of a non-urgent pre-service appeal, the Claim
Administrator shall render a determination of the appeal as
soon as practical, but in no event more than 30 days after
the appeal has been received by the Claim Administrator.
Upon receipt of a non-urgent post-service appeal, the
Claim Administrator shall render a determination of the
appeal as soon as practical, but in no event more than
60 days after the appeal has been received by the Claim
Administrator.
Notice of Appeal Determination
The Claim Administrator will notify the party filing the
appeal, you, and, if a clinical appeal, any health care
provider who recommended the services involved in the
appeal, by a written notice of the determination.
The written notice will include:
41
 1. A reason for the determination;
2. A reference to the benefit plan provisions on which
the determination is based, or the contractual,
administrative or protocol for the determination;
3. Subject to privacy laws and other restrictions, if
any, the identification of the claim, date of service,
health care provider, claim amount (if applicable),
and a statement describing denial codes with their
meanings and the standards used. Upon request,
diagnosis/treatment codes with their meanings and
the standards used are also available;
4 An explanation of the Claim Administrator’s external
review processes (and how to initiate an external
Medical
review) and a statement of your right, if any, to bring a
civil action under Section 502(a) of ERISA following a
final denial on external appeal;
5. In certain situations, a statement in non-English
language(s) that written notices of claim denials and
certain other benefit information may be available
(upon request) in such non-English language(s);
6. In certain situations, a statement in non-English
language(s) that indicates how to access the language
services provided by the Claim Administrator;
7. The right to request, free of charge, reasonable
access to and copies of all documents, records and
other information relevant to the claim for benefits;
8. Any internal rule, guideline, protocol or other similar
criterion relied on in the determination, or a statement
that a copy of such rule, guideline, protocol or other
similar criterion will be provided free of charge on
request;
9. An explanation of the scientific or clinical judgment
relied on in the determination, or a statement that
such explanation will be provided free of charge upon
request;
10. A description of the standard that was used in denying
the claim and a discussion of the decision;
11. Contact information for applicable office of health
insurance consumer assistance or ombudsman.
If the Claim Administrator’s or your Employer’s decision is
to continue to deny or partially deny your claim or you do
not receive timely decision, you may be able to request
an external review of your claim by an independent third
party, who will review the denial and issue a final decision.
Your external review rights are described in the Standard
External Review section below.
42
If You Need Assistance
If you have any questions about the claims procedures or
the review procedure, write or call the Claim Administrator
Headquarters at 1-800-521-2227. The Claim
Administrator Customer Service Helpline is accessible
from 8:00 A.M. to 8:00 P.M., Monday through Friday.
Claim Review Section
Blue Cross and Blue Shield of Texas
P. O. Box 660044
Dallas, Texas 75266-0044
If you need assistance with the internal claims and
appeals or the external review processes that are
described below, you may call the number on the back
of your ID card for contact information. In addition, for
questions about your appeal rights or for assistance,
you can contact the Employee Benefits Security
Administration at 1-866-444-EBSA (3272).
Standard External Review
You or your authorized representative (as described
above) may make a request for a standard external
review or expedited external review of an Adverse
Benefit Determination or Final Internal Adverse Benefit
Determination by an independent review organization
(IRO).
12. Request for external review. Within four months
after the date of receipt of a notice of an Adverse
Benefit Determination or Final Internal Adverse Benefit
Determination from the Claim Administrator, you or
your authorized representative must file your request
for standard external review.
13. Preliminary review. Within five business days
following the date of receipt of the external review
request, the Claim Administrator must complete a
preliminary review of the request to determine whether:
a. You are, or were, covered under the plan at the
time the health care item or service was requested
or, in the case of a retrospective review, was
covered under the plan at the time the health care
item or service was provided;
b. The Adverse Benefit Determination or the Final
Adverse Internal Benefit Determination does not
relate to your failure to meet the requirements for
eligibility under the terms of the plan (e.g., worker
classification or similar determination);
 c. You have exhausted the Claim Administrator’s
internal appeal process unless you are not
required to exhaust the internal appeals process
under the interim final regulations. Please read
the Exhaustion section below for additional
information and exhaustion of the internal appeal
process; and
d. You or your authorized representative have
provided all the information and forms required to
process an external review.
You will be notified within one business day after
we complete the preliminary review if your request
is eligible or if further information or documents
are needed. You will have the remainder of the four
month appeal period (or 48 hours following receipt of
the notice), whichever is later, to perfect the appeal
request. If your claim is not eligible for external review,
d. Upon receipt of any information submitted by you
we will outline the reasons it is ineligible in the notice,
and provide contact information for the Department
of Labor’s Employee Benefits Security Administration
(toll-free number 866-444-EBSA (3272)).
14. Referral to Independent Review Organization. When
an eligible request for external review is completed
within the time period allowed, the Claim Administrator
will assign the matter to an independent review
organization (IRO). The IRO assigned will be accredited
by URAC or by similar nationally-recognized accrediting
organization. Moreover, the Claim Administrator will
take action against bias and to ensure independence.
Accordingly, the Claim Administrator must contract with
at least three IROs for assignments under the plan and
rotate claims assignments among them (or incorporate
other independent, unbiased methods for selection of
IROs, such as random selection). In addition, the IRO
may not be eligible for any financial incentives based
on the likelihood that the IRO will support the denial of
benefits.
The IRO must provide the following:
e. Review all of the information and documents timely
a. Utilization of legal experts where appropriate to
make coverage determinations under the plan.
b. Timely notification to you or your authorized
representative, in writing, of the request’s eligibility
and acceptance for external review. This notice
will include a statement that you may submit in
writing to the assigned IRO within 10 business
days following the date of receipt of the notice
additional information that the IRO must consider
when conducting the external review. The IRO is not
required to, but may, accept and consider additional
information submitted after 10 business days.
c. Within five business days after the date of
assignment of the IRO, the Claim Administrator
must provide to the assigned IRO the documents
and any information considered in making the
Adverse Benefit Determination or Final Internal
Adverse Benefit Determination. Failure by the Claim
Administrator to timely provide the documents
and information must not delay the conduct of the
external review. If the Claim Administrator fails to
timely provide the documents and information, the
assigned IRO may terminate the external review
and make a decision to reverse the Adverse
Benefit Determination or Final Internal Adverse
Benefit Determination. Within one business day
after making the decision, the IRO must notify the
Medical
Claim Administrator and you or your authorized
representative.
or your authorized representative, the assigned
IRO must within one business day forward the
information to the Claim Administrator. Upon
receipt of any such information, the Claim
Administrator may reconsider the Adverse Benefit
Determination or Final Internal Adverse Benefit
Determination that is the subject of the external
review. Reconsideration by the Claim Administrator
must not delay the external review. The external
review may be terminated as a result of the
reconsideration only if the Claim Administrator
decides, upon completion of its reconsideration,
to reverse the Adverse Benefit Determination
or Final Internal Adverse Benefit Determination
and provide coverage or payment. Within one
business day after making such a decision, the
Claim Administrator must provide written notice
of its decision to you and the assigned IRO.
The assigned IRO must terminate the external
review upon receipt of the notice from the Claim
Administrator.
received. In reaching a decision, the assigned IRO
will review the claim de novo and not be bound by
any decisions or conclusions reached during the
Claim Administrator’s internal claims and appeals
process applicable under paragraph (b) of the
interim final regulations under section 2719 of the
Public Health Service (PHS) Act. In addition to the
documents and information provided, the assigned
IRO, to the extent the information or documents are
available and the IRO considers them appropriate,
will consider the following in reaching a decision:
(1) Your medical records;
43
 (2) The attending health care professional’s
recommendation;
(3) Reports from appropriate health care
professionals and other documents submitted
by the Claim Administrator, you, or your treating
provider;
(4) The terms of your plan to ensure that the IRO’s
decision is not contrary to the terms of the plan,
unless the terms are inconsistent with applicable
law;
(5) Appropriate practice guidelines, which must
include applicable evidence-based standards
and may include any other practice guidelines
developed by the Federal government, national
or professional medical societies, boards, and
Medical
associations;
(6) Any applicable clinical review criteria developed
and used by the Claim Administrator, unless the
criteria are inconsistent with the terms of the
plan or with applicable law; and
(7) The opinion of the IRO’s clinical reviewer
or reviewers after considering information
described in this notice to the extent the
information or documents are available and
the clinical reviewer or reviewers consider
appropriate.
f. Written notice of the final external review decision
must be provided within 45 days after the IRO
receives the request for the external review. The
IRO must deliver the notice of final external review
decision to the Claim Administrator and you or your
authorized representative.
g. The notice of final external review decision will
contain:
(1) A general description of the reason for the
request for external review, including information
sufficient to identify the claim (including the date
or dates of service, the health care provider, the
claim amount (if applicable), the diagnosis code
and its corresponding meaning, the treatment
code and its corresponding meaning, and the
reason for the previous denial);
(2) The date the IRO received the assignment to
conduct the external review and the date of the
IRO decision;
(3) References to the evidence or documentation,
including the specific coverage provisions and
evidence-based standards, considered in
reaching its decision;
44
(4) A discussion of the principal reason or reasons
for its decision, including the rationale for its
decision and any evidence-based standards
that were relied on in making its decision;
(5) A statement that the determination is binding
except to the extent that other remedies may be
available under State or Federal law to either the
Claim Administrator or you or your authorized
representative;
(6) A statement that judicial review may be available
to you or your authorized representative; and
(7) Current contact information, including phone
number, for any applicable office of health
insurance consumer assistance or ombudsman
established under PHS Act section 2793.
h. After a final external review decision, the IRO
must maintain records of all claims and notices
associated with the external review process for six
years. An IRO must make such records available
for examination by the Claim Administrator, State
or Federal oversight agency upon request, except
where such disclosure would violate State or
Federal privacy laws, and you or your authorized
representative.
15. Reversal of plan’s decision. Upon receipt of a
notice of a final external review decision reversing
the Adverse Benefit Determination or Final
Internal Adverse Benefit Determination, the Claim
Administrator must immediately provide coverage
or payment (including immediately authorizing or
immediately paying benefits) for the claim.
EXPEDITED EXTERNAL REVIEW
16. Request for expedited external review. The Claim
Administrator must allow you or your authorized
representative to make a request for an expedited
external review with the Claim Administrator at the
time you receive:
a. An Adverse Benefit Determination, if the Adverse
Benefit Determination involve a medical condition
of the claimant for which the time frame for
completion of an expedited internal appeal under
the interim final regulations would seriously
jeopardize your life or health or would jeopardize
your ability to regain maximum function and you
have filed a request for an expedited internal
appeal; or
 b. A Final Internal Adverse Benefit Determination, if
the claimant has a medical condition where the
time frame for completion of a standard external
review would seriously jeopardize your life or health
or would jeopardize your ability to regain maximum
function, or if the Final Internal Adverse Benefit
Determination concerns an admission, availability
of care, continued stay, or health care item or
service for which you received emergency services,
but have not been discharged from a facility.
17. Preliminary review. Immediately upon receipt of
the request for expedited external review, the Claim
Administrator must determine whether the request
meets the review ability requirements set forth in the
Standard External Review section above. The Claim
Administrator must immediately send you a notice of
its eligibility determination that meets the requirements
set forth in Standard External Review section above.
18. Referral to independent review organization.
Upon a determination that a request is eligible for
external review following the preliminary review, the
Claim Administrator will assign an IRO pursuant to
the requirements set forth in the Standard External
Review section above. The Claim Administrator
must provide or transmit all necessary documents
and information considered in making the Adverse
Benefit Determination or Final Internal Adverse Benefit
Determination to the assigned IRO electronically
or by telephone or facsimile or any other available
expeditious method.
The assigned IRO, to the extent the information or
documents are available and the IRO considers
them appropriate, must consider the information or
documents described above under the procedures for
standard review. In reaching a decision, the assigned
IRO must review the claim de novo and is not bound by
any decisions or conclusions reached during the Claim
Administrator’s internal claims and appeals process.
19. Notice of final external review decision. The Claim
Administrator’s contract with the assigned IRO must
require the IRO to provide notice of the final external
review decision, in accordance with the requirements
set forth in the Standard External Review section
above, as expeditiously as your medical condition
or circumstances require, but in no event more than
72 hours after the IRO receives the request for an
expedited external review. If the notice is not in writing,
within 48 hours after the date of providing that notice,
the assigned IRO must provide written confirmation
of the decision to the Claim Administrator and you or
your authorized representative.
EXHAUSTION
For standard internal review, you have the right to request
external review once the internal review process has been
completed and you have received the Final Internal Adverse
Benefit Determination. For expedited internal review, you
may request external review simultaneously with the request
for expedited internal review. The IRO will determine whether
or not your request is appropriate for expedited external
review or if the expedited internal review process must be
completed before external review may be requested.
You will be deemed to have exhausted the internal review
process and may request external review if the Claim
Administrator waives the internal review process or the
Claim Administrator has failed to comply with the internal
Medical
claims and appeals process. In the event you have been
deemed to exhaust the internal review process due to
the failure by the Claim Administrator to comply with the
internal claims and appeals process, you also have the
right to pursue any available remedies under 502(a) of
ERISA or under State law.
External review may not be requested for an Adverse
Benefit Determination involving a claim for benefits for a
health care service that you have already received until
the internal review process has been exhausted.
Interpretation of Employer’s Plan Provisions
The Plan Administrator has given the Claim Administrator
the initial authority to establish or construe the terms and
conditions of the Health Benefit Plan and the discretion to
interpret and determine benefits in accordance with the
Health Benefit Plan’s provisions.
The Plan Administrator has all powers and authority
necessary or appropriate to control and manage the
operation and administration of the Health Benefit Plan.
All powers to be exercised by the Claim Administrator
or the Plan Administrator shall be exercised in a non-
discriminatory manner and shall be applied uniformly
to assure similar treatment to persons in similar
circumstances.
45
 VISION
Introduction Using a Network Versus a Non-Network Provider
The CMC Vision Plan is designed to help you pay for
Network Non-Network
annual vision exams and corrective eyewear. The plan is
Provider Must use a VSP Choice Use any licensed eye
flexible – it allows you to enroll for Premium Coverage or Network provider care provider outside
Basic Coverage and you can choose to receive care from the VSP network
network or non-network providers. The highest level of
benefits is available by enrolling for Premium Coverage
Benefit Your network provider Verify your eligibility
and using providers who participate in the plan’s network. Authorization obtains authorization for services. Submit
from VSP when you copy of your itemized
The plan is insured by Vision Service Plan (VSP). When you make your appointment receipt to VSP for
need assistance or have specific questions regarding this and identify yourself as reimbursement
a VSP member according to your
plan, contact Vision Service Plan at 1-800-877-7195 or go
schedule of allowances.
to the VSP website at www.vsp.com.
Benefits The plan pays a higher The plan pays a lower
benefit level, which benefit level, which
Refer to the glossary at the end of this handbook for means less out-of- means more out-of-
definitions of key terms. pocket cost for you pocket cost for you
Claims Your provider files You pay up front for
Vision Plan Options claims on your behalf services rendered and
When you enroll for coverage, you may choose among the then submit itemized
following options for you and your eligible dependents: receipt to VSP for
■■ Premium Coverage
reimbursement.
Additional Available, which means Not available
■■ Basic Coverage Discounts and your share of the cost
■■ No vision coverage Savings for additional purchases
will be less
VISION

Your elections remain in effect for the entire calendar

Using Network Services
year. You generally cannot make changes until the next
The VSP Choice network of providers includes
Open Enrollment period unless you experience a qualified
optometrists and ophthalmologists who have contracted
status change or become eligible for special enrollment,
with VSP to provide vision care to plan members.
as summarized in the Eligibility and Enrollment section of
this handbook. If you are planning to receive network services, follow
these steps.
■■ Find a VSP network provider by visiting the
Vision Benefits VSP website at www.vsp.com or calling VSP at
1‑800‑877‑7195.
Network and Non-Network Services
■■ Make an appointment with your VSP provider
The plan gives you a choice when it comes to receiving
and identify yourself as a VSP member. The network
eye care. You may receive services from either network or
provider will contact VSP to obtain benefit authorization
non-network providers. Although you are not required to
for services and eyewear before your appointment.
use VSP network providers, your out-of-pocket costs will
be lower when network providers are used. The following
If you do not identify yourself as a VSP member to a Choice
compares some of the key differences between receiving
Network provider and benefits are not authorized by VSP,
care from a network versus a non-network provider:
you are responsible for paying the provider for services
and eyewear.

VSP will pay the provider directly for covered services and
eyewear. You are responsible for paying any copays and/
or additional costs associated with cosmetic options,
noncovered services, or items in excess of plan benefits.

46
Using Non-Network Services
Non-network providers include any licensed optometrist,
ophthalmologist, or dispensing optician who is not
participating in the VSP network.
If you are planning to receive non-network services,
follow these steps.
■■ Contact VSP at 1-800-877-7195 to verify eligibility
before you make your appointment with the non-
network provider.
If you do not verify eligibility with VSP prior to making your
appointment, services and eyewear may not be eligible for
coverage under the plan.
Pay the provider the full fee for his/her services at the
time of your appointment.
■■ Submit an itemized receipt to VSP as summarized in
Vision Claims.
VSP will reimburse you in accordance with the Schedule
of Benefits. There is no assurance that the reimbursement
amount will be sufficient to pay the full cost of the
examination or eyewear.
Services received from a non-network provider are in
lieu of network services and count toward plan benefit
frequency limitations.

Schedule of Benefits
The following table provides a summary of the benefits under the plan. All benefits are subject to the plan’s limitations
and exclusions.
Schedule of Benefits
Premium Coverage Basic Coverage
Service Network Non-Network Network Non-Network
Annual Copay
• Exam $10 $15
• Materials $20 $25
Plan pays Plan pays

VISION
Vision exam
100% Up to $45 100% Up to $45
(once every calendar year)
Lenses
(complete set, not per lens; once every calendar year)
• Single vision
• Bifocal 100% Up to $45 100% Up to $45
• Trifocal 100% Up to $65 100% Up to $65
• Lenticular 100% Up to $85 100% Up to $85
100% Up to $125 100% Up to $125
Frame
Up to $150 Up to $47 Up to $120 Up to $47
(once every 2 calendar years)
Contact lens evaluation and fitting
(in lieu of lenses and frames)
• Visually necessary (prior authorization required) 100% Up to $210 100% Up to $210
• Elective Up to $120 Up to $105 Up to $120 Up to $105
Lens options
• Blended 100% Up to $65 Not covered Not covered
• Oversize 100% Not covered Not covered Not covered
• Progressive 100% Up to $85 Not covered Not covered
• Tinted/Photochromic 100% Up to $5 Not covered Up to $5
• Polycarbonate 100% Not covered 100% (only for Not covered
dependent children)
Low vision care
As necessary for severe visual problems not corrected
with regular lenses (limited to a maximum benefit of
$1,000 every 2 calendar years)
• Supplemental testing 100% Up to $125 100% Up to $125
• Supplemental aids 75% 75% 75% 75%
Discounts
(if eye exam has been provided by a network doctor within
the last 12 months)
• 20% on additional prescription glasses and sunglasses Available Not available Available Not available
• 15% on contact lens fitting and evaluation exam
• 20% off the amount over your frame allowance
• 20% - 25% discount on non-covered lens options
47
 Frequency Limitations
Vision exams and lenses are limited to once every
calendar year and frames are limited to once every two
calendar years. For example, if you have an eye exam on
May 1, the plan will not cover another eye exam until the
following January 1.
Benefit Authorization
Benefit authorization is the advance review and approval
process conducted by VSP. This process is required
and must be completed before you visit your provider as
follows:
■■ When you make an appointment with a network doctor
and identify yourself as a VSP member, the doctor
initiates the benefit authorization process.
■■ If you are planning to visit a non-network provider, you
should contact VSP to verify eligibility.
VSP authorizes benefits according to eligibility
information and the level of coverage (i.e., service
frequencies, covered materials, reimbursement
amounts, limitations and exclusions) under the plan.
In addition, VSP reviews your prior utilization of
plan benefits to determine if you are eligible for new
VISION
services. For example, VSP will not authorize coverage
for an eye examination if you have already had an
examination during the current calendar year.
A benefit authorization is issued only for a certain period
of time. If you do not receive services before the expiration
date, a new benefit authorization must be obtained.
Eligible Charges
Listed below are services and eyewear that are covered
under the plan. Any service or eyewear not specifically
listed is not covered unless VSP reviews the service or
supply and accepts the charges as eligible. Services and
eyewear must be visually necessary or appropriate and
all benefits are subject to the limitations and exclusions
under the plan.
Service/Supply Description
Vision exam Complete initial vision analysis that includes an
appropriate examination of visual functions and
the prescription of corrective eyewear where
indicated.
Lenses and Corrective eyewear and professional services
frames connected with the prescribing, ordering,
fitting, adjusting and follow-up associated with
that eyewear.
48
Service/Supply Description
Contact lenses • Visually Necessary contact lenses are
(in lieu of lenses covered in full, less any applicable copay,
and frames) when VSP benefit criteria is met and verified
by a VSP network doctor for eye conditions
that would prohibit the use of glasses.
When the member chooses a non-VSP
provider instead, the same medical condition
requirements and copay apply. The member
is reimbursed up to a standard $210
allowance.
• Elective contact lenses (selected in lieu of
lenses and frames for other than visually
necessary reasons) including standard eye
examination, contact lens evaluation, fitting,
and adjustments.
Contact lenses for cosmetic purposes (i.e.,
when no correction is necessary) are not
covered.
Low vision care Special aid for patients who have severe acuity
or visual field loss that cannot be corrected with
regular lenses. Coverage includes professional
services and ophthalmic materials including
but not limited to evaluation, diagnosis,
supplemental testing, evaluations, visual
training, low vision prescription services, and
optical and non-optical aids.
Limitations and Exclusions
This plan, like most plans, does not cover every vision
expense you or your covered dependents may incur. The
plan is designed to cover services and supplies that are
visually necessary or appropriate rather than cosmetic
eyewear.
Lens Limitations
If you select any of the following options, the plan will
pay the basic cost of the covered lenses and you will be
responsible for the additional cost of the options except
as otherwise specified in the Schedule of Benefits.
■■ Anti-reflective coating
■■ Blended lenses
■■ Certain low vision care options
■■ Color coating
■■ Cosmetic lenses
■■ Laminated lenses
■■ Mirror coating
■■ Optional cosmetic processes
■■ Progressive multifocal lenses
■■ Scratch coating
■■ Ultraviolet (UV) protected lenses
■■ Oversize lenses
Other Limitations and Exclusions
The plan also excludes benefits for professional services
or material connected with any of the following:
■■ Orthoptics or vision training and any associated
supplemental testing.
■■ Plano lenses (less than ±.50 diopter power).
■■ Two pairs of glasses in lieu of bifocals.
■■ Replacement of lenses and frames furnished under this
plan that are lost, broken or stolen except at intervals
when services are otherwise eligible.
■■ Medical or surgical treatment of the eyes.
■■ Corrective vision treatment of an experimental nature.
■■ Costs for services and eyewear above plan benefit
allowances summarized in the Schedule of Benefits.
■■ Services and eyewear not specified as covered under
the plan.
■■ Other services and materials for which charges are
incurred that are:
• Not specifically described as an eligible expense.
• For or in connection with an injury arising out of, or
in the course of, any employment for wage or profit.
• For or in connection with a sickness covered under
any workers’ compensation or similar law.
• For charges made by a facility owned or operated
by, or which provides care or performs services
for, the United States government, if those charges
are directly related to a military-service-connected
sickness or injury.
• For charges that you are not legally required to pay.
• For charges that would not have been made if you
had no insurance.
The above is not an all-inclusive list. Contact VSP if you
have a question about a particular vision service or
expense. You should keep in mind that any additional care,
service, and/or materials not covered under this plan may
be arranged between you and your doctor. In this event,
you are responsible for the entire cost of these expenses.
Visually Necessary Contact Lenses
Visually Necessary contact lenses are covered in full, less
any applicable copay, when VSP benefit criteria is met
and verified by a VSP network doctor for eye conditions
that would prohibit the use of glasses. When the member
chooses a non-VSP provider instead, the same medical
condition requirements and copay apply. The member is
reimbursed up to a standard $210 allowance.
Prior Authorization Determinations and Appeals
VSP will approve or deny requests for prior authorization
within 15 calendar days of receipt of the request from
your doctor. In the event that a prior authorization
determination cannot be completed within that time
period, VSP may extend the time period by up to an
additional 15 calendar days.
If VSP denies the request for prior authorization, you or
your doctor may appeal the denial by using the appeal
procedures available for denied claims under the plan. VSP
will provide an appeal determination within 30 calendar
days from the date a request for appeal is received.
Lost, Stolen or Broken Eyewear
If your lenses or frames are lost, broken, or stolen
while you are covered under the plan, VSP will process
your claim for benefits as a normal claim. Charges for
replacement will be covered only if they would otherwise
be eligible based on frequency limitations. For example,
if you break a lens, replacement would be covered only
if the lens is replaced after the end of the calendar year
during which you made the initial purchase.
Extension of Benefits
VISION
If your coverage terminates because the plan is
terminated and you are receiving services as of the
termination date, coverage will continue for that service
for up to six months after the termination date of the plan.
For example, if you receive authorization and order
glasses prior to the termination date of the plan, benefits
will be available for those glasses if you receive them
within six months following the date the plan terminates.
Customer Service
If you have a question or problem regarding access to
care or the quality of care, treatment or service, your
first step should be to contact VSP’s customer service
department. The customer service department will make
every effort to answer your question and/or resolve the
matter informally.
If a matter is not initially resolved to your satisfaction, you
may communicate a complaint or grievance to VSP orally or
in writing by using the complaint form that is available upon
request from the customer service department. You may
also submit written comments or supporting documentation
concerning the problem to assist in VSP’s review.
VSP will resolve the problem within 30 days after receipt,
unless special circumstances require an extension of time. If
an extension is needed, VSP will notify you of the extension
period and the expected resolution date. Resolution will be
achieved as soon as possible, but no later than 120 days
after VSP’s receipt of your complaint. Upon final resolution,
you will be notified of the outcome in writing.
49
 Vision Claims
Filing a Claim
For purposes of filing claims and claim appeals, the term
“you” includes you, your dependent who is filing a claim,
or an authorized representative who is filing a claim on
your or your dependent’s behalf.
Network Providers
When you use a network doctor, he/she files claims with
VSP.
Non-Network Providers
You must submit your claim to VSP within six months
following the date you receive services from a non-network
provider. You may submit your claim by completing the
Out-of-Network Reimbursement Form at www.vsp.com
or by mailing the following information to VSP:
■■ Itemized, original receipt listing the services you
received.
■■ Name, address and phone number of the non-network
provider.
■■ Last 4 digits of the employee’s SSN.
VISION
■■ Employee name, phone number and address.
■■ Employer name (CMC).
■■ Patient name, date of birth, phone number and
address.
■■ Patient relationship to the covered member (such as
“self,” “spouse,” “child”).
Keep a copy of the information and mail the originals to:
VSP
Attn: Out-of-Network Provider Claims
P.O. Box 997105
Sacramento, CA 95899-7105
Vision Service Plan (VSP) is the named fiduciary for
adjudicating claims for benefits under the plan, and for
deciding any appeals of denied claims.
VSP has the authority, in its discretion, to interpret the
terms of the plan, to decide questions of eligibility for
coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by VSP are final
and binding on participants and beneficiaries to the full
extent permitted by law.
50
Claim Review
Generally, VSP will pay or deny a claim within 30 days of
receiving the claim. However, if a determination cannot
be made within the 30-day period, VSP may extend the
claim review period for an additional 15 days.
Denied Claims and Appeals
If the claim is denied in whole or in part, VSP will notify
you in writing of the reasons for the denial.
First Level Appeal
If your claim is denied, you may appeal the decision by
requesting a review of the denial within 180 days of the
date you receive the denial notice. You may make your
request by phone or in writing to:
VSP
Attn: Appeals Dept.
PO Box 2350
Rancho Cordova, CA 95741
1-800-877-7195
Your appeal must include the following information:
■■ Employee name and VSP ID number
■■ Patient name and date of birth
■■ Provider name
■■ Claim number
You may also include the reasons you believe that the
claim denial was in error and any related documents that
you wish to be reviewed.
VSP will conduct its review and give you the opportunity
to review pertinent documents and to submit any
statements, documents, or written arguments to support
your claim. You may choose to appear in person to
present materials or arguments.
VSP’s determination, including specific reasons for the
decision, will be provided to you within 30 days after it
receives your request for appeal.
Second Level Appeal
If you disagree with VSP’s determination on your first level
appeal, you may request a second level appeal within 60
calendar days following the date you receive the appeal
denial. VSP will review and resolve the second level appeal
within 30 days after it receives your request for appeal.
Alternative Dispute Resolutions
If your second level appeal is denied, additional voluntary
alternative dispute resolution options may be available,
including mediation and arbitration. Contact the U. S.
Department of Labor or the state insurance regulatory
agency for information. Additionally, you have the right to
bring a civil action under ERISA if you disagree with the
claim appeal process determination.
DENTAL
Introduction
CMC dental coverage is designed to assist you and
your covered dependents by paying a portion of eligible
expenses incurred for a wide range of dental services.
This plan is self-funded by your Employer and claims are
administered by Delta Dental Insurance Company (Delta
Dental). When you need assistance or have specific
questions regarding this plan, contact Delta Dental at
1-800-521-2651 or www.deltadentalins.com.
Dental Benefits
Deductible
The deductible is the amount you must pay for covered
dental expenses before certain plan benefits are payable.
The deductible is in addition to the coinsurance amounts
you pay for dental treatment.
Individual Deductible
You and each of your covered dependents must satisfy a
deductible of $50 each calendar year.

Refer to the glossary at the end of this handbook for Family Deductible
definitions of key terms. Regardless of the number of family members covered
under the plan, the maximum deductible per family is
Dental Plan Options $150 each calendar year.
When you enroll for coverage, you may choose
among the following options for you and your eligible Expenses That Do Not Apply to the Deductible
dependents: The following expenses do not apply to the deductible:

■■ Premium Coverage ■■ Expenses for dental services or supplies that are not
covered under the plan.
■■ Basic Coverage
■■ Expenses for non-network services that exceed
■■ No dental coverage
reasonable and customary charges.
Your elections remain in effect for the entire calendar ■■ Coinsurance amounts.
year. You generally cannot make changes until the next
Open Enrollment period unless you experience a qualified
status change or become eligible for special enrollment,
as summarized in the Eligibility and Enrollment section of
this handbook.

Schedule of Benefits
The following table provides a summary of the dental benefits under the plan. All benefits are subject to the plan’s
limitations and exclusions.

DENTAL
Schedule of Benefits
Premium Coverage Basic Coverage
Network Non-Network Network Non-Network
Annual Deductible
• Individual $50 $50
• Family $150 $150
Annual Maximum Benefits (per person) $1,500 $1,000
Lifetime Orthodontia Maximum
$1,500 Not applicable
Dependent Child
Plan pays Plan pays
Diagnostic and Preventive 100% 100% 100% 100%
Basic Services 80% after deductible 80% after deductible 50% after deductible 50% after deductible
Major Services 50% after deductible 50% after deductible Not covered Not covered
Orthodontia (Only for children under
age 26 who have orthodontic appliances
50% 50% Not covered Not covered
initially installed while they are covered
under a CMC-sponsored dental plan)

51
 Charge Limits
The plan limits the amount of a dentist’s charges that will
be considered for the purpose of calculating benefits.
■■ Contract Allowance
The maximum amount Delta Dental will use for
calculating the Benefits for a Single Procedure. The
Contract Allowance for services provided:
• By Delta Dental PPO Dentists is the lesser of the
Dentist’s submitted fee, the Delta Dental PPO
Dentist’s Fee or the Dentist’s filed fee with Delta
Dental in the Contracting Dentist Agreement.
• By Delta Dental Premier Dentists (who are not PPO
Dentists) is the lesser of the Dentist’s submitted
fee, the Dentist’s filed fee with Delta Dental in the
Contracting Dentist Agreement or the Maximum
Plan Allowance (MPA); or
• By Non-Delta Dental Dentists is the lesser of the
Dentist’s submitted fee or the MPA.
■■ Maximum Plan Allowance (MPA)
The maximum amount Delta Dental will reimburse for a
covered procedure. Delta Dental establishes the MPA
for each procedure through a review of proprietary filed
fee data and actual submitted claims. MPAs are set
annually to reflect charges based on actual submitted
claims from providers in the same geographical area
with similar professional standing. The MPA may vary
by the type of contracting Dentist.
Network and Non-Network Dentists
The plan allows you to visit any licensed dentist you
choose. However, if you use a network dentist, you may
receive a higher level of benefits and save on out-of-
pocket costs.
DENTAL
Network dentists are those that participate in the
Delta Dental Premier and/or PPO network. Dentists
participating in the program have agreed to limit their
charges for dental services to Delta Dental Maximum
Plan Allowance (MPA).
A list of Delta Dental Dentists can be obtained by
accessing the Delta Dental National Dentist Directory at
www.deltadentalins.com or by calling 1-800-521-2651.
You are responsible for verifying whether the Dentist you
select is a PPO Dentist or a Premier Dentist. Dentists are
regularly added to the panel. Additionally, you should
always confirm with the dentist’s office that a listed Dentist
is still a contracted PPO Dentist or a Premier Dentist.
52
Using a Network Dentist
When you schedule an appointment with a network
dentist, you should:
■■ Identify yourself as being covered Premier or under the
plan and eligible for services under the PPO plan.
■■ Confirm that the dentist is currently participating in the
Premier or PPO plan.
Benefits are based on the covered percentage of the
contract allowance. You are responsible for paying:
■■ Your deductible.
■■ Any coinsurance amount.
■■ Any portion of the contract allowance that is not
covered under the plan.
■■ Charges for any service that is not covered under the
plan.
Using a Non-Network Dentist
Schedule an appointment with any licensed dentist you
choose. Benefits are based on the covered percentage of
the contract allowance. (Non-network dentists may charge
you more than the reasonable and customary charge.) You
are responsible for paying:
■■ Your deductible.
■■ Any coinsurance amount.
■■ Any portion of the contract allowance that is not
covered under the plan.
■■ Any amount in excess of the contract allowance.
■■ Charges for any service that is not covered under the
plan.
PPO Dentist
The PPO program potentially allows you the greatest
reduction in your out-of-pocket expenses, since this
select group of Dentists in your area will provide dental
benefits at a charge which has been contractually agreed
upon between Delta Dental and the PPO Dentist.
Premier Dentist
The Premier Dentist, which include specialists
(endodontists, periodontists or oral surgeons), has not
agreed to the features of the PPO program; however, you
may still receive dental care at a lower cost than if you
use a Non-Network Dentist.
Non-Network Dentist
If a Dentist is a Non-Network (Non-Delta Dental) Dentist,
the amount charged to you may be above that accepted
by the PPO or Premier Dentists. Non-Network Dentists
can balance bill for the difference between the Maximum
Plan Allowance (MPA) and the Contract Allowance. For
a Non-Network Dentist, the approved amount is the
dentist’s submitted charge.
Additional advantages of using a PPO Dentist or
Premier Dentist
■■ The PPO Dentist and Premier Dentist must accept
assignment of benefits, meaning PPO Dentists and
Premier Dentists will be paid directly by Delta Dental
after satisfaction of the deductible and coinsurance,
and the Enrollee does not have to pay all the dental
charges while at the dental office and then submit the
claim for reimbursement.
■■ The PPO Dentist and Premier Dentist will complete
the dental claim form and submit it to Delta Dental for
reimbursement.
Orthodontia Treatment
(Premium Coverage, children up to age 26 only)
If you elect Premium Coverage under the plan,
orthodontic treatment generally consists of initial
placement of an appliance and periodic follow-up visits.
(Orthodontic treatment is not available under basic
coverage.) The benefit payable for the initial placement
will not exceed 20% of the maximum benefit amount for
orthodontia. The remaining benefit payable for periodic
follow-up visits is payable on a monthly basis during the
course of the orthodontic treatment.
If the initial placement was made while the patient was
not covered under a CMC-sponsored dental plan,
orthodontia treatment is not covered under this plan.
Alternate Benefit Determination
If Delta Dental determines that more than one dental
service will adequately and appropriately treat a dental
condition, benefits are limited to the least expensive
service. Delta Dental makes determinations according to
generally accepted dental standards for adequate and
appropriate care. Examples are:
■■ If an amalgam filling and a composite filling are both
professionally acceptable methods for filling a molar,
the benefit determination may be based on the
amalgam filling, which is the less costly service.
■■ If a filling and an inlay are both professionally
acceptable methods for treating tooth decay or
breakdown, the benefit determination may be based on
the filling, which is the less costly service.
■■ If a filling and a crown are both professionally
acceptable methods for treating tooth decay or
breakdown, the benefit determination may be based on
the filling, which is the less costly service.
■■ If a partial denture and fixed bridgework are both
professionally acceptable methods for replacing
multiple missing teeth in an arch, the benefit
determination may be based on the partial denture,
which is the less costly service.
You and your dentist may apply your benefits to the
treatment of your choice; however, you are responsible
for any expenses that exceed the amount payable for the
least expensive service.
You are encouraged to request a pretreatment estimate
of benefits from Delta Dental before you begin extensive
dental treatment. This allows you and your dentist to
know in advance what benefits are available before
treatment begins.
Pre-Treatment Estimates
A Dentist may file a claim form before treatment, showing
the services to be provided to you. Delta Dental will
predetermine the amount of benefits payable for the listed
services. Benefits will be processed according to the plan
terms when the treatment is performed. Pre-treatment
estimates are valid for 60 days, or until an earlier
occurrence of any one of the following events:
■■ The date the plan contract terminates;
■■ The date the patient’s coverage ends; or
■■ The date the PPO Dentist’s or Premier Dentist’s
agreement with Delta Dental ends.
DENTAL
Missing Teeth
Coverage is limited for treatment to replace congenitally
missing teeth and teeth that are lost before a person
becomes covered under the plan, as summarized
in Covered Services. The initial installation of a
prosthodontic appliance and/or implants is not covered
unless the prosthodontic appliance and/or implant, bridge
or denture is made necessary by natural, permanent
teeth extraction occurring during a time the patient was
eligible under a CMC-sponsored dental plan.
53
 Covered Services
The following services are covered under the plan. (“Year” refers to a calendar year.)

Diagnostic and Preventive Services

Premium Coverage Basic Coverage
Covered Service Limitations/Comments
Cleaning (prophylaxis) Limited to 2 cleanings every 12 months Limited to 2 cleanings every 12 months
Oral examination Limited to 2 exams every 12 monthsr Limited to 2 exams every 12 months
Panoramic (Panorex) x-ray Limited to 1 x-ray every 5 years Limited to 1 x-ray every 5 years
Space maintainers Children under age 15 only Children under age 15 only
Topical fluoride treatment Children under age 19 only Children under age 19 only
Basic Restorative Services
Premium Coverage Basic Coverage
Covered Service Limitations/Comments
Bitewing x-rays Limited to 2 sets per child every 12 months; 1 Limited to 2 sets per child every 12 months; 1
set per adult every 12 months set per adult every 12 months
Addition of teeth to a partial removable Only to replace natural teeth that are removed Only to replace natural teeth that are removed
denture while the patient is covered under the plan while the patient is covered under the plan
Application of desensitizing medications where Limited to 1 application in a 24-month period Limited to 1 application in a 24-month period
periodontal treatment (including scaling, root
planing, and periodontal surgery such as
osseous surgery) has been performed
Consultations Limited to 1 consultation in a 12-month period Limited to 1 consultation in a 12-month period
Denture adjustment Only if at least 6 months have passed since Only if at least 6 months have passed since
the installation of the denture the installation of the denture
Denture repair – –
Diagnostic casts – –
Emergency palliative treatment to relieve tooth – –
pain
Filling - amalgam Limited to 1 filling in a 24-month period Limited to 1 filling in a 24-month period
Filling - resin Limited to 1 filling in a 24-month period Limited to 1 filling in a 24-month period
General anesthesia or intravenous sedation in Covered only if Delta Dental determines that Covered only if Delta Dental determines that
connection with oral surgery and periodontal anesthesia is necessary in accordance with anesthesia is necessary in accordance with
DENTAL

procedures generally accepted dental standards generally accepted dental standards

Injections of therapeutic drugs
Intraoral-periapical and extraoral x-rays
Local chemotherapeutic agents
Oral surgery
Periodontal maintenance where periodontal
treatment (including scaling, root planing, and
periodontal surgery, such as gingivectomy,
gingivoplasty, gingival curettage and osseous
surgery) has been performed
Periodontal scaling and root planing
Periodontal surgery, including gingivectomy,
gingivoplasty, gingival curettage and osseous
surgery
Pulp capping (excluding final restoration)
and therapeutic pulpotomy (excluding final
restoration)
Pulp therapy and apexification/recalcification
– –
– –
– –
– –
Limited to 4 times in a year less the number of Limited to 4 times in a year less the number of
teeth cleanings received during that 12-month teeth cleanings received during that 12-month
period period
Limited to 1 per quadrant in a 24-month Limited to 1 per quadrant in a 24-month
period period
Limited to 1 surgical procedure per quadrant Limited to 1 surgical procedure per quadrant
in a 36-month period in a 36-month period
– –
– –

54

Pulp vitality, diagnostic photographs, and
bacteriological studies for determination of
bacteriologic agents
Re-cementing of cast restorations
Root canal treatment
Sealants applied to non-restored, non-
decayed first and second permanent molars,
excluding wisdom teeth
Sedative fillings
Simple extractions
Simple repairs of cast restorations
Surgical extractions
Tissue conditioning
Covered Service
Core buildup
Fixed and removable appliances for correction of
harmful habits
Implant supported prosthetics
Implants
Initial installation of cast restorations
Initial installation of full or removable dentures
Labial veneers
Posts and cores
Prefabricated stainless steel crown or
prefabricated resin crown
Relinings and rebasings of existing removable
dentures
Repair of implant supported prosthetics
Repair of implants
Replacement of a non-serviceable denture
Replacement of an immediate, temporary full
denture with a permanent full denture
Replacement of any cast restoration with the
same or a different type of cast restoration
Basic Restorative Services Continued
– –
– –
Limited to 1 treatment in a 24-month period Limited to 1 treatment in a 24-month period
for the same tooth for the same tooth
Children under age 15 only; limited to 1 Children under age 15 only; limited to 1
application every 3 years application every 3 years
– –
– –
– –
– –
Limited to 1 conditioning in a 36-month period Limited to 1 conditioning in a 36-month period
Major Services
Premium Coverage Basic Coverage
Limitations/Comments
Limited to once per tooth in a 5-year period Not covered
– Not covered
Limited to once for the same tooth position in a Not covered
5-year period
Limited to once for the same tooth position in a Not covered
5-year period
– Not covered
Only to replace congenitally missing teeth or Not covered
natural teeth that are removed while the patient
is covered under the plan
Limited to once per tooth in a 5-year period Not covered
DENTAL
Limited to once per tooth in a 5-year period Not covered
Limited to 1 in a 24-month period Not covered
Only if at least 6 months have passed since the Not covered
installation of the existing removable denture and
not more than once in a 36-month period
Limited to once in a 12-month period Not covered
Limited to 1 repair in a 12-month period Not covered
Only if at least 5 years have passed since the Not covered
installation of the denture
Only if the immediate, temporary full denture Not covered
cannot be made permanent and the replacement
is done within 12 months of the installation of the
immediate, temporary full denture
Limited to 1 replacement for the same tooth Not covered
surface within 5 years of a prior replacement
55
 Orthodontic Services
Premium Coverage Basic Coverage
Covered Service Limitations/Comments
Orthodontia Only for children under age 26 who have Not covered
orthodontic appliances initially installed while
they are covered under a CMC-sponsored dental
plan
Delta Dental will pay benefits only for the types of dental services as described above. These services must be provided
by a dentist and must be necessary and customary under generally accepted dental practice standards. Delta Dental may
use dental consultants to review treatment plans, diagnostic materials and/or prescribed treatments to determine generally
accepted dental practices. If you receive dental services from a Dentist outside the state of Texas, the dentist will be
reimbursed according to Delta Dental’s network payment provisions for that state according to the terms of the contract.

If a comprehensive dental procedure includes component or interim procedures that are performed at the same time as
the comprehensive procedure, the component or interim procedures are considered to be part of the comprehensive
procedure for purposes of determining the benefit payable. If the Dentist bills separately for the comprehensive
procedure and each of its component or interim parts, the total benefit payable for all related charges will be limited to
the maximum benefit payable for the comprehensive procedure.

Coordination of Benefits Coordination of Benefits Rules

When you are covered under this plan and another
plan that provides benefits or services for an allowable
expense, one plan pays benefits first, and the other pays
second.
Certain rules are used to determine which plan pays first –
the primary plan, and which pays second – the secondary
plan. When this plan’s benefits are secondary, benefits are
coordinated so that the total benefits from all plans are no
more than the maximum payable under this plan.
A plan without a coordination of benefits provision is
always the primary plan. Other coordination of benefit
DENTAL
Dependent or A plan that covers a person other than as
Non-Dependent a dependent (for example, as an employee,
member, subscriber, or retiree) is primary and
pays benefits before a plan that covers the
person as a dependent. Medicare exception
- the order of benefits between the two plans
is reversed and the plan that covers the
person as a dependent is primary if a person
is a Medicare beneficiary and, as a result of
federal law or regulations, Medicare is:
• Secondary to the plan covering the person
as a dependent, and
• Primary to the plan covering the person
as other than a dependent (e.g., a retired

rules are shown in the following table. The first rule in the employee).
table that allows Delta Dental to determine which plan is
primary is the rule used to coordinate benefits. Child Covered When this plan and another plan cover the
Under More Than same child as the dependent of two or more
In no event will this plan pay more than it would pay if it One Plan – Court parents, and the specific terms of a court
were the primary plan. Decree decree state that one of the parents must
provide health coverage or pay for the child’s
Delta Dental matches the benefits under this program health care expenses, that parent’s plan is
with your benefits under any other group prepaid program primary if this plan has been notified of the
or benefit plan. (This does not apply to a blanket school court decree. This rule does not apply to any
accident policy). Benefits under one of the programs calendar year in which benefits have been
paid for that child before this plan is notified
may be reduced so that your combined coverage does
of the court decree.
not exceed the dentist’s fees for the covered services.
If this is the “primary” program, Delta Dental will not
reduce benefits, but if the other program is the primary
one, Delta Dental will reduce benefits otherwise payable
under this program. The reduction will be the amount paid
for or provided under the terms of the primary program
for services covered under the Contract (see Benefits and
Limitations).

56
Coordination of Benefits Rules Continued
Child Covered When this plan and another plan cover the
Under More Than same child as the dependent of two or more
One Plan – The parents, the primary plan is the plan of the
Birthday Rule parent whose birthday falls earlier in the year
if any of the following apply:
• The parents are married.
• The parents are not separated (whether or
not they have ever married).
• A court decree awards joint custody
without specifying which parent must
provide health coverage.
If both parents have the same birthday, the
plan that has covered either of the parents
for a longer period of time is the primary
plan. However, if the other plan does not have
this rule but instead has a rule based on the
gender of the parent and, as a result, the
plans do not agree on the order of benefits,
the rule in the other plan will determine the
order of benefits.
Child Covered When this plan and another plan cover the
Under More same child as the dependent of two or more
than One Plan – parents, and the parents are not married,
Custodial Parent or are separated (whether or not they ever
married), or are divorced, the primary plan is
the first of the following:
• The plan of the custodial parent.
• The plan of the spouse of the custodial
parent.
• The plan of the non-custodial parent.
• The plan of the spouse of the non-custodial
parent.
Active or Inactive A plan that covers a person as an employee
Employee who is neither laid off nor retired is primary
to a plan that covers the person as a laid-off
or retired employee (or as that person’s
dependent). If the other plan does not have
this rule and, if as a result, the plans do not
agree on the order of benefits, this rule does
not apply.
Continuation The plan that covers a person as an active
Coverage employee, member or subscriber (or as that
person’s dependent) is primary to a plan
that covers that person under a right of
continuation pursuant to federal law (e.g.,
COBRA) or state law. If the other plan does
not have this rule, and, as a result, the plans
do not agree on the order of benefits, this rule
does not apply.
Longer/Shorter If none of the above rules determine which
Time Covered plan is primary, the plan that has covered the
person for the longer period of time will be
primary to a plan that has covered the person
for a shorter period of time.
No Rules Apply If none of the above rules apply, the allowable
expenses are shared equally among all the
plans.
Effect on Plan Benefits
When this plan’s benefits are secondary, benefits are
reduced so that the total benefits from all plans pay no
more than the maximum payable under this plan. Benefits
payable under other plans include all benefits that would
be payable if proper claims had been submitted in a timely
manner.
Information Sharing and Recovery of
Overpayments
Delta Dental reserves the right to obtain and exchange
benefit information from any other insurance company,
organization, or individual to coordinate benefits. If an
overpayment is made, Delta Dental reserves the right to
recover the excess payment from the insurance company,
organization, or individual to whom payment has been
made. You may be required to provide information or
documents and/or take any other steps necessary
to assist Delta Dental with obtaining information or
recovering overpayments.
Limitations and Exclusions
Delta Dental will pay for routine oral examinations and
cleanings (including periodontal cleanings) no more than
twice in any 12 month period while you are enrolled
under any Delta Dental program or dental care program
provided by the company.
■■ Periodontal cleanings are covered as a Basic Service
■■ Routine cleanings are covered as a Diagnostic and
Preventive Benefit.
■■ Additional benefits are covered during pregnancy.
Here are some examples that illustrate how the “twice in
any 12 month period” limitation works:
DENTAL
Example 1
Dates of Service Status
7/2/13 Paid
12/28/13 Paid
6/30/13 Denied
Member not eligible until 7/2/2014 or later
Example 2
Dates of Service Status
7/2/13 Paid
12/28/13 Paid
7/5/14 Paid
Covered services do not include, and no payment will be
made for the following:
■■ Adjustment of a denture made within six months after
installation by the same dentist who installed it.
■■ Appliances or treatment for bruxism (grinding teeth),
including but not limited to occlusal guards and night
guards.
57
 ■■ Caries susceptibility tests.
■■ Charges made by a dentist on a separate basis for:
• Claim form completion.
• Infection control such as gloves, masks, and
sterilization of supplies.
• Local anesthesia, non-intravenous conscious
sedation or analgesia such as nitrous oxide.
■■ Counseling or instruction about oral hygiene, plaque
control, nutrition and tobacco.
■■ Decoration or inscription of any tooth, device,
appliance, crown or other dental work.
■■ Dental services arising out of accidental injury to the
teeth and supporting structures, except for injuries to
the teeth due to chewing or biting of food.
■■ Duplicate prosthetic devices or appliances.
■■ Initial installation of a denture to replace one or more
teeth that were missing before the patient was covered
under the plan, except for congenitally missing teeth.
■■ Intra and extraoral photographic images.
■■ Missed appointments.
■■ Modification of removable prosthodontic and other
removable prosthetic services.
■■ Diagnosis and treatment of temporomandibular joint
disorders.
■■ Personal supplies or devices including, but not limited
to, water piks, toothbrushes, or dental floss.
■■ Precision attachments associated with fixed and
removable prostheses.
■■ Prescription drugs.
■■ Repair or replacement of an orthodontic device.
DENTAL
■■ Replacement of a lost or stolen appliance, cast
restoration or denture.
■■ Restoration of tooth structure damaged by attrition,
abrasion or erosion unless caused by disease.
■■ Restorations or appliances used for the purpose of
periodontal splinting.
■■ Services:
• Covered under any workers’ compensation or
occupational disease law.
• Covered under any employer liability law.
• For which the person receiving the services is not
required to pay.
• Received at a facility maintained by the Company,
labor union, mutual benefit association, or Veterans
Administration hospital.
■■ Services covered under other Company-sponsored
coverage.
58
■■ Services for which the submitted documentation
indicates a poor prognosis.
■■ Services for which you would not be required to pay in
the absence of dental insurance.
■■ Services or appliances that restore or alter occlusion or
vertical dimension.
■■ Services or supplies received by a person before he/
she becomes covered under the plan.
■■ Services that are neither performed nor prescribed by
a dentist except services of a licensed dental hygienist
which are supervised and billed by a dentist for teeth
scaling and polishing or fluoride treatments.
■■ Services that are not dentally necessary, those which
do not meet generally accepted standards of care for
treating the particular dental condition, or those which
Delta Dental deems experimental in nature.
■■ Services that are primarily cosmetic unless required for
the treatment or correction of a congenital defect of a
newborn child.
■■ Services, to the extent those services or benefits
for those services are available under a government
plan. This exclusion applies whether or not the person
receiving the services is enrolled for the government
plan. This exclusion does not apply if the government
plan requires that dental insurance under this plan be
paid first.
■■ Temporary or provisional appliances or restorations.
Additional Exclusions Under Basic Coverage
Covered expenses do not include, and no payment will
be made for the following under basic coverage:
■■ Core buildup and cast post and core.
■■ Fixed and removable appliances for correction of
harmful habits.
■■ Fixed partial dentures.
■■ Implants including, but not limited to, any related
surgery, placement, restorations, maintenance, and
removal.
■■ Initial installation or replacement of dentures.
■■ Labial veneers.
■■ Occlusal adjustments.
■■ Orthodontic services or appliances.
■■ Other fixed denture services.
■■ Prefabricated stainless steel crowns or resin crowns.
■■ Relinings and rebasings of dentures.
■■ Repair of implants.
Dental Claims
Filing a Claim
For purposes of filing claims and claim appeals, the term
“you” includes you, your dependent who is filing a claim,
or an authorized representative who is filing a claim on
your or your dependent’s behalf.
Claim forms are available on the Delta Dental website at
www.deltadentalins.com. Follow the instructions
ton the claim form carefully as this will expedite claim
processing.
When you file a claim, you must also submit proof of loss.
Proof of loss is written evidence provided at your expense
that establishes the nature and extent of the loss or
condition and your right to receive benefits.
Submit your claim and proof of loss as soon as you incur
a covered expense but no later than 90 days following the
date you receive the dental service. If it is not possible to
submit the claim and proof within 90 days, your claim will
not be invalidated or reduced if it is shown that they were
submitted as soon as reasonably possible.
All written proof of loss must be given to Delta Dental
within 6 months from the termination of this plan.
Failure to submit a claim form and proof of loss may
invalidate your claim. Filing a fraudulent claim is a crime
and may result in criminal and civil penalties.
Before approving a claim, Delta Dental will be entitled
to receive, to such extent as may be lawful, from any
attending or examining dentist, or from hospitals in which
a dentist’s care is provided, such information and records
relating to attendance to or examination of, or treatment
provided to, you as may be required to administer the
claim, or that you be examined by a dental consultant
retained by Delta Dental, in or near your community
or residence. Delta Dental will in every case hold such
information and records confidential.
The dental plan is funded by your employer and claims are
administered by Delta Dental.
The employer is liable for all benefits under this plan;
however, Dental Dental supervises and administers the
payment of claims.
Claim Review
Within 30 days of receiving your claim, Delta Dental will
conduct its review to determine whether or not benefits
are payable.
Delta Dental will notify you and your dentist if any
additional information is needed to process the claim
within this 30-day period. Delta Dental will process
the claim within 15 days of receipt of the additional
information.
If the requested information is not received within 45
days, the claim will be denied.
Payment of Claims
PPO Dentists and Premier Dentists will be paid directly.
Any other payments will be made to you, unless you
request when filing a claim that the payment be made
directly to the dentist providing the services.
If your claim is approved, benefits will be paid within 30
days from the date of receipt of claim.
If an overpayment is made, you are required to reimburse
the plan. Delta Dental may recover overpayments by
stopping or reducing future benefits, demanding a refund
of the overpayment from you, or taking legal action. If the
overpayment results from payment of benefits that should
have been paid by another plan, Delta Dental may take
appropriate steps to recover the overpayments from the
dental provider for whom payment was made.
Denied Claims
Delta Dental will notify the Primary Enrollee if Benefits are
denied for services submitted on a Claim Form, in whole
or in part, stating the reason(s) for denial. The Enrollee
DENTAL
has 180 days after receiving a notice of denial to appeal
it by writing to Delta Dental giving reasons why the denial
was wrong. The Enrollee may also ask Delta Dental to
examine any additional information he/she includes that
may support his/her appeal.
Appeal Procedure
Delta Dental will provide you with copies of documents,
records and other information relevant to your claim free
of charge. To appeal a denied claim, submit your appeal
to Delta Dental at the address indicated on the claim form
within 180 days of receiving the notice of claim denial.
This process is available twice for each claim – you may
appeal the initial determination (first appeal), and if the
claim is again denied under that appeal, you may appeal
that determination (second appeal).
59
 Appeals must be in writing and must include at least the
following information:
■■ Name of employee.
■■ Name of the plan.
■■ Reference to the initial decision.
■■ Whether the appeal is the first or second appeal of the
initial determination.
■■ An explanation of why you are appealing the
determination.
As part of each appeal, you may submit any written
comments, documents, records, or other information
relating to your claim.
After Delta Dental receives your written request
appealing the initial determination or determination on
the first appeal, a full and fair review of your claim will be
conducted. The review will look at the claim anew without
consideration of the previous denial. The review on
appeal will take into account all comments, documents,
records, and other information that you submit relating to
your claim without regard to whether the information was
submitted or considered in the previous determination.
The person who reviews your appeal will not be the same
person as the person who made the previous decision to
deny your claim. In addition, the person who is reviewing
the appeal will not be a subordinate of the person who
made the previous decision to deny your claim.
DENTAL
60
If the previous denial was based in whole or in part
on a medical judgment, Delta Dental will consult with
a health care professional with appropriate training
and experience in the field of dentistry involved in the
judgment. This health care professional will not be
one that was consulted on the previous determination,
and will not be a subordinate of any person who was
consulted on the previous determination.
You will be notified in writing of the final decision within 60
days after receipt of your written request for appeal. The
notice will state the reasons why the extension is needed
and indicate when a determination will be made.
If Delta Dental denies the claim on appeal, a final written
decision will be sent to you that states the reason why
the appealed claim is being denied and references to any
specific plan provisions on which the denial is based. If
applicable, the final written decision will state any internal
rule, protocol, guideline or other criteria relied upon in
denying the claim on appeal or indicate that the rule,
protocol, guideline or other criteria was relied upon and
that you may request a copy free of charge.
Legal Actions
A legal action on a claim may be brought against the plan
only during a certain period. This period begins 60 days
after the date you submit your proof of loss and ends
three years after the date the proof of loss was required
to be submitted.
SHORT TERM DISABILITY
Introduction
The CMC Short Term Disability (STD) Plan is designed to
replace a portion of your income if you are unable to work
due to a physical disease, injury, pregnancy, or mental
disorder.
The plan is administered by Standard Insurance Company
of Portland, Oregon (The Standard). When you need
assistance or have specific questions regarding this plan,
contact Employee Services.
Refer to the glossary at the end of this handbook for
definitions of key terms.
STD Benefits
Benefit Amount
If you are unable to work as a result of a disability that
begins while you are covered under the plan, you will
be eligible for benefits at the end of your benefit waiting
period. You may be eligible for benefits even while you are
working part-time during your disability, as summarized in
the Partial Disability provision.
Always notify your supervisor promptly if you are unable to
report to work for any reason.
The gross weekly STD benefit varies based on the length
of your disability:
Time Period Gross Weekly STD Benefit
0-7 days Benefit waiting period - no STD benefits
1-8 weeks 80% of predisability earnings
9-16 weeks 70% of predisability earnings
17-26 weeks 60% of predisability earnings
Generally, predisability earnings are your earnings in
effect on the day before your first day of disability –
refer to the glossary at the end of this handbook for a
complete definition.
Your gross weekly benefit amount is reduced by other
income benefits (such as state disability insurance). It may
also be reduced by any work earnings during your period
of disability. Please see Partial Disability section for more
information.
Benefit payments under the plan are considered taxable
income under current federal and state tax regulations
because CMC pays the cost of this benefit.
Weekly benefits are based on a five-day work week. If
an STD benefit is payable for less than a week, the plan
will pay 1/5th of the weekly benefit amount for each day of
disability during that week.
All benefits are subject to the plan’s limitations and
exclusions.
Disability Defined
You are considered disabled if The Standard determines
that, solely because of injury or sickness, you are:
■■ Unable to perform with reasonable continuity the
material duties of your own occupation, and
■■ Unable to earn more than 80% of your predisability
earnings from working in your own occupation.
Your loss of a professional or occupational license/
certification to perform the duties of your own occupation
does not alone mean that you are disabled.
When STD Benefits Begin
The number of days that must pass from the first day of
disability until benefits become available is referred to as
your benefit waiting period. Your benefit waiting period is
the first seven consecutive days during which you cannot
work because of your disability and STD benefits are
not paid during this period. Your benefits begin after The
Standard approves your claim and you have completed
your benefit waiting period.
For example, if your predisability earnings are $1,000 per
week, your disability benefit would be as follows:
Time Period Gross Weekly STD Benefit
0-7 days Benefit waiting period - no STD benefits
1-8 weeks $800 (80% of predisability earnings)
9-16 weeks $700 (70% of predisability earnings)
17-26 weeks $600 (60% of predisability earnings)
Your gross weekly benefit amount is reduced by other income
benefits and (such as state disability insurance). It may also be short Term
Disability
reduced by any work earnings during your period of disability.
Please see Partial Disability section for information.
61
 When STD Benefits End
Generally, STD benefits continue for up to 182 days in a
rolling 12 month period. However, STD benefits will end
on the earliest of:
■■ The date Long Term Disability benefits become
payable.
■■ The date you fail to provide proof of continued disability
or partial disability and regular attendance of a
physician.
■■ The date you fail to cooperate in the administration of
your claim. Cooperation includes, but is not limited to,
providing any information or documents needed to
determine whether benefits are payable or the actual
benefit amount due.
■■ The date you refuse to be examined or evaluated at
reasonable intervals.
■■ The date you refuse to receive appropriate available
treatment.
■■ The date you are able to work in your own occupation
and earn at least 20% of your predisability earnings,
but choose not to.
■■ The date your work earnings equal 80% of your
predisability earnings.
■■ The date you are no longer disabled as determined by
The Standard.
■■ The date your employment terminates.
■■ The end of the maximum benefit period.
■■ The date you die.
Successive Periods of Disability
If you receive benefits under the plan, you may
temporarily recover from your disability, and then become
disabled again, without having to complete a new benefit
waiting period. The following will apply:
■■ You recover for less than a total of 30 days.
■■ The subsequent disability results from the same or
related causes for which you previously received
benefits.
short Term
Disability
If any of the above do not apply, your subsequent
disability will be treated as a new disability and you must
satisfy another benefit waiting period before benefits will
become payable under the plan.
If you become covered under any other group short
term disability coverage, this provision will no longer
apply to you.
62
Partial Disability
If you are disabled but able to earn a portion of your
predisability earnings, you may be eligible for a partial
disability benefit. Amounts you make during a period of
partial disability are referred to as your work earnings.
Work earnings are any wage or salary for work performed
for any employer including commissions, bonuses,
overtime pay, or other extra compensation.
Depending on the amount of your work earnings, this
benefit allows you to continue to receive up to 100% of
your STD benefits while you are working, subject to the
maximum weekly benefit amount under the plan.
To be eligible for a partial disability benefit all of the
following must apply:
■■ Your partial disability must result from an injury or
sickness that occurs while you are covered under the
plan.
■■ You must be able to perform:
• One or more, but not all, of the material and
substantial duties of your own or any other
occupation on a part-time basis, or
• All of the material and substantial duties of your own
or any other occupation on a part-time basis.
■■ You must complete the benefit waiting period. (You
will be considered to have satisfied the benefit waiting
period if you are disabled, partially disabled, or a
combination of both during the period.)
Partial Disability Benefit
During any week in which you work, your STD benefit will
be reduced only if the gross weekly STD benefit and your
work earnings during partial disability exceed 100% of
your predisability earnings during any given week.
Each week, your work earnings are added to your gross
weekly STD benefit amount and:
■■ If the total does not exceed 100% of your predisability
earnings, your gross weekly STD benefit remains the
same.
■■ If the total exceeds 100% of your predisability earnings,
the amount in excess of 100% is subtracted from your
gross weekly STD benefit amount before reductions
are made for other income benefits. The remainder is
your weekly STD benefit.
For example, if prior to your disability you were regularly
scheduled to work 40 hours per week and your
predisability earnings were $1,000 per week ($25/hour),
your gross weekly STD benefit would be $800 ($1,000
x 80%). If your physician indicates that you may return
to work for three hours per day, two days per week (six
hours per week), your STD benefit would be calculated as
follows:
Partial Disability Benefit Calculation
1 Weekly predisability earnings $1,000
2 Gross weekly STD benefit
$800
(#1 multiplied by 80%)
3 Your weekly work earnings (reduced work schedule
$150
of 6 hours per week multiplied by $25 per hour)
4 Your weekly work earnings are added to your
$950
weekly STD benefit (#2 plus #3)
Because # 4 is less than # 1, your gross weekly STD benefit
remains the same. Keep in mind that your gross weekly benefit is
reduced by other income benefits whether or not you are working
during a period of disability.
Other Circumstances
Affecting STD
Benefits
Other Income Benefits
Gross weekly STD benefit amounts are reduced by the
amount of other income benefits available as a result of
the disability for which you are claiming benefits. This
includes any benefits for which you or your dependents
are eligible, or that are paid to you, your dependents,
or to a third party on your behalf. (For purposes of this
provision, your dependents include any persons who are
eligible to receive benefits based on your entitlement to
benefits.) Other income benefits include any amounts
from:
■■ Disability and/or retirement benefits under the United
States Social Security Act, the Canada Pension Plan,
the Quebec Pension Plan or any similar plan or act that:
• You receive or are eligible to receive.
• Your dependents receive or are eligible to receive
because of your disability or eligibility for retirement
benefits.
■■ Any other governmental program or coverage required
or provided by law (including any amount attributable to
your dependents).
■■ Any CMC sick leave or salary continuation plan.
■■ Any workers’ or workmen’s compensation benefits.
■■ Any unemployment compensation benefits.
Estimation of Benefits
Your benefits under this plan will be reduced by the
amount of other income benefits that The Standard
estimates are payable to you and/or your dependents.
However, your benefits will not be reduced by the
estimated amount if you are not receiving these benefits,
but do the following:
■■ Provide satisfactory proof that you have applied for
other income benefits,
■■ If applicable, provide satisfactory proof that all appeals
for other income benefits have been made on a timely
basis to the highest administrative level (unless The
Standard determines that further appeals are not likely
to succeed), and
■■ If applicable, submit satisfactory proof that other
income benefits have been denied at the highest
administrative level (unless The Standard determines
that further appeals are not likely to succeed).
The Standard will not estimate or reduce for any benefits
under a Company-sponsored pension or retirement plan
until you actually receive those benefits.
If The Standard overestimates the amount payable to
you from any other plans, you will be reimbursed for that
amount upon receipt of written proof of the amount of
other income benefits awarded (whether by compromise,
settlement, award or judgment) or denied (after the
highest administrative level appeal).
Increases in Other Income Benefits
An increase in an other income benefit due to a cost of
living adjustment that occurs after your STD benefits
begin will not further reduce your STD benefits. (This
does not apply to any cost of living adjustment for
earnings you receive for work performed for any employer
during your period of disability.)
Lump Sum Payments
If other income benefits are paid in a lump sum, The
Standard will prorate the lump sum over the period of
time those benefits would have been payable if they had short Term
Disability
not been paid in a lump sum. For example, if you receive
a lump sum payment of $2,400 for a 12-week period
of disability, your STD benefit will be reduced by $200
($2,400 divided by 12 weeks) during each applicable week.
Third Party Liability
If your injury or sickness appears to be someone else’s
fault, benefits otherwise payable under the plan as a
result of your injury or sickness will not be paid unless you
or your legal representative agrees:
63
 ■■ To repay The Standard for benefits paid under the
plan for your loss if compensation is paid to you for the
same loss by or on behalf of the person at fault.
■■ To allow The Standard a lien on that compensation and
to hold the compensation in trust for The Standard.
If benefits under the plan are paid to you or on your
behalf, The Standard will be entitled to all rights of
recovery that you have against the person at fault. These
rights (referred to as subrogation rights) will extend only to
recovery of the amount The Standard has paid.
You will be required to provide The Standard with any
necessary documents and to take any actions required to
secure the above rights to The Standard.
STD Limitations and
Exclusions
In addition to other limitations and exclusions under the
plan, STD benefits are not payable for a disability that
results directly or indirectly from:
■■ War, declared or undeclared, or any act of war.
■■ Intentionally self-inflicted injuries, while sane or insane.
■■ Active participation in a riot or violent disorder.
■■ The committing of or attempting to commit a felony.
■■ Injury that occurs because of or in the course of other
employment.
■■ Cosmetic surgery unless the surgery is in connection
with an injury or sickness sustained while covered
under the plan.
■■ A gender change, including, but not limited to, any
operation, drug therapy, or any other procedure related
to a gender change.
In addition, STD benefits are not payable during any
period of incarceration.
short Term
Disability
64
General STD
Provisions
Workers’ Compensation Insurance
The plan does not replace or affect any requirements for
coverage under any workers’ compensation insurance law.
STD Claims
Filing a Claim
For purposes of filing claims and claim appeals, the term
“you” includes you, an authorized representative who is
filing a claim on your behalf, or your beneficiary.
Claim forms are available from Employee Services. You
should submit your claim within 30 days following the
date you become disabled. When you file a claim, you
must also submit proof of loss at your expense. Proof of
loss is evidence in a form or format satisfactory to The
Standard that supports a claim for benefits. Proof
includes, but is not limited to, the following:
■■ Your attending physician’s completed and signed
statement.
■■ Supporting documentation from your attending
physician that supports the diagnosis, such as chart
notes, lab findings, test results, x-rays, and/or other
forms of objective medical evidence in support of a
claim for benefits.
Your proof of loss should be submitted to The Standard
within 30 days following the completion of your benefit
waiting period.
If it is not possible to submit the documents within the
applicable time periods, the claim will not be invalidated
or reduced if it is shown that the claim and proof of
loss were submitted as soon as reasonably possible.
However, the additional time allowed cannot exceed
one year following the date that your proof of loss was
originally required unless you are legally incapacitated.
If your claim is approved and you are receiving benefits,
you will be required to provide proof of continued
disability, the regular attendance of a physician, and
receipt of appropriate available treatment at intervals
determined by The Standard. You must submit proof of
continued loss within 30 days of The Standard’s request.
Failure to provide The Standard with proof of loss or any
other requested information may invalidate your claim.
Claim Review
The Standard will review your claim and determine
whether or not benefits are payable in accordance with
the terms and provisions of the plan.
During the review, The Standard may require additional
information regarding the claim or a physical examination
or evaluation at its expense. The Standard has the right to
examine/evaluate any person for whom a claim is made
as often as it determines to be reasonably necessary.
Failure to cooperate with The Standard’s request for
information or physical examination or evaluation may
invalidate your claim.
Generally, you will be notified of the claim decision within
45 days of receipt of your claim. However, the review
period may be extended by two 30-day periods if it
is determined to be necessary due to circumstances
beyond The Standard’s control. In this event, you will be
notified in writing before the end of the current review
period:
■■ That an extension is necessary.
■■ The standards on which benefit eligibility is based.
■■ The unresolved issues that prevent a claim decision.
■■ The additional information needed.
■■ The expected claim decision date.
If the review period is extended due to your failure to
submit necessary information, you will be given at least
45 days to provide the information. However, the review
period will be further extended by the number of days it
takes you to provide the information.
Payment of Claims
If your claim is approved, you will receive benefits in
accordance with plan provisions.
Overpayments
If an overpayment is made due to a circumstance such
as fraud, a plan administration/claim processing error, or
receipt of other income benefits, The Standard has the
right to full reimbursement. If an overpayment is made,
The Standard will take actions such as the following:
■■ Request a lump sum payment of the overpaid amount.
■■ Reduce any amounts that later become payable under
the plan.
■■ Take any appropriate collection activity.
■■ Place a lien, if not prohibited by law, in the amount of
the overpayment on the proceeds of any other income
benefits, whether they are paid on a periodic or lump
sum basis.
In the event of your death, an overpayment will be
recovered from any benefits payable under the plan.
Denied Claims
If your claim is denied, you will receive a notice of denial
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A description of any additional material or information
necessary to complete your claim and an explanation
of why that material or information is necessary.
■■ A description of the plan’s appeal procedures and time
frames, including a statement of your right to bring a
civil action under ERISA following an adverse decision
on appeal.
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion
or limit, an explanation of the scientific or clinical
judgment for the adverse decision or a statement that
the explanation will be provided free of charge upon
request.
You have the right to appeal the decision by making a
written request for appeal to The Standard within 180
days from the date you receive the claim denial. If you
do not make the request within that time period, you will
have waived your right to appeal.
The claim appeal procedure allows you the right to:
■■ Submit written comments, documents, records, and
other information relating to the claim for review by The
Standard.
■■ Request, free of charge, reasonable access to and
copies of all documents, records and other information
relevant to your claim.
■■ A review that takes into account all comments,
short Term
Disability
documents, records, and other information submitted
by you without regard to whether the information was
submitted or considered in the initial claim decision.
■■ A review that does not consider the initial adverse
decision and which is conducted neither by the
individual who made the initial adverse decision nor
his/her subordinate.
65
 ■■ If the appeal involves an adverse decision based on
medical judgment, a review of your claim by a health
care professional who has appropriate training and
experience in the applicable field of medicine and who
was neither consulted in connection with the initial
claim decision nor the subordinate of that individual.
■■ The identification of medical or vocational experts,
if any, consulted in connection with the claim denial
without regard to whether the advice was relied upon in
making the initial claim decision.
The Standard will review your appeal within 45 days after
receipt of your properly filed request for appeal. However,
the review period may be extended for an additional
45-day period if it is determined to be necessary due to
circumstances beyond The Standard’s control. In this
event, you will be notified in writing before the end of the
initial 45-day review period that an extension is necessary,
why the extension is necessary, and the expected
determination date. If the review period is extended due
to your failure to submit necessary information, the review
period will be further extended by the number of days it
takes you to provide the information.
short Term
Disability
66
If your appeal is denied, you will receive written notice
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A statement that you are entitled to receive, upon
request and free of charge, reasonable access to and
copies of all documents, records, and other information
relevant to your claim.
■■ Statements describing any voluntary appeal
procedures offered by The Standard, your right to
obtain information about the procedures, and your right
to bring an action under ERISA.
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion or
limit, an explanation of the scientific or clinical judgment
for the adverse decision or a statement that the
explanation will be provided free of charge upon request.
Legal Actions
No legal action may be taken against the plan:
■■ Until 60 days following the date you provide proof of
loss to The Standard.
■■ More than three years following the date you were
required to provide proof of loss to The Standard.
LONG TERM DISABILITY
Introduction
The CMC Long Term Disability (LTD) Plan is designed to
replace a portion of your income if you are unable to work
for an extended period due to a physical disease, injury,
pregnancy, or mental disorder. The plan also provides
support, services, and assistance to help you get back to
work and to an independent lifestyle.
The plan is insured by Standard Insurance Company
of Portland, Oregon (The Standard). When you need
assistance or have specific questions regarding this plan,
contact Employee Services.
Refer to the glossary at the end of this handbook for
definitions of key terms.
LTD Benefits
Benefit Amount
If you are unable to work because of a disability that
begins while you are covered under the plan, you will be
eligible to receive LTD benefits at the end of your benefit
waiting period. You may be eligible for benefits even
while you are working part-time during your disability, as
summarized in the Partial Disability provision.
The gross monthly LTD benefit is 60% of your
predisability earnings. Generally, predisability earnings
are your earnings in effect on the day before your first
day of disability – refer to the glossary at the end of this
handbook for a complete definition.
Your gross monthly benefit amount is reduced by other
income benefits (such as sick leave and Social Security
disability benefits). It is also reduced by any work earnings
during your period of disability. Work earnings are any
wage or salary for work performed for any employer
including commissions, bonuses, overtime pay, or other
extra compensation. The remainder is your monthly LTD
benefit subject to a:
■■ Minimum monthly benefit of $50
■■ Maximum monthly benefit of $10,000
Benefit payments under the plan are considered taxable
income under current federal and state tax regulations
because CMC pays the cost of this benefit.
Monthly benefits are based on a calendar month. If an
LTD benefit is payable for less than a month, the plan will
prorate of the monthly benefit amount for each day of
disability during that month.
All benefits are subject to the plan’s limitations and
exclusions.
Disability Defined
During your benefit waiting period (as summarized in the
When LTD Benefits Begin provision) and the following
24 months, you are considered disabled if The Standard
determines that you are unable to perform all of the
material and substantial duties of your own occupation
because of an injury or sickness.
After benefits have been paid for 24 months, you will be
considered disabled if The Standard determines that you
are unable to perform on a regular basis the material and
substantial duties of any occupation for which you are
or may reasonably become qualified based on training,
education, experience, age, and physical and mental
capacity.
Your loss of a professional or occupational license/
certification to perform the duties of your own occupation
does not alone mean that you are disabled.
When LTD Benefits Begin
The number of days that must pass from the first day of
disability until benefits become available is referred to as
your benefit waiting period. Your benefit waiting period
is 189 days. Your benefits begin after The Standard
approves your claim and you have completed your benefit
waiting period.
For example, if your predisability earnings are $4,000 per
month, your disability benefit would be as follows:
Beginning on the
189 Day Waiting 190th Day of Disability
Period Gross Monthly LTD Benefit
No LTD benefits $2,400 (60% of predisability earnings)
Your gross monthly LTD benefit is reduced by other income benefits
and any work earnings.
If you recover for 30 days or less during your benefit
waiting period, but cannot continue working due to
your disability, your benefit waiting period will not be
discontinued. However, the period will be extended by
one calendar day for each day you are at work.
long Term
Disability
67
 When LTD Benefits End Maximum Benefit Period
Generally, LTD benefits continue for up to the maximum The maximum benefit period depends on your age at the
benefit period. However, LTD benefits will end on the time you become disabled as shown in the following table:
earliest of:
■■ The date you fail to provide proof of continued disability
Your Age When Maximum
Disability Begins Benefit Period
or partial disability and regular attendance of a
To age 65
physician. 61 or under
(or 42 months, if longer)
■■ The date you fail to cooperate in the administration of 62 42 months
your claim. Cooperation includes, but is not limited to, 63 36 months
providing any information or documents needed to 64 30 months
determine whether benefits are payable or the actual 65 24 months
benefit amount due. 66 21 months
■■ The date you refuse to be examined or evaluated at 67 18 months
reasonable intervals. 68 15 months
■■ The date you refuse to receive appropriate available 69 or over 12 months
treatment.
Exceptions to the maximum benefit period are
■■ The date you refuse a job with the Company if summarized below.
workplace modifications or accommodations have
been made to allow you to perform the material and Limited Benefit Periods for Disabilities Due to
substantial duties of the job. Mental Disorder, Substance Abuse, and/or Other
Limited Conditions
■■ The date you are able to work in your own occupation
Payment of LTD benefits is limited to 12 months
on a part-time basis, but choose not to.
during your entire lifetime for a disability caused by
■■ The date your work earnings exceed 80% of your or contributed to by any one or more of the following:
predisability earnings. Because your work earnings medical or surgical treatment of mental disorders,
may fluctuate, The Standard will average earnings over substance abuse, or other limited conditions. However, if
three consecutive months rather than immediately you are confined in a hospital solely because of a mental
terminating benefits once your work earnings exceed disorder at the end of the 12 months, this limitation will
80% of your predisability earnings. not apply while you are continuously confined.
■■ The date you are no longer disabled according to plan
provisions.
Successive Periods of Disability
You may temporarily recover from your disability, and
■■ The end of the maximum benefit period. then become disabled again, from the same cause or
■■ The date you die. causes without having to complete a new benefit waiting
period if:
■■ Your recovery during the benefit waiting period is less
than a total of 30 days snd/or
■■ Your recovery during the maximum benefit period is
less than 180 days for each period of recovery.
If any of the above do not apply, your subsequent
disability will be treated as a new disability and you must
satisfy another benefit waiting period before benefits will
become payable under the plan.
long Term
Disability

68
Partial Disability and
Other Special LTD
Benefits
Partial Disability
If you are partially disabled but able to earn a portion
of your predisability earnings, you may be eligible for a
partial disability benefit. Amounts you make during a
period of partial disability are referred to as your work
earnings. Work earnings are any wage or salary for work
performed for any employer including commissions,
bonuses, overtime pay, or other extra compensation.
Depending on the amount of your work earnings, this
benefit allows you to continue to receive up to 100% of
your LTD benefits while you are working, subject to the
minimum and maximum monthly benefit amounts under
the plan.
To be eligible for a disability benefit while working, the
following must apply:
■■ You must be disabled as defined by the plan.
■■ You must suffer a loss of at least 20% of your
predisability earnings.
Separate calculations are used to determine disability
benefits during the first 12 months after you return
to work while disabled, and subsequent months as
summarized below.
Return to Work Incentive
During the first 12 months following completion of your
benefit waiting period, your benefit is reduced only
if your gross monthly LTD benefit and your earnings
during partial disability exceed 100% of your predisability
earnings during any given month.
Each month, your work earnings are added to your gross
monthly benefit amount and:
■■ If the total does not exceed 100% of your predisability
earnings, your gross monthly benefit remains the same.
■■ If the total exceeds 100% of your predisability earnings,
the amount in excess of 100% is subtracted from your
gross monthly benefit amount before reductions are
made for other income benefits. The remainder is your
monthly LTD benefit.
For example, if prior to your disability you were regularly
scheduled to work 40 hours per week and your
predisability earnings were $4,000 per month ($23.07 per
hour), your gross monthly LTD benefit would be $2,400
($4,000 x 60%). If your physician indicates that you
may return to work for two hours per day (40 hours per
month), your LTD benefit would be calculated as follows:
Disability Benefit Calculation During First 12 Months of
the Return to Work Incentive
1 Monthly predisability earnings $ 4,000.00
2 Gross monthly LTD benefit (#1 multiplied by 60%) $ 2,400.00
Your monthly work earnings (reduced work
schedule of 40 hours per month multiplied by
3 $23.07 per hour) $ 922.80
Your monthly work earnings are added to your
4 monthly LTD benefit (#2 plus #3) $ 3,322.80
Because line 4 is less than line 1, your gross monthly LTD benefit
remains the same. Keep in mind that your gross monthly benefit is
reduced by other income benefits whether or not you are working
during a period of disability.
Disability Benefit After the First 12 Months of
the Return to Work Incentive
After 12 months of partial disability benefits, your monthly
LTD benefit during partial disability is calculated using the
formula: (A ÷ B) x C.
A = Your monthly predisability earnings minus your
monthly work earnings. This is your amount of lost
earnings.
B = Your monthly predisability earnings.
C = Your gross monthly LTD benefit plus your monthly
work earnings.
For purposes of the return to work incentive and definition
of disability, the amount used as your monthly predisability
earnings will be adjusted annually by any increase in the
Consumer Price Index.
Rehabilitation Incentive Benefit
If The Standard determines that rehabilitation is appropriate
for your disability, you may be eligible to participate in a
program designed to help you return to work. A rehabilitation
program is a comprehensive, individually tailored, goal
oriented program to help return you to gainful employment.
The services offered may include the following:
■■ Training and education expenses
■■ Family care expenses
■■ Job-related expenses
long Term
Disability
■■ Job search expenses
69

Penalty for Failure to
Participate in Rehabilitation
No LTD benefits will be paid for any period of disability
when you are not participating in good faith in a plan,
program, or course of medical treatment or vocational
training or education approved by The Standard unless
your disability prevents you from participating.
Reasonable Accommodation
Expense Benefit
If you return to work in any occupation for any employer,
not including self-employment, as a result of a reasonable
accommodation made by such employer, The Standard
will pay that employer a reasonable accommodation
expense benefit of up to $25,000, but not to exceed the
expenses incurred.
The reasonable accommodation expense benefit is
payable only if the reasonable accommodation is approved
by The Standard in writing prior to its implementation.
Survivor Benefit
If you die while LTD Benefits are payable, and on the date
you die you have been continuously Disabled for at least
180 days, a Survivors Benefit will be paid to your eligible
survivor. This benefit is a lump sum equal to 3 times your
LTD Benefit without reduction by Deductible Income. (If
an overpayment is due to The Standard at the time fo
your death, the Survivors Benefit will first be applied to
reduce any overpayment of your claim.)
Survivor Benefits are paid to:
■■ Your surviving spouse;
■■ Your surviving children, including adopted children,
under age 25;
■■ Your spouse’s surviving children, including adopted
children, under age 25; or
■■ Any person providing the care and support of any
person listed above.
■■ Your estate, if you are not survived by any person listed
above.
long Term
Disability
70
Other Circumstances
Affecting LTD
Benefits
Other Income Benefits
Gross monthly LTD benefit amounts are reduced by the
amount of other income benefits available as a result of
the disability for which you are claiming benefits. This
includes any benefits for which you or your dependents
are eligible, or that are paid to you, your dependents,
or to a third party on your behalf. (For purposes of this
provision, your dependents include any persons who are
eligible to receive benefits based on your entitlement to
benefits.) Other income benefits include:
1. Sick pay, annual or personal leave pay, or other salary
continuation (but not vacation pay), paid to you by
CMC, if it exceeds the amount found in a., b., and c.
a. Determine the amount of your LTD Benefit as if there
were no Deductible Income, and add your sick pay
or other salary continuation to that amount.
b. Determine 100% of your Indexed Predisability
Earnings.
c. If a. is greater than b., the difference will be
Deductible Income.
2. Your Work Earnings, as described in the Return To
Work Provisions.
3. Any amount you receive or are eligible to receive
because of your disability, including amounts for partial
or total disability, whether permanent, temporary, or
vocational, under any of the following:
a. A workers’ compensation law;
b. The Jones Act;
c. Maritime Doctrine of Maintenance, Wages, or Cure;
d. Longshoremen’s and Harbor Worker’s Act; or
e. Any similar act or law.
4. Any amount you, your spouse, or your child under age
18 receive or are eligible to receive because of your
disability or retirement under:
a. The Federal Social Security Act;
b. The Canada Pension Plan;
c. The Quebec Pension Plan;
d. The Railroad Retirement Act; or
e. Any similar plan or act.
 Full offset: Both the primary benefit (the benefit
awarded to you) and dependents benefit are
Deductible Income.
Benefits your spouse or a child receives or are eligible
to receive because of your disability are Deductible
Income regardless of marital status, custody, or place
of residence. The term “child” has the meaning given in
the applicable plan or act.
5. Any amount you receive or are eligible to receive
because of your disability under any state disability
income benefit law or similar law.
6. Any amount you receive or are eligible to receive
because of your disability under another group
insurance coverage.
7. Any disability or retirement benefits you receive under
your Employer’s retirement plan.
8. Any earnings or compensation included in Predisability
Earnings which you receive or are eligible to receive
while LTD Benefits are payable.
9. Any amount you receive or are eligible to receiveunder
any unemployment compensation law or similar act or
law.
10. Any amount you receive or are eligible to receive
from or on behalf of a third party because of your
disability, whether by judgment, settlement or other
method. If you notify us before filing suit or settling
your claim against such third party, the amount used
as Deductible Income will be reduced by a pro rata
share of your costs of recovery, including reasonable
attorney fees.
11. Any amount you receive by compromise, settlement,
or other method as a result of a claim for any of the
above, whether disputed or undisputed.
Estimation of Benefits
Your benefits under this plan will be reduced by the
amount of other income benefits that The Standard
estimates are payable to you and/or your dependents.
However, your benefits will not be reduced by the
estimated amount if you are not receiving these benefits,
but do the following:
■■ Provide satisfactory proof that you have applied for other
income benefits,
■■ If applicable, provide satisfactory proof that all appeals
for other income benefits have been made on a timely
basis to the highest administrative level (unless The
Standard determines that further appeals are not likely
to succeed), and
■■ If applicable, submit satisfactory proof that other income
benefits have been denied at the highest administrative
level (unless The Standard determines that further
appeals are not likely to succeed).
The Standard will not estimate or reduce for any benefits
under a Company-sponsored pension or retirement plan
until you actually receive those benefits.
If The Standard overestimates the amount payable to
you from any other plans, you will be reimbursed for that
amount upon receipt of written proof of the amount of
other income benefits awarded (whether by compromise,
settlement, award or judgment) or denied (after the
highest administrative level appeal).
Increases in Other Income Benefits
An increase in an other income benefit due to a cost
of living adjustment that occurs after your LTD benefits
begin will not further reduce your LTD benefits. (This does
not apply to any cost of living adjustment for earnings you
receive for work performed for any employer during your
period of disability.)
Lump Sum Payments
If you are paid deductible income in a lump sum or by a
method other than monthly, The Standard will determine
your LTD Benefit using a prorated amount. The Standard
will use the period of time to which the deductible income
applies. If no period of time is stated, The Standard will
use a reasonable one.
Third Party Liability
If your injury or sickness appears to be someone else’s
fault, benefits otherwise payable under the plan as a
result of your injury or sickness will not be paid unless you
or your legal representative agrees:
■■ To repay The Standard for benefits paid under the
plan for your loss if compensation is paid to you for the
same loss by or on behalf of the person at fault.
■■ To allow The Standard a lien on that compensation and
to hold the compensation in trust for The Standard.
If benefits under the plan are paid to you or on your
behalf, The Standard will be entitled to all rights of
recovery that you have against the person at fault. These
rights (referred to as subrogation rights) will extend only to
recovery of the amount The Standard has paid.
You will be required to provide The Standard with any
necessary documents and to take any actions required to
secure the above rights to The Standard.
long Term
Disability
71
 LTD Limitations and
Exclusions
Preexisting Condition Limitation
LTD benefits are not payable for any disability that begins in
the first 12 months immediately following your effective date
of coverage if that disability is caused by or contributed
to by a preexisting condition. A preexisting condition is
a condition resulting from an injury or sickness that was
diagnosed or for which you received treatment within the
three-month period prior to your effective date of coverage.
Exclusions
In addition to other limitations and exclusions under the
plan, LTD benefits are not payable for any disability that is
due to:
■■ War, declared or undeclared, or any act of war.
■■ Intentionally self-inflicted injuries, while sane or insane.
■■ Active participation in a riot or violent disorder.
■■ The committing of or attempting to commit a felony.
In addition, LTD benefits are not payable during any
period of incarceration or after 12 months for each period
of continuous disability while you reside outside of the
United States or Canada.
General LTD
Provisions
Incontestability
Any statement made to obtain insurance or to increase
insurance is a representation and not a warranty.
No misrepresentation will be used to reduce or deny a
claim or contest the validity of insurance unless:
1. The insurance would not have been approved if we had
known the truth; and
2. The Standard has given you or any other person
claiming benefits a copy of the signed written
instrument which contains the misrepresentation.
After insurance has been in effect for two years during
the lifetime of the insured, The Standard will not use a
misrepresentation to reduce or deny the claim, unless it
was a fraudulent misrepresentation.
Misstatement of Age
If The Standard determines that your age has been
misstated, benefit amounts will be adjusted accordingly
long Term
Disability
and the maximum benefit period will be the period to
which you would have been entitled if your correct age
were known.
72
Workers’ Compensation Insurance
The plan does not replace or affect any requirements for
coverage under any workers’ compensation insurance
law or similar law.
Other LTD Services
There are several other additional special benefit
provisions available under the LTD plan as follows:
■■ Social Security assistance
■■ Rehabilitation during disability
■■ Transitional work arrangements
■■ Work incentive benefits
■■ Survivor benefits
LTD Conversion
When your insurance ends, you may buy LTD conversion
insurance if you meet the following:
1. Your insurance ends for a reason other than:
a. Termination or amendment of the group policy;
b. Your failure to make a required premium contribution;
or
c. Your retirement.
2. You were continuously insured under CMC’s long term
disability insurance plan for at least one year as of the
date your insurance ended.
3. You are not disabled on the date your insurance ends.
4. You are a citizen or resident of the United States or
Canada.
You must apply in writing and pay the first premium to
The Standard within 31 days after your insurance ends.
The maximum LTD conversion insurance benefit you may
select is the smallest of $4,000 (however, if you provide
satisfactory evidence of insurability, this upper limit is
$8,000); and 60% of your insured predisability earnings
on the date your insurance ended; and the LTD Benefit
payable if you had become disabled on the day before
your insurance ended and you had no deductible income.
The maximum LTD conversion insurance benefit is
reduced by deductible income. The certificate The
Standard will issue to you when your LTD conversion
insurance becomes effective will contain other provisions
which will also differ from the group policy.
For more information or to request application forms for
conversion, contact Employee Services.
LTD Claims
Filing a Claim
For purposes of filing claims and claim appeals, the term
“you” includes you, or an authorized representative who is
filing a claim on your behalf.
If you transition from STD to LTD, a claim form may not be
required. Claim forms are available from Employee
Services. It is recommended that you submit your claim
within 90 days following the date you become disabled or
as soon as you know you will be off work for 189 days or
longer. When you file a claim, you must also submit proof
of loss at your expense. Proof of loss is evidence in a
form or format satisfactory to The Standard that supports
a claim for benefits. Proof includes, but is not limited to,
the following:
■■ Your attending physician’s completed and signed
statement.
■■ Supporting documentation from your attending
physician that supports the diagnosis, such as chart
notes, lab findings, test results, x-rays, and/or other
forms of objective medical evidence in support of a
claim for benefits.
Your proof of loss must be submitted to The Standard
within 90 days following the completion of your benefit
waiting period.
If it is not possible to submit the documents within the
applicable time periods, the claim will not be invalidated
or reduced if it is shown that the claim and proof of
loss were submitted as soon as reasonably possible.
However, the additional time allowed cannot exceed
one year following the date that your proof of loss was
originally required unless you are legally incapacitated.
If your claim is approved and you are receiving benefits,
you will be required to provide proof of continued
disability, the regular attendance of a physician, and
receipt of appropriate available treatment at intervals
determined by The Standard. You must submit proof of
continued loss at The Standard’s request.
Failure to provide The Standard with proof of loss or any
other requested information may invalidate your claim.
Standard Insurance Company of Portland, Oregon (The Standard) is
the named fiduciary for adjudicating claims for benefits under the
plan and for deciding any appeals of denied claims. The Standard
has the authority, in its discretion, to interpret the terms of the plan,
to decide questions of eligibility for coverage or benefits under the
plan, and to make any related findings of fact. All decisions made
by The Standard are final and binding on participants to the full
extent permitted by law.
Claim Review
The Standard will review your claim and determine
whether or not benefits are payable in accordance with
the terms and provisions of the plan.
During the review, The Standard may require additional
information regarding the claim or a physical examination
or evaluation at its expense. The Standard has the right to
examine/evaluate any person for whom a claim is made
as often as it determines to be reasonably necessary.
Failure to cooperate with The Standard’s request for
information or physical examination or evaluation may
invalidate your claim.
Generally, you will be notified of the claim decision within
45 days of receipt of your claim. However, the review
period may be extended by two 30-day periods if it is
determined to be necessary due to circumstances beyond
The Standard’s control. In this event, you will be notified in
writing before the end of the current review period:
■■ That an extension is necessary.
■■ The standards on which benefit eligibility is based.
■■ The unresolved issues that prevent a claim decision.
■■ The additional information needed.
■■ The expected claim decision date.
If the review period is extended due to your failure to
submit necessary information, you will be given at least
45 days to provide the information. However, the review
period will be further extended by the number of days it
takes you to provide the information.
Payment of Claims
If your claim is approved, you will receive benefits in
accordance with plan provisions.
Overpayments
If an overpayment is made due to a circumstance such
as fraud, a plan administration/claim processing error, or
receipt of other income benefits, The Standard has the
right to full reimbursement. If an overpayment is made,
The Standard will take actions such as the following:
■■ Request a lump sum payment of the overpaid amount.
■■ Reduce any amounts that later become payable under
the plan. (In this event, your benefit amount may be
less than the plan’s minimum benefit amount.)
■■ Take any appropriate collection activity.
■■ Place a lien, if not prohibited by law, in the amount of
the overpayment on the proceeds of any other income
benefits, whether they are paid on a periodic or lump
long Term
Disability
sum basis.
■■ In the event of your death, an overpayment will be
recovered from any benefits payable under the plan.
73
 Denied Claims
If your claim is denied, you will receive a notice of denial
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A description of any additional material or information
necessary to complete your claim and an explanation
of why that material or information is necessary.
■■ A description of the plan’s appeal procedures and time
frames, including a statement of your right to bring a
civil action under ERISA following an adverse decision
on appeal.
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion
or limit, an explanation of the scientific or clinical
judgment for the adverse decision or a statement that
the explanation will be provided free of charge upon
request.
You have the right to appeal the decision by making a
written request for appeal to The Standard within 180
days from the date you receive the claim denial. If you
do not make the request within that time period, you will
have waived your right to appeal.
The claim appeal procedure allows you the right to:
■■ Submit written comments, documents, records, and
other information relating to the claim for review by The
Standard.
■■ Request, free of charge, reasonable access to and
copies of all documents, records and other information
relevant to your claim.
■■ A review that takes into account all comments,
documents, records, and other information submitted
by you without regard to whether the information was
submitted or considered in the initial claim decision.
■■ A review that does not consider the initial adverse
decision and which is conducted neither by the
individual who made the initial adverse decision nor
his/her subordinate.
■■ If the appeal involves an adverse decision based on
medical judgment, a review of your claim by a health
care professional who has appropriate training and
long Term
Disability
experience in the applicable field of medicine and who
was neither consulted in connection with the initial
claim decision nor the subordinate of that individual.
74
■■ The identification of medical or vocational experts,
if any, consulted in connection with the claim denial
without regard to whether the advice was relied upon in
making the initial claim decision.
The Standard will review your appeal within 45 days after
receipt of your properly filed request for appeal. However,
the review period may be extended for an additional
45-day period if it is determined to be necessary due
to circumstances beyond The Standard’s control. In
this event, you will be notified in writing before the end
of the initial 45-day review period that an extension
is necessary, why the extension is necessary, and
the expected determination date. If the review period
is extended due to your failure to submit necessary
information, the review period will be further extended
by the number of days it takes you to provide the
information.
If your appeal is denied, you will receive written notice
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A statement that you are entitled to receive, upon
request and free of charge, reasonable access to and
copies of all documents, records, and other information
relevant to your claim.
■■ Statements describing any voluntary appeal
procedures offered by The Standard, your right to
obtain information about the procedures, and your right
to bring an action under ERISA.
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion
or limit, an explanation of the scientific or clinical
judgment for the adverse decision or a statement that
the explanation will be provided free of charge upon
request.
Legal Actions
No legal action may be taken against the plan:
■■ Until 60 days following the date you provide proof of
loss to The Standard.
■■ More than three years following the date you were
required to provide proof of loss to The Standard.
LIFE INSURANCE

Introduction
The CMC Life Insurance Plan helps to protect you and
your family against financial disaster in the event of death.
It provides basic life insurance for you at no cost. And,
you may elect additional coverage for yourself under
optional life as well as dependent life insurance for your
spouse and children.
This plan is insured by ING ReliaStar Life Insurance
Company (ING). When you need assistance or have specific
questions regarding this plan, contact Employee Services.
life
Life Insurance
Benefits
Basic Life Insurance
Your basic life insurance amount is equal to two times
your annual pay (up to a maximum of $1,000,000). If the
insurance amount is not a multiple of $1,000, it is rounded
to the next higher multiple of $1,000. For example: If your
annual pay is $50,250, your basic life insurance amount
will be $101,000 ($100,500 rounded to the next higher
multiple of $1,000).

If your pay changes, your basic life insurance amount

will automatically change on the first day of the month
Refer to the glossary at the end of this handbook for
following your pay change if you are actively at work.
definitions of key terms.
Reduction of Basic Life Insurance Amount Due
Life Insurance Plan Options to Age
If you are eligible, basic life insurance is provided by CMC Your basic life insurance amount will be reduced
at no cost to you. If you choose to enroll for additional automatically when you reach certain ages as follows:
coverage, you may elect among the following options for
you and your eligible dependents: Reduction of Basic Life Insurance Amount
■■ Optional life insurance for you Percentage of Pre-70
Covered Person’s Age Insurance Amount
■■ Dependent life insurance for your spouse 70 - 74 65%
■■ Dependent life insurance for your children 75 - 79 45%
Your elections remain in effect for the entire calendar 80 - 84 30%
year. You generally cannot make changes until the next 85 and over 20%
Open Enrollment period unless you experience a qualified
Reductions become effective on the dates you attain the
status change, as summarized in the Eligibility and
specified ages regardless of whether you are actively at
Enrollment section of this handbook.
work or not on those dates. If you become insured or
your insurance amount increases on or after age 70, the
Enrollments and insurance amount changes are subject applicable reduction for your age will apply.
to the actively at work and confined for care requirements
as summarized in the Eligibility and Enrollment section of
this handbook.

75
life

Optional and Dependent Life Insurance
Optional and dependent life insurance are available to
allow you to purchase additional coverage for yourself
and/or your dependents.
Optional Life Insurance
You may elect optional life insurance in amounts from one
to seven times your annual pay subject to a maximum
insurance amount of $1,500,000. If the insurance amount
is not a multiple of $1,000, it is rounded to the next higher
multiple of $1,000. Optional life insurance amounts in
excess of the lesser of 3 times pay or $1 million are
subject to evidence of insurability requirements.
If your pay changes, your optional life insurance amount
will automatically change on the first day of the month
following your pay change if you are actively at work.
Dependent Life Insurance
Dependent life insurance is available in the following
amounts:
■■ Spouse - increments of $25,000 up to a maximum of
$250,000.
■■ Children - $5,000, $10,000, $15,000, or $20,000 for
each child. If you elect this coverage, all of your eligible
children are covered.
A dependent life insurance amount for your spouse that is
in excess of $25,000 is subject to evidence of insurability
requirements.
Evidence of Insurability (EOI) Requirements
The following optional and dependent life insurance
amounts are subject to EOI requirements:
■■ An optional life insurance amount that exceeds the
lesser of 3 times your annual pay or $1 million.
■■ A dependent life insurance amount for your spouse
that exceeds $25,000.
EOI is a statement of proof of an individual’s medical
history. (EOI forms are available by calling Employee
Services.) ING uses this statement to determine
acceptance for insurance. You are responsible for any
costs associated with EOI. For example, if a physician’s
statement or a physical examination is necessary, you
would be required to pay any corresponding charges.
The following table shows effective dates for optional life
insurance and dependent life insurance for your spouse
based on EOI requirements. The information in the table
assumes that you and your spouse are both newly eligible
for coverage under the plan.

Evidence of
Insurance Amount Insurability Effective Date of Insurance*
1, 2 or 3 x pay Not required The date you are first eligible for coverage
Optional life
insurance The date you are first eligible for coverage or the date ING approves coverage,
4, 5, 6, or 7 x pay Required
whichever is later
Dependent life $25,000 Not required The date your spouse is first eligible for coverage
insurance for The date your spouse is first eligible for coverage or the date ING approves
your spouse $50,000 - $250,000 Required
coverage, whichever is later
* Subject to timely enrollment, actively at work, and confinement for care requirements as summarized in the Eligibility and Enrollment section
of this handbook.
If insurance has previously been denied to you and/or your spouse, EOI may also be required for insurance increases
elected during an Open Enrollment period or as a result of a qualified status change. Please see Making Changes
During the Year for more information regarding permitted elections and change limitations.

76

Coverage During Total Disability
Under certain circumstances, your basic and optional
life insurance coverage may continue if you become
totally disabled while you are covered under the plan. The
amount of coverage that may be continued is generally
the amount that is in effect on the date immediately
preceding the date you become totally disabled; however:
■■ Any reduction due to age will continue to apply to basic
life insurance during your period of disability.
■■ Coverage will not be continued under this provision for
any insurance amount you elect to port or convert, as
summarized in Life Insurance Continuation Coverage.
Basic Life Insurance
Your basic life insurance may continue for up to six
months as long as you remain totally disabled.
If your insurance terminates, you may be able to apply for
conversion or portability as summarized in Life Insurance
Continuation Coverage.
Optional Life Insurance
If you become totally disabled before you attain age 60,
you may continue your optional life insurance for up to six
months by paying your required contributions.
For purposes of this provision, totally disabled means
the complete inability, as a result of injury or sickness,
to perform the material and substantial duties of any
occupation:
■■ Any occupation refers to any occupation that you are
or become reasonably fitted by training, education,
experience, age, physical and mental capacity.
■■ Material and substantial duties are responsibilities that
are normally required to perform an occupation and
cannot be reasonably eliminated or modified.
You may be required to be examined, free of charge, by a
physician chosen by ING.
Waiver of Premium Provision
If you are still disabled after six months, your life insurance
may be continued by ING without further premium (i.e.,
premium waiver). To be eligible for premium waiver, you
must submit proof that your total disability has continued
for six months. This proof must be received by ING
no later than one year following the date your active
employment terminates. Thereafter, you must submit
proof of your continuing disability before the end of each
subsequent 12-month period.
life
When satisfactory proof of your total disability has been
received, your premiums for life insurance will be waived
effective on the date ING approves your disabled status
or six months from the date you are no longer in active
employment, whichever is later. As an additional benefit,
the premiums you have paid for your first six months
of optional life insurance under this provision will be
reimbursed to you.
Your life insurance will be continued under this provision
without further premiums until the earliest of the following
dates:
■■ The date you are no longer disabled.
■■ The date you return to work.
■■ The date you refuse to have an examination by a
physician chosen by ING or fail to provide satisfactory
proof of continued disability.
■■ 90 days after the date ING mails you a request for
additional proof of loss if ING has not received the
requested proof by that date.
■■ The date you attain age 65.
■■ The date you begin receiving a benefit from a
retirement or pension plan.
■■ The date CMC classifies you as a retired employee.
If your insurance terminates, you may be able to apply for
conversion or portability as summarized in Life Insurance
Continuation Coverage. Waiver of Premium includes
Life Insurance and Accelerated Death Benefit. It does
not include AD&D Insurance or Dependent Life/AD&D
Insurance which were in effect at the time of disability.
Accelerated Death Benefit
If you develop a terminal condition while you are insured
under the plan, you may elect to receive an accelerated
death benefit. A terminal condition is a condition that is
expected to result in death within 12 months and from
which there is no reasonable prospect of recovery.
The amount of the accelerated death benefit cannot
exceed 50% of your total basic and optional life insurance
amounts, subject to a maximum benefit of $250,000. If
your basic life insurance amount is scheduled to reduce
based on age within 12 months following the date you
request accelerated death benefits, the benefit will be
based on the reduced amount.
77
life
The accelerated death benefit will reduce the benefit
payable at the time of death and may be taxable. Because
tax laws relating to this type of benefit are complex, you
are encouraged to consult your personal financial advisor
regarding the effect of this benefit on your beneficiary/
estate.
You are not eligible for accelerated death benefits if any of
the following apply:
■■ You are required by law to use this benefit to meet the
claims of creditors.
■■ You are required by a government agency to use this
benefit in order to apply for, receive, or continue a
government benefit or entitlement.
■■ All or a part of your insurance must be paid to your
children, spouse or former spouse as part of a divorce
decree, separate maintenance agreement, or property
settlement agreement.
■■ You are married and live in a community property state,
unless your spouse submits a signed written consent
to ING.
■■ You have previously received an accelerated death
benefit under this plan or any other group plan
sponsored by CMC.
Applying for an Accelerated Death Benefit
You must submit a completed claim form and the
following proof of your terminal condition to ING:
■■ Certification by a physician that you are terminally ill,
there is no reasonable prospect of recovery, and your
life expectancy is less than 12 months.
■■ Evidence that supports the physician’s certification
such as radiology or laboratory reports.
If you have named an irrevocable beneficiary or assigned
all or a portion of your insurance, you must also submit a
signed written consent from the beneficiary or assignee.
ING may require you to be examined by a physician of its
choice and at its expense.
78
Beneficiary Designation
If you have not assigned your insurance, you may
designate a beneficiary by completing a beneficiary
designation form. Forms are available from Employee
Services. Any benefits payable under the plan for other
than your loss of life are payable to you.
You may change a previously designated beneficiary
by completing a new beneficiary designation form and
submitting it to the Company. (Your previous beneficiary’s
consent is required only if you made your previous
designation irrevocable.) The change will become
effective on the date you sign your form; however, the
change will not apply to actions taken or benefits paid by
ING before your form is received.
Unless you specify otherwise in your beneficiary
designation:
■■ If two or more individuals are entitled to your benefits,
they will be paid in equal shares.
■■ If a beneficiary dies before you die, his/her share will be
paid equally to any surviving beneficiaries.
If benefits become payable to a minor or another person
who is physically or mentally incapable of giving a valid
release for the payment, ING may pay up to $2,000 to a
party who appears to have assumed responsibility for the
care and support of that person. This good faith payment
will satisfy ING’s legal obligation to the extent of that
payment.
If No Beneficiary Is Designated
If you die without designating a beneficiary or if your
beneficiary dies before you die, benefits may be paid to
the executor or administrator of your estate. Alternatively,
ING may choose to pay benefits to a surviving relative in
the following order:
■■ Spouse
■■ Child
■■ Parent
■■ Estate
Payment of benefits will release ING of all further liability
to the extent of the payment amount.
Assignment of Insurance
You may, if you wish, assign your insurance by submitting
the original or a certified copy of your assignment to ING.
If you assign your insurance, you will give up all your
rights of ownership to the assigned insurance, including
the right to designate/change a beneficiary, as long as
your assignment remains in force.

Life Insurance
Continuation
Coverage
Two methods are available for continuing life insurance
when your coverage under the plan terminates or your
benefits under the plan are reduced. Depending on the
reason your coverage ends or reduces, you may have
the opportunity to apply for a conversion policy and/or
portability coverage. The following briefly describes the
conversion and portability features of the plan.
Conversion
If coverage ends because your employment terminates
or your benefits under the plan are reduced, you may
apply for a conversion policy without providing evidence
of insurability. The maximum amount that you can
convert is the insurance amount that ended or was
reduced; however, you may elect to convert a lesser
insurance amount. (If coverage ends because the policy
is terminated or coverage is no longer available for
your employee class, the amount of insurance you may
convert may be limited or not available at all.)
The conversion policy will be the type of life insurance
that ING is offering for conversion at the time you apply
and will not provide the same benefits as this plan.
Premium amounts will be based on your age, class of
risk, and amount of coverage.
You must apply for conversion and pay the first premium
within 31 days following the date your coverage ends
or is reduced. If you die within the 31-day period during
which you were eligible to convert your insurance, the
insurance amount that you were eligible to convert will be
paid to your beneficiary whether or not you applied for a
conversion policy during that period.
In certain circumstances, your dependent may also be
eligible for a conversion policy when his/her coverage
ends. Contact Employee Services for further information.
For more information or to request application forms for
conversion, contact Employee Services.
Portability
You are eligible for portability if all of the following apply:
■■ Your coverage ends because you are no longer in
an eligible class or your employment terminates for a
reason other than retirement. (Portability is not available
if your coverage ends because the policy terminates.)
■■ You are under age 70 and not disabled.
■■ You are a citizen of the United States or Canada.
life
■■ You are not a full-time member of the armed forces of
any country.
The minimum and maximum insurance amounts available
for portability are:
■■ Minimum - $10,000.
■■ Maximum - the lesser of the amount of insurance that
terminated under the plan or $500,000.
The insurance amount is subject to any reductions due to
age that may be contained in the portability policy.
The portability policy will be the group term life insurance
that ING is offering for portability at the time you apply.
Premium amounts will be based on your age, class of
risk, and amount of coverage.
You must apply for portability and pay the first premium
within 31 days after the date your coverage ends. You
may not increase the amount of portability insurance you
initially elect; however, you may decrease the insurance
amount at any time.
If you elect portability, you may also elect portability for
your spouse if his/her coverage terminates when your
coverage terminates.
For more information or to request application forms for
portability, contact Employee Services.
General Life
Insurance Provisions
Incontestability
ING will consider statements that you make to obtain
coverage under the plan to be made to the best of your
knowledge and belief. A statement will not be used to
deny or reduce benefits unless a copy of the document
containing the statement has been provided to you, your
representative, or beneficiary.
After an insurance amount or increased insurance
amount has been in effect for two years or more, a
statement made to obtain coverage will not be used to
deny or reduce benefits except in the event of fraud or
eligibility for benefits.
Misstatement of Age
If ING determines that a covered person’s age has
been misstated, insurance amounts will be adjusted
accordingly. Contribution amounts will not be refunded
for a period of more than twelve months prior to the date
ING becomes aware of the misstatement.
79
life

Workers’ Compensation Insurance Claim Review

The plan does not replace or affect any requirements for The claim and proof of loss will be reviewed upon
coverage under any workers’ compensation insurance receipt. During the review, ING may send notification that
law or similar law. additional information is needed. In addition, a physical
examination may be required at ING’s expense. (ING has
the right to examine any person for whom a claim is made
Life Insurance Claims as often as it determines to be reasonably necessary.)
Except where prohibited by law, an autopsy may be
Filing a Claim required in the event of death. Failure to cooperate
To file a claim, a completed claim form and proof of loss with ING’s request for additional information, physical
must be submitted to ING. Claim forms are available from examination, or autopsy may invalidate a claim.
Employee Services. Proof of loss is evidence in a form
Claim Review Periods
or format satisfactory to ING that supports the claim for
Claim review periods depend on the type of claim being
benefits and includes, but is not limited to, the following:
filed. ING will send notification of the claim decision within
■■ For death claims, a certified copy of the death the time periods summarized in the following table.
certificate.
■■ For other claims, a completed and signed attending Claim Review Periods
physician’s statement that includes diagnosis, chart Total Disability
Claims (Premium Other Claims
notes, lab findings, test results, x-rays, and/or other
Waiver)
forms of objective medical evidence in support of a
45 days following 90 days following
claim for benefits. Review period
receipt of the claim receipt of the claim
The completed claim form and proof of loss must be If an extension
submitted to ING within 30 days of the loss. If it is not is needed due to
Up to an additional Up to an additional
circumstances
possible to submit the documents within the 30-day 30 days 90 days
beyond ING’s
period, the claim will not be invalidated or reduced if it is control
shown that the documents were submitted as soon as If an additional
reasonably possible. However, the additional time allowed extension is
cannot exceed one year following the 30-day period needed due to Up to an additional
Not applicable
unless the claimant is legally incapacitated. circumstances 30 days
beyond ING’s
Failure to provide ING with a completed claim form, proof control
of loss, or any other requested information may invalidate
If an extension is necessary, ING will send written
the claim.
notification before the end of the current review period of
ING ReliaStar Life Insurance Company (ING) is the named the special circumstances that require an extension and
fiduciary for adjudicating claims for benefits under the plan the expected claim decision date. If the review period is
and for deciding any appeals of denied claims. extended due to failure to submit necessary information,
at least 45 days will be given to provide the information.
ING has the authority, in its discretion, to interpret the However, the review period will be further extended by
terms of the plan, to decide questions of eligibility for the number of days it takes to provide the information.
coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by ING are final
and binding on participants and beneficiaries to the full
extent permitted by law.

80

Payment of Claims
Benefits become payable upon receipt of satisfactory
written proof of loss. Payment will be made to the
employee or, in the event of the employee’s death, in
accordance with the Beneficiary Designation provision.
Benefits are usually paid in a lump sum. However, you
may elect in writing to have benefits paid through an
installment program offered by ING. (Your beneficiary
will also have the option to elect an installment program
if benefits become payable to him/her in the event of
your death.) If you elect an installment program, you will
need to designate how any remaining installments are to
be paid in the event of death of the person receiving the
installments. The designation must be approved by ING.
Recovery of Overpayment
If an overpayment is made due to a circumstance such as
fraud or a plan administration/claim processing error, ING
has the right to full reimbursement. An overpayment may
be recovered by methods such as the following:
■■ Requesting a lump sum payment of the overpaid
amount.
■■ Reducing any amounts that later become payable
under the plan.
■■ Taking any appropriate collection activity available
including any legal action needed.
Denied Claims
If the claim is denied, ING will send a notification of denial
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A description of any additional material or information
necessary to complete the claim and an explanation of
why that material or information is necessary.
■■ A description of the plan’s appeal procedures and time
frames, including a statement of the claimant’s right to
bring a civil action under ERISA following an adverse
decision on appeal.
life
If the claim is for premium waiver during total disability,
the notice of denial will also include:
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion or
limit, an explanation of the scientific or clinical judgment
for the adverse decision or a statement that the
explanation will be provided free of charge upon request.
Claim Appeals
A denied claim decision may be appealed by making
written request for appeal to ING within 60 days from
the date the claim denial is received. If the request is not
made within that time period, the right to appeal is waived.
The claim appeal procedure allows the right to:
■■ Submit written comments, documents, records, and
other information relating to the claim for review by ING.
■■ Request, free of charge, reasonable access to and
copies of all documents, records and other information
relevant to the claim.
■■ A review that takes into account all comments,
documents, records, and other information submitted
without regard to whether the information was
submitted or considered in the initial claim decision.
If the claim is for premium waiver during total disability,
the claim appeal procedure also allows the right to:
■■ A review that does not consider the initial adverse
decision and which is conducted neither by the
individual who made the adverse decision nor that
person’s subordinate.
■■ If the appeal involves an adverse decision based on
medical judgment, a review of the claim by a health
care professional who has appropriate training and
experience in the field of medicine involved in the
medical judgment, and who was neither consulted
in connection with the adverse decision nor the
subordinate of that individual.
■■ The identification of medical or vocational experts, if
any, consulted in connection with the claim denial,
without regard to whether the advice was relied upon in
making the decision.
81
life
Appeal review periods depend on the type of claim being
appealed. ING will send notification of the appeal decision
within the time periods summarized in the following table.
Appeal Review Periods
Total Disability
Claims (Premium Other Claims
Waiver)
45 days following 60 days following
Review period
receipt of the claim receipt of the claim
If an extension
is needed due to Up to an additional Up to an additional
circumstances 45 days 60 days
beyond ING’s control
If an extension is necessary, ING will send written
notification before the end of the initial review period of
the special circumstances that require an extension and
the expected claim decision date. If the review period is
extended due to failure to submit necessary information,
the review period will be further extended by the number
of days it takes to provide the information.
If the appeal is denied, ING will send written notification
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A statement that the claimant is entitled to receive,
upon request and free of charge, reasonable access
to and copies of all documents, records, and other
information relevant to the claim.
82
■■ A statement describing any voluntary appeal
procedures offered by the plan and the right to obtain
information about the procedures, and a statement of
the claimant’s right to bring an action under ERISA.
If the appeal is for a premium waiver during total disability
claim, the notice of denial will also include:
■■ If applicable, any internal rule, guideline, protocol, or
other similar criteria relied upon in making the adverse
decision, or a statement that a rule, guideline, protocol,
or other similar criteria was relied upon and that a copy
will be provided free of charge upon request.
■■ If the adverse decision was based on a medical
necessity, experimental treatment, or similar exclusion
or limit, an explanation of the scientific or clinical
judgment for the adverse decision or a statement that
the explanation will be provided free of charge upon
request.
Legal Actions
Generally, legal action may not be taken against the
plan until the plan’s claim and appeal process has been
completed. No legal action may be taken against the
plan:
■■ Until 60 days following the date proof of loss is
provided to ING.
■■ More than three years following the date proof of loss
was required to be provided to ING.
Ad&D Insurance
Introduction
The CMC Accidental Death & Dismemberment (AD&D)
Insurance Plan helps to protect you and your family
against financial disaster in the event of a severe
accidental injury or death.
AD&D Benefits
Basic AD&D Insurance
Your basic AD&D insurance amount is equal to two times
your annual pay (up to a maximum of $1,000,000). If the
insurance amount is not a multiple of $1,000, it is rounded

This plan is insured by ING ReliaStar Life Insurance
Company (ING). When you need assistance or have specific
questions regarding this plan, contact Employee Services.
Refer to the glossary at the end of this handbook for
definitions of key terms.
AD&D Insurance Plan Options
If you are eligible, basic AD&D insurance is provided
by CMC at no cost to you. If you choose to enroll for
additional coverage, you may elect optional AD&D
insurance as follows:
■■ Employee only
■■ Employee plus family
Your elections remain in effect for the entire calendar
year. You generally cannot make changes until the next
Open Enrollment period unless you experience a qualified
status change, as summarized in the Eligibility and
Enrollment section of this handbook.
Enrollments are subject to the actively at work and
confined for care requirements as summarized in the
Eligibility and Enrollment section of this handbook.
AD&D
to the next higher multiple of $1,000. For example: If
your annual pay is $50,250, your basic AD&D insurance
amount will be $101,000 ($100,500 rounded to the next
higher multiple of $1,000).
If your pay changes, your basic AD&D insurance amount
will automatically change on the first day of the month
following your pay change if you are actively at work.
Reduction of Basic AD&D Insurance Amount Due
to Age
Your basic AD&D insurance amount will be reduced
automatically when you reach certain ages as follows:
Reduction of Basic AD&D Insurance Amount
Percentage of Pre-70
Covered Person’s Age
Insurance Amount
70 - 74 65%
75 - 79 45%
80 - 84 30%
85 and over 20%
Reductions become effective on the dates you attain the
specified ages regardless of whether you are actively at
work or not on those dates. If you become insured or
your insurance amount increases on or after age 70, the
applicable reduction for your age will apply.

Optional AD&D Insurance

You may elect optional AD&D insurance amounts as shown in the following table. If you elect insurance for yourself,
you may also elect insurance for your eligible dependents. If you elect family coverage, your spouse and/or children’s
insurance amount is based on your eligible family members at the time of the loss, as shown below:

Optional AD&D Insurance Amounts

Employee
Spouse If children are insured
If children are not insured
Children If spouse is insured
If spouse is not insured
Insurance Amount Maximum Insurance Amount
1 to 10 times your annual pay, rounded to the next higher
$1,000,000
multiple of $1,000
50% of your insurance amount $250,000
60% of your insurance amount $250,000
15% of your insurance amount $25,000
25% of your insurance amount $25,000

Schedule of Benefits
The following table shows losses that are covered under the plan. Benefits are stated as a percentage of the covered
person’s insurance amount. When a covered loss is suffered while coverage is in effect, the applicable benefit shown
will be paid. Benefits are payable only if the loss results directly and independently of all other causes from a covered
accident and either:
■■ Death occurs within 365 days of the accident.
■■ Injury results in one or more of the covered losses within 365 days of the accident.

83
 If a person suffers more than one covered loss as a result of the same accident, only the largest benefit amount will
be paid. For example, if a person suffers loss of a hand and quadriplegia, the quadriplegia benefit amount will apply. If
death occurs following payment of benefits for another loss suffered during the same accident, the loss of life benefit
will be reduced by that benefit amount.

Except as summarized in the Additional Benefits provision, no more than 100% of the covered person’s insurance
amount will be paid for all losses suffered from any one accident.
AD&D

Schedule of Benefits
Benefit Amount
(Shown as a percentage of the covered
Covered Loss person’s insurance amount)
Life
Both hands, both feet or sight of both eyes
One hand and one foot
One hand or one foot AND sight of one eye 100%
Speech and hearing in both ears
Quadriplegia
Coma (employee and covered spouse only)*
One hand or one foot, or sight of one eye
Paraplegia 50%
Hemiplegia
Speech or hearing in both ears
25%
Thumb and index finger of same hand
• Loss of a hand or foot means complete, permanent severance through or above the wrist or ankle joint.
• Loss of sight, speech, or hearing means total and permanent loss.
• Loss of a thumb and index finger means that the entire thumb and index finger are cut off at or above the joint closest to the wrist.
• Hemiplegia means total paralysis of one arm and one leg on the same side of the body; paraplegia means total paralysis of both legs;
quadriplegia means total paralysis of both arms and both legs. Paralysis means total loss of use of a limb. To be covered, a physician must
determine the loss of use to be permanent, complete, and irreversible.
• Coma or comatose means that you remain unresponsive to any stimuli and speechless for at least 30 days. The covered person must
become comatose within 31 days following the covered accident, remain comatose for at least 30 days, and be expected to remain
comatose as certified by a physician.
*Coma benefits are paid at 2% per month for up to 12 months to a total maximum of $24,000.

Exposure and Disappearance Burn Disfigurement Benefit

Benefits will also be payable if: If you suffer disfigurement from burns to at least 5% of
■■ A covered loss is suffered as a result of unavoidable your body due to a covered accident, the plan will play an
exposure to the elements following an accident. additional burn disfigurement benefit. The burn disfigurement

■■ The covered person’s body is not found within 365

days after the disappearance, sinking or wrecking of a
public conveyance in which he/she was known to be a
fare-paying passenger. In this event, it will be assumed
that the covered person suffered loss of life.
The benefit payable will be the amount that would
otherwise be payable for the applicable covered loss.
Additional Benefits
The benefits summarized below are paid in addition to
other plan benefits and are available only when a loss is
otherwise covered under the plan.
benefit amount equals 10% of your full optional AD&D
benefit amount (up to a maximum of $30,000).
Common Carrier Benefit
If you die as a result of a covered accident that occurs
while riding as a fare-paying passenger on a public
conveyance, a common carrier benefit will be available. The
benefit amount is 50% of the covered person’s optional
AD&D insurance amount (up to a maximum of $50,000).
Common Disaster Benefit
If the same covered accident or another covered accident
that occurs within the same 24-hour period results in your
death and the death of your covered spouse within 365
days of the respective accidents, a common accident
benefit will be available. The benefit increases your
spouse’s insurance amount up to 100% of your AD&D
insurance amount, provided the additional amount does
not exceed $50,000.

84
Elder Care Benefit
If you die due to a covered accident while an
elderly relative is dependent on you for support and
maintenance, the plan will play an additional elder care
benefit. The elder care benefit amount equals 5% of your
full optional AD&D benefit amount (up to a maximum of
$5,000).
HIV Accident Benefit
The plan pays this benefit if you acquire the Human
Immunodeficiency Virus (HIV) because of a covered
accident which occurs while you are actively at work. All
of these conditions must be met:
■■ You submit a Workers’ Compensation injury report to
CMC within 48 hours of the accident.
■■ You submit an initial negative blood test for HIV to CMC
within 48 hours of the accident.
■■ You test positive for HIV within one year of the accident.
All tests to determine the presence of HIV must be
conducted by a licensed medical provider.
If you meet these conditions, the HIV accident benefit
amount will equal 20% of your full optional AD&D benefit
amount (up to a maximum of $50,000).
Occupational Assault Benefit
If you suffer a covered loss due to another person’s act
of violence while you are at work, an occupational assault
benefit will be available. The occupational assault benefit
amount equals 100% of your full optional AD&D coverage
amount (up to a maximum of $10,000).
Safe Driver Benefit
If you or your covered spouse are killed due to an
automobile accident and were wearing a properly
fastened safety belt when the accident occurred, an
additional benefit amount will be available.
An additional amount will be paid if you were also driving
or riding in an automobile equipped with a factory-installed
airbag that operated properly upon impact.
The safety belt only benefit amount is an additional 10%
of your full AD&D benefit amount (up to a maximum of
$25,000).
The safety belt and airbag benefit amount is an additional
15% of your full AD&D benefit amount (up to a maximum of
$40,000).
Transportation Benefit
If you die at least 75 miles from your primary residence
as a result of a covered accident, the plan will pay an
additional transportation benefit equal 2% of your full
optional AD&D benefit amount (up to a maximum of
$2,000).
Beneficiary Designation
If you have not assigned your insurance (as summarized
below), you may designate a beneficiary by completing
a beneficiary designation form. Forms are available from
Employee Services.
You may change a previously designated beneficiary
AD&D
by completing a new beneficiary designation form and
submitting it to the Company. (Your previous beneficiary’s
consent is required only if you made your previous
designation irrevocable.) The change will become
effective on the date you sign your form; however, the
change will not apply to actions taken or benefits paid by
ING before your form is received.
Unless you specify otherwise in your beneficiary
designation:
■■ If two or more individuals are entitled to your benefits,
they will be paid in equal shares.
■■ If a beneficiary dies before you die, his/her share will be
paid equally to any surviving beneficiaries.
If benefits become payable to a minor or another person
who is physically or mentally incapable of giving a valid
release for the payment, ING may pay up to $2,000 to a
party who appears to have assumed responsibility for the
care and support of that person. This good faith payment
will satisfy ING’s legal obligation to the extent of that
payment.
If No Beneficiary Is Designated
If you die without designating a beneficiary or if your
beneficiary dies before you die, benefits may be paid to
the executor or administrator of your estate. Alternatively,
ING may choose to pay benefits to a surviving relative in
the following order:
■■ Spouse
■■ Child
■■ Parent
■■ Estate
Payment of benefits will release ING of all further liability
to the extent of the payment amount.
Assignment of Insurance
You may, if you wish, assign your insurance by submitting
the original or a certified copy of your assignment to ING.
If you assign your insurance, you will give up all your
rights of ownership to the assigned insurance, including
the right to designate/change a beneficiary, as long as
your assignment remains in force.
85
 Limitations and Exclusions
In addition to other limitations and exclusions under
the plan, benefits will not be paid for any loss that is
contributed to or caused by any of the following:
■■ War, declared or undeclared, or any act of war.
■■ Intentionally self-inflicted injuries, while sane or insane.
AD&D
■■ Suicide, or suicide attempt, while sane or insane.
■■ Active participation in a riot.
■■ Committing or attempting to commit a felony or
misdemeanor.
■■ Disease, bodily or mental illness (or medical or surgical
treatment thereof).
■■ Infections, except septic infections of and through a
visible wound.
■■ Controlled substances (as defined in Title II of the
Comprehensive Drug Abuse Prevention and Control
Act of 1970 and all amendments) that are voluntarily
taken, ingested or injected, unless as prescribed or
administered by a physician.
■■ Serving full-time active duty in the armed forces of any
country or international authority.
■■ The presence of alcohol in the covered person’s blood
if the presence raises a presumption that the covered
person was under the influence of alcohol and the
influence contributed to the cause of the accident. The
blood alcohol level is governed by the jurisdiction of the
state in which the accident occurs.
No benefit will be payable for any loss suffered as a result
of accidental injury during any period of incarceration.
General AD&D
Provisions
Incontestability
ING will consider statements that you make to obtain
coverage under the plan to be made to the best of your
knowledge and belief. A statement will not be used to
deny or reduce benefits unless a copy of the document
containing the statement has been provided to you, your
representative, or beneficiary.
After an insurance amount or increased insurance
amount has been in effect for two years or more, a
statement made to obtain coverage will not be used to
deny or reduce benefits except in the event of fraud or
eligibility for benefits.
86
Misstatement of Age
If ING determinates that a covered person’s age has
been misstated, insurance amounts will be adjusted
accordingly. Contribution amounts will not be refunded
for a period of more than twelve months prior to the date
ING becomes aware of the misstatement.
Workers’ Compensation Insurance
The plan does not replace or affect any requirements for
coverage under any workers’ compensation insurance
law or similar law.
AD&D Claims
Filing a Claim
For purposes of filing claims and claim appeals, the term
“you” includes you, your dependent who is filing a claim,
an authorized representative who is filing a claim on your
or your dependent’s behalf, or your beneficiary.
To file a claim, you must submit a completed claim form
(available from Employee Services) and proof of loss.
Proof of loss is evidence in a form or format satisfactory
to ING that supports the claim for benefits and includes,
but is not limited to, the following:
■■ For death claims, a certified copy of the death
certificate.
■■ For other claims, a completed and signed attending
physician’s statement that includes diagnosis, chart
notes, lab findings, test results, x-rays, and/or other
forms of objective medical evidence in support of a
claim for benefits.
Supplementary proof of loss requirements for certain
benefits under the plan (such as child care and
repatriation benefits) are summarized in the Additional
Benefits provision.
Your completed claim form and proof of loss must be
submitted to ING within 30 days of the loss. If it is not
possible to submit the documents within the 30-day
period, the claim will not be invalidated or reduced if it is
shown that the documents were submitted as soon as
reasonably possible. However, the additional time allowed
cannot exceed one year following the 30-day period
unless you are legally incapacitated.
Failure to provide ING with a completed claim form, proof
of loss, or any other requested information may invalidate
your claim.

ING ReliaStar Life Insurance Company (ING) is the named
fiduciary for adjudicating claims for benefits under the plan
and for deciding any appeals of denied claims.
ING has the authority, in its discretion, to interpret the
terms of the plan, to decide questions of eligibility for
coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by ING are final
and binding on participants and beneficiaries to the full
extent permitted by law.
Claim Review
Your claim and proof of loss will be reviewed upon
receipt. During the review, you may be notified that
additional information is needed. In addition, a physical
examination may be required at ING’s expense. (ING has
the right to examine any person for whom a claim is made
as often as it determines to be reasonably necessary.)
Except where prohibited by law, an autopsy may be
required in the event of death. Failure to cooperate
with ING’s request for additional information, physical
examination, or autopsy may invalidate a claim.
Generally, you will be notified of the claim decision
within 90 days of receipt of your claim. However, the
review period may be extended by 90 days if it is
determined to be necessary due to circumstances
beyond ING’s control. In this event, you will be notified
in writing before the end of the initial 90-day period of
the special circumstances that require an extension and
the expected claim decision date. If the review period
is extended due to your failure to submit necessary
information, the review period will be further extended
by the number of days it takes you to provide the
information.
Payment of Claims
Benefits become payable upon receipt of satisfactory
written proof of loss, including any supplementary proof
of loss required as summarized in the Additional Benefits
provision. Payment will be made to the employee or, in
the event of the employee’s death, in accordance with the
Beneficiary Designation provision.
Benefits are usually paid in a lump sum. However, you
may elect in writing to have benefits paid through an
installment program offered by ING. (Your beneficiary
will also have the option to elect an installment program
if benefits become payable to him/her in the event of
your death.) If you elect an installment program, you will
need to designate how any remaining installments are to
be paid in the event of death of the person receiving the
installments. The designation must be approved by ING.
Recovery of Overpayment
If an overpayment is made due to a circumstance such as
fraud or a plan administration/claim processing error, ING
has the right to full reimbursement. An overpayment may
be recovered by methods such as the following:
■■ Requesting a lump sum payment of the overpaid
AD&D
amount.
■■ Reducing any amounts that later become payable
under the plan.
■■ Taking any appropriate collection activity available
including any legal action needed.
Denied Claims
If your claim is denied, you will receive a notice of denial
that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A description of any additional material or information
necessary to complete your claim and an explanation
of why that material or information is necessary.
■■ A description of the plan’s appeal procedures and time
frames, including a statement of your right to bring a
civil action under ERISA following an adverse decision
on appeal.
Claim Appeals
You have the right to appeal the decision by making a
written request for appeal to ING within 60 days from the
date you receive the claim denial. If you do not make the
request within that time period, you will have waived your
right to appeal.
The claim appeal procedure allows you the right to:
■■ Submit written comments, documents, records, and
other information relating to the claim for review by ING.
■■ Request, free of charge, reasonable access to and
copies of all documents, records and other information
relevant to your claim.
■■ A review that takes into account all comments,
documents, records, and other information submitted
by you without regard to whether the information was
submitted or considered in the initial claim decision.
87
 ING will review your appeal within 60 days after receipt
of your properly filed request for appeal. However, the
review period may be extended for an additional 60-
day period if it is determined to be necessary due to
circumstances beyond ING’s control. In this event, you
will be notified in writing before the end of the initial 60-
day period of the special circumstances that require an
AD&D
Legal Actions
Generally, you may not take legal action against the plan
until you have completed the plan’s claim and appeal
process. No legal action may be taken against the plan:
■■ Until 60 days following the date you provide proof of
loss to ING.

■■ More than three years following the date you were

extension and the expected claim decision date. If the
required to provide proof of loss to ING.
review period is extended due to your failure to submit
necessary information, the review period will be further
extended by the number of days it takes you to provide
the information.

If your appeal is denied, you will receive written notice

that includes the following information:
■■ The specific reasons for denial with reference to plan
provisions on which the denial is based.
■■ A statement that you are entitled to receive, upon
request and free of charge, reasonable access to and
copies of all documents, records, and other information
relevant to your claim.
■■ A statement describing any voluntary appeal
procedures offered by the plan and your right to obtain
information about the procedures, and a statement of
your right to bring an action under ERISA.

88
Business Travel Accident
Introduction
The CMC Business Travel Accident (BTA) Insurance Plan
helps to protect you and your family against financial
disaster in the event of severe accidental injury or death
while you are traveling on Company business.
This plan is insured by Metropolitan Life Insurance
Company (MetLife). When you need assistance or have
specific questions regarding this plan, contact Employee
Services.
Refer to the glossary at the end of this handbook for
definitions of key terms.
Business Travel
BTA insurance provides coverage while you are on
business trips that are:
■■ Requested, authorized or consented to by CMC for the
purpose of furthering Company business, and
■■ Paid for by CMC.
Business travel begins when you leave your residence,
regular place of employment, or other location (whichever
occurs last) for the purpose of traveling to the business
trip destination and ends when you return to your
residence or regular place of employment (whichever
occurs earlier) following the trip.

Business travel
Business travel does not include:

accident
■■ Travel between your residence and regular place of
BTA Benefits employment.
■■ Travel to another location where you are expected to be
Amount of Insurance
assigned for more than 30 days or a location that CMC
Your BTA insurance amount is equal to two times your
deems to be your new regular work location.
annual pay. (If the insurance amount is not a multiple
of $1,000, it is rounded to the next higher multiple of ■■ Regular driving assignments if you are employed by
$1,000.) Your insurance amount is subject to: CMC as a truck driver, delivery person, chauffeur, or
■■ A minimum insurance amount of $250,000
other commercial driver.
■■ Leaves of absence or vacations.
■■ A maximum insurance amount of $1,000,000
■■ Personal travel or activity that is not reasonably related
■■ An aggregate limit of $5,000,000
to or incidental to a business trip and is not paid for by
Aggregate Limit CMC.
The aggregate limit of $5,000,000 is the maximum
amount the plan will pay for all losses incurred as the
result of any single covered accident or any series or
combination of covered accidents directly arising out of
one or more associated events. Events are associated
if they have a common cause or are a chain of events
forming part of a larger or broader event even if the
individual events themselves are separate in time and
place.

When the aggregate limit applies, benefits for each

covered person are reduced in the same proportion so
that the total amount the plan pays does not exceed the
$5,000,000 limit.

For example, if a single accident or a series or

combination of accidents result in the death of eight
employees who each have the maximum BTA insurance
amount ($1,000,000), the benefit payable for each death
would be reduced from $1,000,000 to $625,000 (8 x
$625,000 = $5,000,000.)

89
 Covered Losses
Benefits are payable only if a covered accident is the direct and sole cause of your loss and the loss occurs within 12
months of an accident that occurs while you are traveling on a business trip. The following table shows losses that are
covered under the plan. Benefit amounts are stated as a percentage of your insurance amount. When a covered loss is
suffered while coverage is in effect, the applicable benefit shown will be paid.

Schedule of Benefits
Benefit Amount
Covered Loss
(Shown as a percentage of your BTA insurance amount)
Life
One hand and one foot
Speech and hearing 100%
Either hand or foot and sight in both eyes
Paralysis of both arms and both legs
Business travel

One hand or one foot

Sight in one eye
accident

Four fingers of same hand

50%
Speech or hearing
Paralysis of both legs
Paralysis of arm and leg on either side of the body
Thumb and index finger of same hand
25%
Paralysis of one arm or leg
• Loss of a hand means permanent severance at or above the wrist.
• Loss of a foot means permanent severance at or above the ankle.
• Loss of sight means permanent and uncorrectable loss of sight. Visual acuity must be 20/200 or worse in the eye or the field of vision must
be less than 20 degrees.
• Loss of hearing means a loss of hearing continuing for 6 consecutive months after which a physician determines the loss to be entire and
irrecoverable.
• Loss of speech means a loss of speech continuing for 6 consecutive months after which a physician determines the loss to be entire and
irrecoverable.
• Loss of thumb and index finger of the same hand means that the thumb and index finger are permanently severed through or above the third
joint from the tip of the index finger and the second joint from the tip of the thumb.
• Paralysis means the complete loss of use of a limb that has not been severed. A physician must determine the loss of use to be permanent
and irreversible.
If you suffer more than one covered loss as a result of the same accident, only the largest benefit amount will be paid.
For example, if you suffer loss of a hand as well as loss of speech and hearing, the loss of speech and hearing benefit
amount will apply. If death occurs following payment of benefits for another loss suffered during the same accident,
the loss of life benefit will be reduced by that benefit amount. Except as summarized in the Additional Seat Belt and Air
Bag Benefits provision, no more than 100% of your insurance amount will be paid for all losses suffered from any one
accident.

Exposure and Disappearance

Exposure and disappearance coverage provides benefits for covered losses suffered as a result of:
■■ Unavoidable exposure to the elements if the exposure is a direct result of a covered accident and independent of
other causes.
■■ An aircraft or other vehicle in which you were traveling on business disappearing, sinking, or being wrecked if your
body is not found within one year following the date:
• The aircraft or other vehicle was scheduled to have arrived at its destination if you were traveling in an aircraft or
other vehicle operated by a common carrier, or
• You are reported missing to the authorities if traveling in any other aircraft or vehicle.
• In this event, it will be assumed that you suffered loss of life.

Benefits payable are as shown in the Schedule of Benefits for the applicable covered loss.

90
Terrorist Act
Terrorist act coverage provides benefits for losses that
are otherwise covered under the plan and are incurred
as a direct result of a terrorist act. Benefits payable are
as shown in the Schedule of Benefits for the applicable
covered loss.
Terrorist act coverage does not apply if you are traveling
to, from, or within the following countries: Afghanistan,
Algeria, Burundi, Chad, Chechnya, Colombia, Cote d’
Ivoire, Democratic Republic of the Congo, Georgia,
Guinea, Haiti, Indonesia, Iran, Iraq, Israel, Lebanon,
Liberia, North Korea, Pakistan, Saudi Arabia, Somalia, Sri
Lanka, Sudan, Syria and Tajikistan.
War Risk
War risk coverage provides benefits for losses that are
otherwise covered under the plan and are incurred as
a direct result of war, whether declared or undeclared,
or an act of war. Benefits payable are as shown in the
Schedule of Benefits for the applicable covered loss.
War risk coverage does not apply to war or acts of war
occurring in:
■■ Afghanistan, Algeria, Burundi, Chad, Chechnya,
Colombia, Cote d’ Ivoire, Democratic Republic of the
Congo, Georgia, Guinea, Haiti, Indonesia, Iran, Iraq,
Israel, Lebanon, Liberia, North Korea, Pakistan, Saudi
Arabia, Somalia, Sri Lanka, Sudan, Syria or Tajikistan.
■■ The United States, its territories and possessions.
■■ Your country of residence.
Additional Seat Belt
and Air Bag Benefits
If you die as a result of an accidental injury sustained in
a covered accident, an additional seat belt benefit will be
available if:
■■ Benefits become payable under the plan for your loss
of life, and
■■ MetLife receives proof that you:
• Were in an accident while driving or riding as a
passenger in a land vehicle,
• Were wearing a seat belt that was properly fastened
at the time of the accident, and
• Died as a result of injuries sustained in the accident.
A police officer investigating the accident must certify that
the seat belt was properly fastened and a copy of that
certification must be submitted to MetLife with the claim
for benefits.
The additional benefit for seat belt use is equal to 10% of
your insurance amount subject to a minimum benefit of
$1,000 and a maximum benefit of $25,000.
If a seat belt benefit is payable and the proper
deployment of an air bag for the seat you occupied is
verified in the police officer’s certification, an additional air
bag benefit will be payable. This benefit is equal to 10%
of your insurance amount subject to a minimum benefit of
$1,000 and a maximum benefit of $10,000.
Beneficiary Designation
You may designate a beneficiary by completing a
beneficiary designation form, which is available on from
Business travel
Employee Services. (You may not assign your insurance
under this plan.) Any benefits payable under the plan for
accident
other than loss of life are payable to you.
If you designate two or more beneficiaries and do not
specify otherwise, they will share benefits equally. If
benefits become payable to a minor or another person
that is not legally competent, benefits may be paid to that
person’s guardian.
You may change a previously designated beneficiary
by completing a new beneficiary designation form and
submitting it to Employee Services. (Your previous
beneficiary’s consent is not required.) The change
will become effective on the date you sign your form;
however, the change will not take effect if the form is
received after your death or more than 30 days following
the date you sign the form. The change will not apply to
any benefits paid by MetLife before your form is received.
If No Beneficiary Is Designated
If you die without designating a beneficiary or if your
beneficiary dies before you die, MetLife may determine
the beneficiary to be one or more of the following who
survive you:
■■ Legal spouse
■■ Children
■■ Parents
■■ Siblings
Alternatively, MetLife may choose to pay your estate. Any
payment made in good faith will satisfy MetLife’s payment
of benefits to the extent of that payment amount.
91
 Limitations and Exclusions
In addition to other limitations and exclusions, benefits will
not be paid for any loss caused or contributed to by:
■■ Physical or mental illness or infirmity, or the diagnosis
or treatment of that illness or infirmity.
■■ Suicide or attempted suicide.
■■ War, whether declared or undeclared, or act of war,
insurrection, rebellion, riot, or terrorist act except as
provided in the Terrorist Act and War Risk provisions.
■■ Your intoxication at the time of the incident if you are
the operator of a vehicle or other device involved in the
incident.

■■ Intentionally self-inflicted injury. ■■ Your commission of or attempt to commit a felony.

■■ Infection, other than infection occurring in an external ■■ Your voluntary intake or use by any means of:
accidental wound or from accidental food poisoning. • Any drug, medication or sedative unless it is taken
or used as prescribed by a physician or any over-
■■ Participation in hazardous activities such as scuba
the-counter drug, medication or sedative unless it is
diving, bungee jumping, skydiving, hang gliding,
taken as directed.
ballooning, drag racing, driving a car fitted for
Business travel

• Alcohol in combination with any drug, medication,

competitive racing, aerial hunting, aerial skiing, or
or sedative.
accident

travel in an aircraft for the purpose of parachuting or

• Poison, gas, or fumes.
otherwise exiting an aircraft while the aircraft is in flight
except for the purpose of self-preservation.
■■ Service in the armed forces of any country or
international authority, except the United States
BTA Claims
National Guard. Filing a Claim
■■ Any nuclear reaction or release of nuclear energy.
For purposes of filing claims and claim appeals, the term
This includes the radioactive, toxic, explosive or other
“you” includes you, an authorized representative who is
hazardous or contaminating properties of radioactive
filing a claim on your behalf, or your beneficiary.
matter.
■■ The emission, discharge, dispersal, release or escape
You may obtain a claim form from Employee Services.
of any solid, liquid or gaseous chemical or biological
Instructions for completing and submitting the claim form
agent.
are indicated on the form. When you file a claim, you
■■ Any incident related to travel in an aircraft: must also submit proof of loss, which is written evidence
• As a pilot, crew member, flight student, or while satisfactory to MetLife that you have met the conditions
acting in any capacity other than as a passenger. and requirements for benefits under the plan. Proof of
• That does not have a valid certificate of loss must be provided at your expense and establish:
airworthiness.
■■ The nature and extent of the loss or condition,
• That is not flown by a pilot with a valid license to
operate that aircraft. ■■ The plan’s obligation to pay the claim, and
• That is owned, leased, controlled or chartered by ■■ Your right to receive payment.
CMC.
Submit your claim form and proof of loss within 90
• Or device used by or for any military authority.
days following the date of the loss. If it is not possible
• Or device used for testing or experimental purposes;
to submit the documents within the 90-day period, the
travel or designed for travel beyond the earth’s
claim will not be invalidated or reduced if it is shown that
atmosphere; crop dusting, spraying, or seeding; fire
the documents were submitted as soon as reasonably
fighting; sky diving; hang gliding; pipeline or power
possible. However, the additional time allowed cannot
line inspection; sky writing; aerial photography
exceed one year following the date of the loss except in
or exploration; racing, endurance tests, stunt or
the case of legal incapacity.
acrobatic flying; or any use that requires a special
permit from the Federal Aviation Administration.

92

Metropolitan Life Insurance Company (MetLife) is the
named fiduciary for adjudicating claims for benefits under
the plan and for deciding any appeals of denied claims.
MetLife has the authority, in its discretion, to interpret
the terms of the plan, to decide questions of eligibility
for coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by MetLife are
final and binding on participants and beneficiaries to the
full extent permitted by law.
Claim Review
MetLife will review your claim to determine whether or
not benefits are payable within 60 days of receiving
satisfactory proof of loss.
During the claim review, MetLife may require that you
be examined by one or more physicians as often as
is reasonably necessary to process the claim. MetLife
chooses the physicians and pays for the examinations. In
the event of death, an autopsy may be requested where
permitted by law.
Payment of Claims
If the claim is approved, benefits are generally paid in a
lump sum; however, different payment options may be
requested by calling MetLife.
Payment will be made to you or, in the event of your
death, in accordance with the Beneficiary Designation
provision. If an overpayment is made, you/your
beneficiary will be required to reimburse MetLife.
Denied Claims
If your claim is denied, you will receive written notice from
MetLife that includes the following information:
■■ The specific reasons for denial with reference to the
plan provisions on which the denial is based.
■■ A description of any additional information necessary
for your claim to be reconsidered and the reason this
information is necessary.
■■ An explanation of the review procedure.
Claim Appeal Procedure
If your claim is denied, you may appeal MetLife’s decision.
The claim appeal procedure allows you the right to:
Business travel
■■ Submit a written request for review within 60 days from
accident
the date you receive the claim denial.
■■ Review applicable documents.
■■ Submit issues and comments in writing.
MetLife will review your appeal within 60 days after
receipt of your properly filed request for appeal. However,
the review period may be extended for an additional
60-day period under special circumstances such as the
need to hold a hearing.
If your appeal is denied, you will receive written notice
that includes the specific reasons for denial with
reference to plan provisions on which the denial is based.
Legal Actions
A legal action on a claim may be brought against the
plan only during a certain period. This period begins 60
days after the date proof of loss is submitted and ends
three years after the date proof of loss was required to be
submitted.
93
 Health Care Fsa
Introduction
Many of us have health care expenses that are not fully
covered under a benefit plan or reimbursed by any other
source. The CMC Health Care Flexible Spending Account
(FSA) Plan provides a way for you to pay some of these
expenses on a pretax basis.
The plan is administered by WageWorks (the claim
administrator). When you need assistance or have
specific questions regarding this plan, contact the claim
administrator at 1-877-924-3967 or www.wageworks.com.
Refer to the glossary at the end of this handbook for
definitions of key terms.
Health Care FSA
Benefits
Participating in the Health Care FSA
The plan allows you to make contributions on a pretax
health care fsa
basis to pay for eligible health care expenses that are
not fully covered under a benefit plan or reimbursed by
any other source. You are reimbursed from your account
as you incur eligible out-of-pocket health care expenses
such as medical and dental deductibles and copays.
Your contributions are deducted from your pay before
federal income taxes, Social Security taxes, and in most
states, before state income taxes are withheld.
When you elect to participate in the Health Care FSA:
■■ You elect how much to contribute to the plan and your
contributions are deducted from your pay on a pretax
basis.
■■ You have access to the total annual contribution
amount you elect as soon as you incur eligible
expenses. Keep in mind that expenses are not
eligible if they are incurred before your participation
begins or after your participation ends (e.g., if your
participation begins on April 1, expenses incurred on
or before March 31 are not eligible). This also applies
to expenses incurred by a dependent during any
period in which he/she does not qualify as your eligible
dependent.
■■ A health care card (similar to a debit card) will be
sent to you. This card allows you to pay many eligible
expenses directly from your account and eliminates
claim processing time.
■■ As you incur eligible health care expenses during the
year, you can:
94
• Use your health care card to pay for eligible
purchases from providers and merchants who
accept the card (you must submit receipts to the
claim administrator for certain health care card
transactions).
• Use the Pay My Provider feature of the plan,
which is similar to an online bill paying service.
You request direct payment to your provider via
www.wageworks.com
• Submit traditional claim forms and receipts/
statements to the claim administrator. You will
need to use this process for services or supplies
purchased from any provider or merchant that
cannot accept your health care card.
■■ You should keep copies of your itemized receipts/
statements for each purchase whether you use your
health care card, the Pay My Provider feature, or file
traditional claims. You may need these documents to
satisfy requirements established by the plan and/or the
IRS.
■■ You must submit all claims for reimbursement of
expenses incurred during a calendar year by March 31
of the following year.
■■ Any unclaimed balance in your account after March 31
of the following calendar year is forfeited.
You must make a Health Care FSA enrollment election
each year during the Open Enrollment period if you wish
to participate in the plan during the following calendar
year - participation is not automatically renewed. If you
are currently a plan participant and you do not elect to
participate in the plan during an Open Enrollment period,
your participation will end on the December 31 following
that Open Enrollment period.
Contributions
You may elect to contribute between $120 and $2,500
to the Health Care FSA each calendar year. However
if you are a Highly Compensated Employee (HCE) as
determined by the IRS, there may be situations where the
Company is required to reduce your contributions. If your
enrollment occurs at any time other than January 1, your
annual contribution will be prorated accordingly.
Your contributions are withheld from your pay and are
subject to the minimum and maximum payroll deduction
amounts shown below.
Minimum Maximum
Pay Cycle ($120 per year) ($2,500 per year)
Weekly* $2.50 $52.08
Biweekly** $5.00 $104.16
* Contributions are withheld from your first four pay checks each
month.
** Contributions are withheld from your first two pay checks each
month.
Your contribution amount may be reduced as follows:
■■ Your maximum contribution amount will be prorated if
you are newly eligible and begin participation at a time
other than the beginning of a calendar year.
■■ The Company may reduce your contribution amount if
the plan fails one of several IRS benefit limitation tests.
You will be advised if this occurs.
Before you make your election, consider the plan
advantages, disadvantages, eligible and ineligible
expenses, and other Health Care FSA information. Also
contact your tax advisor or the IRS to discuss how your
contribution amount (if any) will affect your personal tax
situation.
Advantages and Disadvantages of
Participation
Participating in the Health Care FSA saves you money
by reducing your income taxes. Since your contributions
are deducted from your pay on a pretax basis – before
federal, state, and Social Security (FICA) taxes are
calculated and withheld – you can expect to see tax
savings in your paycheck. For example, if you earn
$3,000 a month and contribute $500 to the Health Care
FSA, you will pay taxes on $2,500 per month. Your actual
savings will depend on your personal tax situation.
In exchange for the tax advantages provided under
the Health Care FSA, the IRS imposes significant
restrictions. It is important that you carefully read all of
the plan information before you decide whether or not to
participate. You are also encouraged to contact your tax
advisor or the IRS to discuss how participation will affect
your specific tax situation.
Potential disadvantages of participating in the Health Care
FSA are summarized in the following table.
Potential Disadvantages of
Participating in the Health Care FSA
Use It or Lose It The Internal Revenue Code requires that
Rule you forfeit any contribution amount that you
do not use for expenses incurred during the
same calendar year. Any balance remaining
in your account at the end of the year cannot
be refunded to you or carried over to the next
calendar year. Forfeited amounts are used to
help pay administrative costs under the plan.
Irrevocable The amount you elect to contribute is
Elections irrevocable for the entire calendar year. You
cannot change your election unless you
experience a qualified status change as
summarized in the Eligibility and Enrollment
section of this handbook.
Effect on Social Pretax contributions reduce the amount of
Security your earnings that are reported for Social
Security purposes. Therefore, if you earn
less than the Social Security wage base or
if pretax contributions reduce your earnings
below the Social Security wage base, your
Social Security withholding will be reduced.
Because Social Security benefits are based
on your career earnings history, this reduced
health care fsa
withholding could decrease any Social
Security benefits you may receive.
Effect on Other Pretax contributions may affect other statutory
Statutory Benefits benefits (such as unemployment insurance,
workers’ compensation, and state disability
insurance) for the same reasons that they
affect Social Security benefits. Because
statutory benefits are also based on taxable
earnings, benefits for which you may become
eligible could be reduced as a result of pretax
contributions to the Health Care FSA.
Loss of Income The IRS does not allow you to take a tax
Tax Deductions deduction for expenses reimbursed through
the plan. (Under current tax laws, tax
deductions for medical expenses are available
for eligible expenses that exceed 7.5% of your
adjusted gross income.) You should consult
with your tax advisor to determine whether
participating in the Health Care FSA or taking
a tax deduction is best for your personal
situation.
No Guarantee There is no guarantee that any amounts
of Tax reimbursed under the Health Care FSA will
Consequences be excludable from your income taxes. For
example, if the IRS audits your tax return,
you may be required to show that expenses
reimbursed through the plan meet the
applicable tax requirements. Reimbursement
does not guarantee that Health Care FSA
payments will not be declared taxable
by the IRS at some time in the future. If
reimbursements are subject to taxation,
including any reimbursements paid in error,
you will be liable for any taxes or penalties.
95
 Other items to consider before you enroll in the plan are:
■■ Only expenses that are incurred while you are
participating in the plan are eligible for reimbursement.
This means that amounts you contribute to the Health
Care FSA during a calendar year may be used only to
reimburse expenses incurred:
• After your participation begins, and
• Before that calendar year ends or before your
participation ends if that occurs earlier.
■■ You cannot transfer money from one flexible spending
account to another. If you are also participating in the
Dependent Day Care Flexible Spending Account Plan,
you cannot transfer money between the two plans.
Your health care FSA contributions will apply only to
eligible Health Care expenses and may not be used to
reimburse dependent day care expenses.
■■ Some individuals experience cash flow concerns
when participating in the plan. Although many eligible
expenses can be paid directly from your account
with the health care card or by paying your providers
through the Pay My Provider feature of the plan, there
health care fsa
will be occasions when you need to make out-of-
pocket payments for health care expenses at the same
time Health Care FSA contributions are being deducted
from your pay. When you use the traditional claim
process, reimbursement requires a reasonable period
of time for claim processing.
If you decide to enroll in the plan, estimate your eligible
expenses carefully and elect to contribute only the
amount that you are confident you will spend during the
calendar year to avoid forfeiture of your contributions. If
you are unsure if an expense will be eligible, contact the
claim administrator for clarification before you make your
contribution election.
Effect of Contributions on Other
Company Benefits
Your Health Care FSA contributions will not affect any
Company benefits that are based on pay, such as life
and disability insurance. These benefits will continue to
be based on your salary before pretax contributions are
deducted.
Eligible Expenses
Eligible expenses are health care expenses that:
■■ Are incurred for medical care, as defined by Internal
Revenue Code (IRC) Section 213(d),
■■ Are incurred by you or an individual who qualifies as
your dependent for federal income tax purposes during
the period you participate in the plan,
■■ Have not been reimbursed by any other source and
will not be submitted for reimbursement by any other
source, and
96
■■ Subject to certain exceptions, qualify as allowable tax
deductions under federal income tax rules.
Generally, the IRC defines medical care as the diagnosis,
treatment or prevention of a specific medical condition
or for purposes of affecting a function or structure of the
body.
Not every health related expense will qualify as an
expense for medical care. For example, an expense
is not for medical care if it is merely beneficial to the
health of you or your eligible dependents (e.g., vitamins
or nutritional supplements that are not taken to treat a
specific medical condition) or for cosmetic purposes,
unless necessary to correct a deformity resulting from
illness, injury, or birth defect. You may be required to
provide additional documentation from a health care
provider showing that you have a medical condition and/
or the particular item is necessary to treat a medical
condition. Expenses for cosmetic purposes are also not
reimbursable unless they are necessary to correct an
abnormality caused by illness, injury, or birth defect.
In addition, certain expenses that might otherwise
be considered medical care under the IRC are not
reimbursable under any Health Care FSA-type plan (per
IRS regulations):
■■ Health insurance premiums,
■■ Expenses incurred for qualified long-term care
services, and
■■ Any other expenses that are specifically excluded
under a plan.
Only expenses that are incurred after your participation
in the Health Care FSA begins and in the same calendar
year in which you make contributions are eligible
for reimbursement. (Expenses incurred after your
participation in the plan terminates are not eligible for
reimbursement.) Expenses are considered incurred on
the day the service is provided, regardless of when you
are billed or pay for the service.
Eligible expenses include the following:
■■ Health care expenses that are not payable by medical,
dental, vision, mental health, or prescription drug plans
under which you/your dependents are covered. These
include expenses such as deductibles and copay
amounts.
■■ Health care expenses you must pay before you reach
out-of-pocket limits under a plan.
■■ Health care expenses that are not covered under a
plan.
■■ Amounts over a plan’s annual maximum or lifetime
maximum as well as amounts above reasonable and
customary charges.
Eligible Expense Examples
Following are some common eligible health care expenses.
For more information about eligible and ineligible health
care expenses, refer to IRS Publication 502, Medical and
Dental Expenses or contact the claim administrator.
Although IRS Publication 502 is a good resource, not all of
the expenses included in the publication are reimbursable
under the Health Care FSA. You are encouraged to contact
the claim administrator to determine whether a particular
expense will be reimbursable before you incur the expense.
Examples of eligible expenses include:
■■ Out-of-pocket medical and dental expenses such as
deductibles, coinsurance, and copay amounts under
an insurance policy or health care plan.
■■ Charges in excess of reasonable and customary limits
or annual maximum benefits under an insurance policy
or health care plan.
■■ Certain infertility treatments.
■■ Dental services and supplies including bridges,
crowns, orthodontics, and dentures.
■■ Donor’s organ transplant expenses.
■■ Fees such as those for ambulance services,
diagnostics, doctor and surgical services.
■■ Medical equipment and supplies such as artificial
limbs, braces, crutches, splints, orthopedic shoes,
oxygen equipment, and wheelchairs.
■■ Physicals including routine, preventive, school, and
work physicals.
■■ Prescription drugs such as insulin, vitamins that are
available only by prescription to treat a specific medical
condition, and other legally prescribed drugs.
■■ Private nursing services.
■■ Psychiatric care such as alcohol/substance abuse
treatment, psychoanalysis, and legal fees for
authorizing treatment for mental illness.
■■ Smoking cessation programs and prescribed drugs.
(Amounts paid for over-the-counter drugs such as
nicotine patches and gum are not eligible, even if
prescribed by a doctor.)
■■ Special medical care, education and equipment for the
handicapped such as Braille books and magazines,
guide dogs and their upkeep, and the cost and repair
of special telephone equipment and television audio
display equipment for the deaf.
■■ Specialized training and equipment required for a deaf
or blind individual.
■■ Speech therapy, hearing exams, hearing aids, and
batteries for hearing aids.
■■ Therapy treatment such as acupuncture and
electrolysis if medically necessary and performed by a
licensed technician.
■■ Transportation amounts paid primarily for, and essential
to, medical care.
■■ Vision care such as eye exams, eyeglasses, contact
lenses/lens solution, and LASIK, radial keratotomy, or
other surgical treatment of the eye.
■■ Weight-loss programs only if prescribed by a doctor
to treat a specific medical condition such as heart
disease.
■■ Certain over-the-counter drugs that are used to treat
medical conditions (as summarized below).
Special Rules for Over-the-Counter Drugs
Special rules apply regarding eligibility for over-the-
counter (OTC) drug purchases, which require a doctor’s
prescription in most cases. Eligibility is based on the
reason the drug is being used as follows:
Over-the-Counter Drugs
Medical Use Expenses for these drugs are generally eligible
health care fsa
because they are used primarily to treat a medical
condition. Examples include allergy medicines,
antacids, antibiotic creams, hydrocortisone
creams, pain relievers, cold medicines, and diaper
rash ointments.
Dual Purpose These drugs serve multiple purposes. Expenses
Use are eligible only if they are being used to treat a
medical condition as documented by a note from
the health care provider that states the medical
diagnosis and recommendation for use of the OTC
drug. Examples include medicated shampoos,
nasal sprays, Retin-A, glucosamine/chondroitin,
dietary or herbal supplements, weight-loss
supplements, vitamins and fiber supplements.
Personal Use Expenses for these drugs are not eligible because
they do not treat a medical condition and are
instead used to benefit one’s general health and
well-being. Examples include cosmetics, denture
care items, toothpaste, toothbrushes, deodorants,
non-medicinal shampoos or soaps, sun blocks,
sleeping aids, weight-reduction aids, and vitamins.
Most Over the Counter (OTC) drug or medicine purchases
will require a doctor’s prescription before it can be
reimbursed from the Health Care FSA.
You will have to first go to a doctor for a prescription,
which will then need to be submitted to WageWorks
along with the receipt.
When you go to the doctor, simply ask him or her to write
you a prescription for the item for which you want to be
reimbursed. The prescription will need to comply with
state prescription laws, but generally, if the prescription is
written on a prescription pad, it should be sufficient.
97
 FSA Eligible Medical Items
Does NOT Require a Doctor’s Prescription Requires a Doctor’s Prescription
• Bandages and related items (over-the-counter) • Acne treatments
• Birth control (over-the-counter) • Allergy & sinus medicine and products
• Blood pressure monitors • Antacids
• Cholesterol test kits and supplies • Antibiotic ointment
• Condoms • Aspirin or other pain relievers
• Contact lenses, cleaning solutions, etc. • Asthma medicines or treatments
• Crutches, canes, walkers or like equipment (purchase or rental) • Canker & cold sore treatments
• Dentures, bridges, etc. • Chest rubs
• Diabetic monitors, test kits, strips and supplies • Cold & flu medicines
• Eye related equipment/materials • Corn and callus removers
• Eyeglasses (over-the-counter) • Cough drops & sore throat lozenges
• Fertility monitors (over-the-counter) • Cough syrup
• First aid kits (over-the-counter) • Diaper rash ointments and creams
• Hearing aids and batteries • Ear drops & wax removal
• Incontinence supplies • Gastrointestinal medications
• Insulin, testing materials and supplies • Herbal or homeopathic medicines
• Magnetic therapy (over-the-counter) • Laxatives
• Medical equipment (for treatment of medical condition) & repairs • Lice treatments
• Medical monitoring and testing devices • Motion & nausea medicines
• Medical supplies (for treatment of a medical condition) • Over-the-counter products for dental, oral and teething pain
• Monitors & test kits (over-the-counter) • Pain relievers
• Occlusal guards to prevent teeth grinding • Propecia (for treatment of a medical condition)
• Orthotics • Retin-A (for non-cosmetic purposes)
health care fsa

• Orthopedic and surgical supports • Sleep aids

• Over-the-counter bandages and related items • Toothache and teething pain relievers
• Ovulation monitor (over-the-counter) • Wart removal treatments
• Pregnancy tests (over-the-counter)
• Reading glasses (over the counter)
• Teeth grinding prevention devices
• Urological products
• Walking aids (canes, walkers, crutches and related supplies)
• Wheelchair and repairs
Wound care (over-the-counter)
You are encouraged to contact the claim administrator to determine whether your OTC drug purchase will be
considered an eligible expense.

Special Rules for Drugs Purchased Outside the Ineligible Expenses

United States
Special rules apply regarding eligibility for prescription
drugs that are purchased outside the United States. In
general, a drug is not eligible if it is:
■■ Carried in or mailed in from another country unless the
FDA specifically allows that drug to be legally imported
by individuals.
■■ Purchased and consumed in another country unless
the drug is legal in both the other country and the
United States.
Certain health care expenses are ineligible. Ineligible
health care expenses include – but are not limited to – the
following:
■■ Amounts reimbursed by a health care plan or any other
source.
■■ Charges incurred while you are not a plan participant.
For example, if you participate in the plan from
April 1 through November 30 during a given year,
expenses incurred on or before March 31 and on
or after December 1 of that year are not eligible for
reimbursement.

98
■■ Charges that you are not legally required to pay.
■■ Cosmetic treatment (unless the treatment corrects
a deformity resulting from or directly related to a
congenital abnormality, a personal injury resulting
from an accident or trauma, or a disfiguring disease).
Cosmetic treatment includes, but is not limited to, teeth
bleaching, laser peels, chemical peels, hair transplants,
treatment for male pattern baldness, and cosmetic
surgery.
■■ Cosmetics and toiletries, such as toothpaste.
■■ Diaper service.
In addition, any expenses that you incur during one
calendar year may not be reimbursed from contributions
made to the health care FSA during a different calendar
year.
If you have any questions regarding ineligible expenses,
contact the claim administrator.
IRS regulations governing eligible and ineligible expenses
under health care flexible spending accounts have changed
in the past and may change again in the future. It is your
responsibility to determine whether your anticipated

■■ Dues for athletic clubs, health clubs or spas.

health care expenses will be eligible for reimbursement
under the plan. If the IRS audits your individual income tax
■■ Expenses identified as ineligible in IRS Publication 502, return, you may be required to show that your reimbursed
Medical and Dental Expenses. expenses meet the applicable requirements.
■■ Funeral expenses.
Reimbursement does not guarantee that Health Care
■■ Household and domestic help, even if recommended FSA payments will not be declared taxable by the IRS at
by a doctor. some time in the future. If reimbursements are subject to
■■ Insurance premiums including health care and long- taxation, including any reimbursements paid in error, you
term care insurance premiums. will be liable for any taxes or penalties.
■■ Long-term care services.

health care fsa

■■ Marriage or family counseling.
■■ Maternity clothes.
■■ Medical or dental expenses claimed as a deduction on
your federal income tax return.
■■ Nursing services for care of healthy infants.
■■ Over-the-Counter drugs (except insulin) unless
processed through a pharmacy with a doctor’s
prescription.
■■ Vitamins taken for general health purposes and not
prescribed by a doctor.
■■ Weight-loss programs unless prescribed by a doctor to
treat a specific medical condition such as heart disease.

99
 Health Care FSA
Reimbursement
(Claims)
Reimbursement Options
Three reimbursement options are available under the
plan. You may:
■■ Use your Health Care FSA debit card.
■■ Use the Pay My Provider feature of the plan.
■■ File traditional paper claims.
WageWorks (the claim administrator) is the named
fiduciary for adjudicating claims for benefits under the
plan, and for deciding any appeals of denied claims.
WageWorks has the authority, in its discretion, to interpret
the terms of the plan, to decide questions of eligibility
for coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by WageWorks
are final and binding on participants and beneficiaries to
the full extent permitted by law.
health care fsa
Debit Card
A health care card will be sent to you following your
enrollment in the plan. The card works like a debit card
and allows you to pay many eligible expenses directly
from your account at the point of purchase. By using
the card, you eliminate paying out-of-pocket money for
eligible expenses and waiting for reimbursement.
The card tracks your available balance and permits
transactions up to that amount. Your available balance is
the amount you elect to contribute for the entire year, less
any reimbursements that have already been paid.
When you receive your debit card, a cardholder agreement
will be included. You must agree to the terms and
conditions of the cardholder agreement before you use the
card. If you do not agree to the terms and conditions stated
in the cardholder agreement, you may use the Pay My
Provider feature or traditional claim processing instead of
the health care card.
100
Providers That Accept the Health Care Card
The card is designed for use at health care provider
offices, pharmacies, and drugstores. You can also use
the card for purchases from merchants who participate in
the Inventory Information Approval System (IIAS). The IIAS
was established as the result of an IRS rule that requires
non-healthcare merchants – such as supermarkets and
discount stores – to identify health care items at the
time of purchase. You can view a list of IIAS participating
merchants at www.sig-is.org. Transactions at non-
IIAS merchants are rejected. Although this provides a
safeguard, you are fully responsible for ensuring that
only eligible expenses are paid using the card. (Using
your card for charges other than eligible expenses is
considered fraud.)
Receipts
Normally, receipts will not be required by the claim
administrator for purchases made at IIAS participating
merchants. However, since health care provider offices,
pharmacies, and drugstores do not need to be IIAS
participants, you may be asked to submit receipts for
those transactions. Receipts must contain the following
information:
■■ Nature of expense (i.e., what service or supply was
provided).
■■ Date of expense.
■■ Provider name.
■■ Expense amount.
■■ Patient name.
If a receipt is required, the claim administrator will
normally request that you submit your receipt within 45
days of the debit card transaction. If you fail to submit
receipts when requested, your card may be deactivated.
It is highly recommended that you keep receipts for your
purchases. Even if you are not required to submit them to
the claim administrator, you may need receipts to satisfy
IRS requirements.
Purchasing Errors and Lost or Stolen Cards
If you make a mistake and purchase an ineligible item
with your card, contact the claim administrator. You will
be required to send your receipt and a reimbursement
check for the amount of the ineligible expense to the
claim administrator.
If your card is lost or stolen, contact the claim
administrator immediately to deactivate your card and to
order a replacement card.
Card Deactivation
Your card will be deactivated:
■■ When you report your card lost or stolen.
■■ When the claim administrator requests a receipt to
substantiate a purchase made with your card and
you fail to respond to that request within a reasonable
period of time.
■■ When your employment terminates. (Note: Your
card will be deactivated even if you elect COBRA
continuation coverage as health care cards are not
available to COBRA participants.)
■■ When your participation in the plan terminates for any
other reason.
Pay My Provider
The Pay My Provider feature of the plan is similar to an
online bill paying service. You request direct payment to
your provider via www.wageworks.com.
Use Pay My Provider to pay for expenses such as
monthly chiropractic visits, orthodontia installment
payments, or even for a one time expense. You submit
information regarding the payee and the services
provided and indicate whether your payment is a one
time only payment or a recurring payment (e.g., pay once
per month).
Funds are transferred from your account to your provider
promptly. Simply set up your direct payment request at
least ten days prior to the payment due date.
As with other reimbursement options, requests for
payment of ineligible expenses will be denied.
Traditional Paper Claims
For purposes of filing claims and claim appeals, the term
“you” includes you or an authorized representative who is
filing a claim on your behalf.
Filing a Claim
Claim forms are available from Employee Services. Send
your claim form to:
WageWorks Claims Administrator
P.O. Box 14053
Lexington, KY 40512
Or via facsimile to 1-877-353-9236
Submit a claim whenever you incur an eligible expense,
but no later than the March 31 following the year in which
you incur the expense. Your claim will be denied if it is
not received by the claim administrator by the March 31
deadline. Any unclaimed balance in your account after
March 31 will be forfeited.
Proof of Expense
When you submit your claim, you must also submit one
of the following to prove that your expense is eligible for
reimbursement:
■■ An explanation of benefits (EOB) from your health care
plan showing the date of service and out-of-pocket
expenses. If the EOB indicates the procedure is not
covered by your health care plan, you may be required
to submit an itemized statement from the provider.
■■ For expenses not covered by a health care plan, an
itemized statement from the service provider. The
itemized statement should include the patient’s name,
date of service, procedure description, provider name,
and the charges for the service. Account balance
statements, balance forward statements, cancelled
checks, cash register receipts, and credit card receipts
are not acceptable documentation. In some cases, a
letter of medical necessity from a medical practitioner
may be required.
■■ For drugs that require a prescription for reimbursement,
a pharmacy statement including the name of the
health care fsa
pharmacy, patient’s name, date of fill, cost, prescription
number, and name of the drug/item.
Your claim will be denied if you fail to provide the
claim administrator with proof of expense or any other
requested information.
Always keep copies of proof of expense documents,
including receipts and itemized statements. You will need
these documents to meet plan requirements and/or IRS
requirements.
Filing Claims After Your Employment Terminates
Expenses incurred after your participation in the plan
ends are not eligible for reimbursement. However, you
may continue to file claims for reimbursement of expenses
that you incur before your participation ends (including
participation during a period of COBRA continuation
coverage). You must file those claims before March 31 of
the following calendar year. Any unclaimed balance in your
account after March 31 of the following calendar year is
forfeited.
Claim Review
The claim administrator will review your claim within
30 days of receipt and determine whether or not your
expense is reimbursable in accordance with the terms
and provisions of the plan.
101
 The claim administrator may require more time to review
your claim if necessary due to circumstances beyond
its control. If this should happen, you will be notified in
writing that the review period is being extended for up to
an additional period of 15 days.
If an extension is necessary because you need to furnish
additional information, you will have up to 45 days to
furnish the requested information, and the extension
period will be further extended by the number of days it
takes you to provide the additional information. Failure
to cooperate with a claim administrator request for
additional information may invalidate your claim.
Reimbursement of Claims
Claims are reimbursed based on your elected annual
contribution amount. Claims for reimbursement in excess
of your elected annual contribution amount will not be
paid and may not be carried over into the following
calendar year. This is because expenses incurred
during one calendar year may not be reimbursed from
contributions made during a different calendar year.
If Your Claim Is Denied
health care fsa
If your claim is denied, in whole or in part, you will receive
written notice from the claim administrator during the
review period (or the extended review period if applicable).
The notice will include the following information:
■■ The reasons for the denial and the plan provisions on
which the denial is based.
■■ A description of any additional information necessary
for your claim to be reconsidered, why the information
is necessary, and your time limit for submitting the
information.
■■ A description of the appeal procedures and applicable
time limits.
■■ Your right to request all documentation relevant to your
claim.
First Level Appeal Procedure
If the claim is denied, you have the right to appeal
the decision. You must make your written request for
appeal to the claim administrator within 180 days from
the date you receive the notice of claim denial. Include
all additional information necessary for your claim to be
reconsidered (as identified in the notice of claim denial)
and any other information that you believe will support
your appeal.
102
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives
your appeal. If your appeal is denied, the notice will
include the same type of information that was provided in
the initial claim denial.
Second Level Appeal Procedure
If your first level appeal is denied, you have the right to a
second level claim appeal. To file your second level appeal,
take the same action that you took in filing your initial claim
appeal. You must make your written request for a second
level appeal to the claim administrator within 180 days from
the date you receive the initial claim appeal denial. If you do
not make the request within that time period, you will have
waived your right to a second level appeal.
Submit all additional information necessary for your claim
to be reconsidered (as identified in the notice of claim
appeal denial) and any other information that you believe
will support your second level appeal.
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives your
second level appeal. If your second level appeal is denied,
the notice will include the same type of information that was
provided in the initial claim denial.
Additional Appeal Information
Each level of appeal will be independent from the previous
level. For example, the review will not be conducted by
persons who made the previous claim determination or by
subordinates of those persons.
During each level of appeal, the claim reviewer will review
relevant information that you submit including any new
information.
You cannot file suit in federal court until you have
exhausted the plan’s appeal procedures.
Incorrect or Excess Reimbursement
If it is determined that an incorrect or excess
reimbursement has been made, the claim administrator
may do any of the following:
■■ Notify you of the error and require you to repay the
amount within sixty days of receipt of the notification.
■■ Reduce a future reimbursement to you.
■■ Withhold the amount from your pay (to the extent
permitted by law).
If none of the above results in adequate repayment, the
remaining amount will be reported to CMC as a bad
business debt and treated accordingly.
Dental/Vision Fsa
Introduction
If you enroll in the Consumer Choice Plan, you may also
enroll in a Health Savings Account (HSA), which allows
you to reimburse yourself for out-of-pocket medical
expenses. But, you cannot enroll in both an HSA and the
CMC Health Care FSA. The CMC Dental/Vision Flexible
Spending Account (FSA) Plan provides a way for you to
pay some of these expenses on a pretax basis.
The plan is administered by WageWorks (the claim
administrator). When you need assistance or have
specific questions regarding this plan, contact the claim
administrator at 1-877-924-3967 or www.wageworks.com.
Refer to the glossary at the end of this handbook for
definitions of key terms.
Dental/Vision FSA
Benefits
Participating in the Dental/Vision FSA
The plan allows you to make contributions on a pretax
basis to pay for eligible dental/vision expenses that are
not fully covered under a benefit plan or reimbursed by
any other source. You are reimbursed from your account
as you incur eligible out-of-pocket dental/vision expenses
such as dental deductibles or vision copays.
Your contributions are deducted from your pay before
federal income taxes, Social Security taxes, and in most
states, before state income taxes are withheld.
When you elect to participate in the Dental/Vision FSA:
■■ You elect how much to contribute to the plan and your
contributions are deducted from your pay on a pretax
basis.
■■ You have access to the total annual contribution
amount you elect as soon as you incur eligible
expenses. Keep in mind that expenses are not eligible
if they are incurred before your participation begins or
after your participation ends (e.g., if your participation
begins on April 1, expenses incurred on or before
March 31 are not eligible). This also applies to expenses
incurred by a dependent during any period in which he/
she does not qualify as your eligible dependent.
■■ A health care card (similar to a debit card) will be sent to
you. This card allows you to pay many eligible expenses
directly from your account and eliminates claim
processing time.
■■ As you incur eligible dental/vision expenses during the
year, you can:
• Use your health care card to pay for eligible
purchases from providers and merchants who
accept the card (you must submit receipts to the
claim administrator for certain health care card
transactions).
• Use the Pay My Provider feature of the plan,
which is similar to an online bill paying service.
You request direct payment to your provider via
www.wageworks.com
• Submit traditional claim forms and receipts/
statements to the claim administrator. You will
need to use this process for services or supplies
purchased from any provider or merchant that
cannot accept your health care card.
■■ You should keep copies of your itemized receipts/
statements for each purchase whether you use your
health care card, the Pay My Provider feature, or file
traditional claims. You may need these documents to
satisfy requirements established by the plan and/or the
IRS.
■■ You must submit all claims for reimbursement of
expenses incurred during a calendar year by March 31
of the following year.
■■ Any unclaimed balance in your account after March 31
Dental/vision fsa
of the following calendar year is forfeited.
You must make a Dental/Vision FSA enrollment election
each year during the Open Enrollment period if you wish
to participate in the plan during the following calendar
year - participation is not automatically renewed. If you
are currently a plan participant and you do not elect to
participate in the plan during an Open Enrollment period,
your participation will end on the December 31 following
that Open Enrollment period.
Contributions
You may elect to contribute between $120 and $2,500
to the Dental/Vision FSA each calendar year. However
if you are a Highly Compensated Employee (HCE) as
determined by the IRS, there may be situations where the
Company is required to reduce your contributions. If your
enrollment occurs at any time other than January 1, your
annual contribution will be prorated accordingly.
103
 Your contributions are withheld from your pay and are
subject to the minimum and maximum payroll deduction
amounts shown below.
Minimum Maximum
Pay Cycle ($120 per year) ($2,500 per year)
Weekly* $2.50 $52.08
Biweekly** $5.00 $104.16
* Contributions are withheld from your first four pay checks each
month.
** Contributions are withheld from your first two pay checks each
month.
Your contribution amount may be reduced as follows:
■■ Your maximum contribution amount will be prorated if
you are newly eligible and begin participation at a time
other than the beginning of a calendar year.
■■ The Company may reduce your contribution amount if
the plan fails one of several IRS benefit limitation tests.
You will be advised if this occurs.
Before you make your election, consider the plan
advantages, disadvantages, eligible and ineligible
expenses, and other Dental/Vision FSA information. Also
contact your tax advisor or the IRS to discuss how your
contribution amount (if any) will affect your personal tax
situation.
Advantages and Disadvantages of
Participation
Participating in the Dental/Vision FSA saves you money
by reducing your income taxes. Since your contributions
Dental/vision fsa
are deducted from your pay on a pretax basis – before
federal, state, and Social Security (FICA) taxes are
calculated and withheld – you can expect to see tax
savings in your paycheck. For example, if you earn $3,000
a month and contribute $500 to the Dental/Vision FSA,
you will pay taxes on $2,500 per month. Your actual
savings will depend on your personal tax situation.
In exchange for the tax advantages provided under
the Dental/Vision FSA, the IRS imposes significant
restrictions. It is important that you carefully read all of
the plan information before you decide whether or not to
participate. You are also encouraged to contact your tax
advisor or the IRS to discuss how participation will affect
your specific tax situation.
Potential disadvantages of participating in the Dental/
Vision FSA are summarized in the following table.
104
Potential Disadvantages of
Participating in the Dental/Vision FSA
Use It or Lose It The Internal Revenue Code requires that
Rule you forfeit any contribution amount that you
do not use for expenses incurred during the
same calendar year. Any balance remaining
in your account at the end of the year cannot
be refunded to you or carried over to the next
calendar year. Forfeited amounts are used to
help pay administrative costs under the plan.
Irrevocable The amount you elect to contribute is
Elections irrevocable for the entire calendar year. You
cannot change your election unless you
experience a qualified status change as
summarized in the Eligibility and Enrollment
section of this handbook.
Effect on Social Pretax contributions reduce the amount of
Security your earnings that are reported for Social
Security purposes. Therefore, if you earn
less than the Social Security wage base or
if pretax contributions reduce your earnings
below the Social Security wage base, your
Social Security withholding will be reduced.
Because Social Security benefits are based
on your career earnings history, this reduced
withholding could decrease any Social
Security benefits you may receive.
Effect on Other Pretax contributions may affect other statutory
Statutory Benefits benefits (such as unemployment insurance,
workers’ compensation, and state disability
insurance) for the same reasons that they
affect Social Security benefits. Because
statutory benefits are also based on taxable
earnings, benefits for which you may become
eligible could be reduced as a result of pretax
contributions to the Dental/Vision FSA.
Loss of Income The IRS does not allow you to take a tax
Tax Deductions deduction for expenses reimbursed through
the plan. (Under current tax laws, tax
deductions for medical expenses are available
for eligible expenses that exceed 7.5% of
your adjusted gross income.) You should
consult with your tax advisor to determine
whether participating in the Dental/Vision
FSA or taking a tax deduction is best for your
personal situation.
No Guarantee There is no guarantee that any amounts
of Tax reimbursed under the Dental/Vision FSA will
Consequences be excludable from your income taxes. For
example, if the IRS audits your tax return,
you may be required to show that expenses
reimbursed through the plan meet the
applicable tax requirements. Reimbursement
does not guarantee that Dental/Vision
FSA payments will not be declared taxable
by the IRS at some time in the future. If
reimbursements are subject to taxation,
including any reimbursements paid in error,
you will be liable for any taxes or penalties.
Other items to consider before you enroll in the plan are:
■■ Only expenses that are incurred while you are
participating in the plan are eligible for reimbursement.
This means that amounts you contribute to the Dental/
Vision FSA during a calendar year may be used only to
reimburse expenses incurred:
• After your participation begins, and
• Before that calendar year ends or before your
participation ends if that occurs earlier.
■■ You cannot transfer money from one flexible spending
account to another. If you are also participating in the
Dependent Day Care Flexible Spending Account Plan,
you cannot transfer money between the two plans.
Your Dental/Vision FSA contributions will apply only to
eligible health care expenses and may not be used to
reimburse dependent day care expenses.
■■ Some individuals experience cash flow concerns
when participating in the plan. Although many eligible
expenses can be paid directly from your account
with the health care card or by paying your providers
through the Pay My Provider feature of the plan, there
will be occasions when you need to make out-of-pocket
payments for health care expenses at the same time
Dental/Vision FSA contributions are being deducted
from your pay. When you use the traditional claim
process, reimbursement requires a reasonable period
of time for claim processing.
If you decide to enroll in the plan, estimate your eligible
expenses carefully and elect to contribute only the
amount that you are confident you will spend during the
calendar year to avoid forfeiture of your contributions. If
you are unsure if an expense will be eligible, contact the
claim administrator for clarification before you make your
contribution election.
Effect of Contributions on Other
Company Benefits
Your Dental/Vision FSA contributions will not affect any
Company benefits that are based on pay, such as life
and disability insurance. These benefits will continue to
be based on your salary before pretax contributions are
deducted.
Eligible Expenses
Eligible expenses are dental/vision expenses that:
■■ Are incurred for expenses, as defined by Internal
Revenue Code (IRC) Section 213(d),
■■ Are incurred by you or an individual who qualifies as
your dependent for federal income tax purposes during
the period you participate in the plan,
■■ Have not been reimbursed by any other source and
will not be submitted for reimbursement by any other
source, and
■■ Subject to certain exceptions, qualify as allowable tax
deductions under federal income tax rules.
Not every dental/vision related expense will qualify for
reimbursement. For example, an expense is not for
medical care if it is merely beneficial to the health of you
or your eligible dependents (e.g., vitamins or nutritional
supplements that are not taken to treat a specific medical
condition) or for cosmetic purposes, unless necessary
to correct a deformity resulting from illness, injury, or
birth defect. You may be required to provide additional
documentation from a health care provider showing that
you have a medical condition and/or the particular item
is necessary to treat a medical condition. Expenses for
cosmetic purposes are also not reimbursable unless they
are necessary to correct an abnormality caused by illness,
injury, or birth defect.
In addition, certain expenses that might otherwise
be considered medical care under the IRC are not
reimbursable under any health care FSA-type plan (per
IRS regulations):
■■ Health insurance premiums,
■■ Expenses incurred for qualified long-term care services,
and
■■ Any other expenses that are specifically excluded under
a plan.
Dental/vision fsa
Only expenses that are incurred after your participation
in the Dental/Vision FSA begins and in the same
calendar year in which you make contributions are
eligible for reimbursement. (Expenses incurred after your
participation in the plan terminates are not eligible for
reimbursement.) Expenses are considered incurred on the
day the service is provided, regardless of when you are
billed or pay for the service.
Eligible expenses include the following:
■■ Dental/vision expenses that are not payable by dental
or vision plans under which you/your dependents are
covered. These include expenses such as deductibles
and copay amounts.
■■ Dental/vision expenses you must pay before you reach
out-of-pocket limits under a plan.
■■ Dental/vision expenses that are not covered under a
plan.
■■ Amounts over a plan’s annual maximum or lifetime
maximum as well as amounts above reasonable and
customary charges.
105
 Eligible Expense Examples
Following are some common eligible health care expenses.
For more information about eligible and ineligible health
care expenses, refer to IRS Publication 502, Medical and
Dental Expenses or contact the claim administrator.
Although IRS Publication 502 is a good resource, not all of
the expenses included in the publication are reimbursable
under the Dental/Vision FSA. You are encouraged to contact
the claim administrator to determine whether a particular
expense will be reimbursable before you incur the expense.
■■ Insurance premiums including health care and long-
term care insurance premiums.
■■ Dental or vision expenses claimed as a deduction on
your federal income tax return.
In addition, any expenses that you incur during one
calendar year may not be reimbursed from contributions
made to the Dental/Vision FSA during a different calendar
year.
If you have any questions regarding ineligible expenses,
contact the claim administrator.

IRS regulations governing eligible and ineligible expenses

Examples of eligible expenses include: under health care flexible spending accounts have changed
■■ Out-of-pocket dental expenses such as deductibles, in the past and may change again in the future. It is your
coinsurance, and copay amounts under an insurance responsibility to determine whether your anticipated dental
policy or health care plan. or vision expenses will be eligible for reimbursement
under the plan. If the IRS audits your individual income tax
Ineligible Expenses return, you may be required to show that your reimbursed
Certain health care expenses are ineligible. Ineligible
expenses meet the applicable requirements.
health care expenses include – but are not limited to – the
following: Reimbursement does not guarantee that Dental/Vision
■■ Medical or Pharmacy expenses FSA payments will not be declared taxable by the IRS at
some time in the future. If reimbursements are subject to
■■ Amounts reimbursed by a health care plan or any other
taxation, including any reimbursements paid in error, you
source.
will be liable for any taxes or penalties.
■■ Charges incurred while you are not a plan participant.
For example, if you participate in the plan from
April 1 through November 30 during a given year,
expenses incurred on or before March 31 and on
or after December 1 of that year are not eligible for
Dental/vision fsa

reimbursement.
■■ Charges that you are not legally required to pay.
■■ Cosmetic treatment (unless the treatment corrects
a deformity resulting from or directly related to a
congenital abnormality, a personal injury resulting
from an accident or trauma, or a disfiguring disease).
Cosmetic treatment includes, but is not limited to, teeth
bleaching, and cosmetic surgery.
■■ Cosmetics and toiletries, such as toothpaste.
■■ Expenses identified as ineligible in IRS Publication 502,
Medical and Dental Expenses.

106
Dental/Vision FSA
Reimbursement
(Claims)
Reimbursement Options
Three reimbursement options are available under the plan.
You may:
■■ Use your Dental/Vision FSA debit card.
■■ Use the Pay My Provider feature of the plan.
■■ File traditional paper claims.
WageWorks (the claim administrator) is the named
fiduciary for adjudicating claims for benefits under the
plan, and for deciding any appeals of denied claims.
WageWorks has the authority, in its discretion, to interpret
the terms of the plan, to decide questions of eligibility
for coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by WageWorks
are final and binding on participants and beneficiaries to
the full extent permitted by law.
Debit Card
A health care card will be sent to you following your
enrollment in the plan. The card works like a debit card
and allows you to pay many eligible expenses directly
from your account at the point of purchase. By using the
card, you eliminate paying out-of-pocket money for eligible
expenses and waiting for reimbursement.
The card tracks your available balance and permits
transactions up to that amount. Your available balance is
the amount you elect to contribute for the entire year, less
any reimbursements that have already been paid.
When you receive your debit card, a cardholder agreement
will be included. You must agree to the terms and
conditions of the cardholder agreement before you use the
card. If you do not agree to the terms and conditions stated
in the cardholder agreement, you may use the Pay My
Provider feature or traditional claim processing instead of
the health care card.
Providers That Accept the Health Care Card
The card is designed for use at health care provider
offices, pharmacies, and drugstores. You can also use
the card for purchases from merchants who participate in
the Inventory Information Approval System (IIAS). The IIAS
was established as the result of an IRS rule that requires
non-healthcare merchants – such as supermarkets and
discount stores – to identify health care items at the
time of purchase. You can view a list of IIAS participating
merchants at www.sig-is.org. Transactions at non-
IIAS merchants are rejected. Although this provides a
safeguard, you are fully responsible for ensuring that only
eligible expenses are paid using the card. (Using your card
for charges other than eligible expenses is considered
fraud.)
Receipts
Normally, receipts will not be required by the claim
administrator for purchases made at IIAS participating
merchants. However, since health care provider offices,
pharmacies, and drugstores do not need to be IIAS
participants, you may be asked to submit receipts for
those transactions. Receipts must contain the following
information:
■■ Nature of expense (i.e., what service or supply was
provided).
■■ Date of expense.
■■ Provider name.
■■ Expense amount.
■■ Patient name.
Dental/vision fsa
If a receipt is required, the claim administrator will normally
request that you submit your receipt within 45 days of the
debit card transaction. If you fail to submit receipts when
requested, your card may be deactivated.
It is highly recommended that you keep receipts for your
purchases. Even if you are not required to submit them to
the claim administrator, you may need receipts to satisfy
IRS requirements.
Purchasing Errors and Lost or Stolen Cards
If you make a mistake and purchase an ineligible item
with your card, contact the claim administrator. You will
be required to send your receipt and a reimbursement
check for the amount of the ineligible expense to the claim
administrator.
If your card is lost or stolen, contact the claim
administrator immediately to deactivate your card and to
order a replacement card.
107
 Card Deactivation
Your card will be deactivated:
■■ When you report your card lost or stolen.
■■ When the claim administrator requests a receipt to
substantiate a purchase made with your card and
you fail to respond to that request within a reasonable
period of time.
■■ When your employment terminates. (Note: Your card will
be deactivated even if you elect COBRA continuation
coverage as health care cards are not available to
COBRA participants.)
■■ When your participation in the plan terminates for any
other reason.
Pay My Provider
The Pay My Provider feature of the plan is similar to an
online bill paying service. You request direct payment to
your provider via www.wageworks.com.
Use Pay My Provider to pay for expenses such as
orthodontia installment payments, or even for a one time
expense. You submit information regarding the payee and
the services provided and indicate whether your payment
is a one time only payment or a recurring payment (e.g.,
pay once per month).
Funds are transferred from your account to your provider
promptly. Simply set up your direct payment request at
least ten days prior to the payment due date.
As with other reimbursement options, requests for
payment of ineligible expenses will be denied.
Dental/vision fsa
Traditional Paper Claims
For purposes of filing claims and claim appeals, the term
“you” includes you or an authorized representative who is
filing a claim on your behalf.
Filing a Claim
Claim forms are available from Employee Services. Send
your claim form to:
WageWorks Claims Administrator
P.O. Box 14053
Lexington, KY 40512
Or via facsimile to 1-877-353-9236
Submit a claim whenever you incur an eligible expense,
but no later than the March 31 following the year in which
you incur the expense. Your claim will be denied if it is
not received by the claim administrator by the March 31
deadline. Any unclaimed balance in your account after
March 31 will be forfeited.
108
Proof of Expense
When you submit your claim, you must also submit one
of the following to prove that your expense is eligible for
reimbursement:
■■ An explanation of benefits (EOB) from your health care
plan showing the date of service and out-of-pocket
expenses. If the EOB indicates the procedure is not
covered by your health care plan, you may be required
to submit an itemized statement from the provider.
■■ For expenses not covered by a health care plan, an
itemized statement from the service provider. The
itemized statement should include the patient’s name,
date of service, procedure description, provider name,
and the charges for the service. Account balance
statements, balance forward statements, cancelled
checks, cash register receipts, and credit card receipts
are not acceptable documentation. In some cases, a
letter of medical necessity from a medical practitioner
may be required.
Your claim will be denied if you fail to provide the
claim administrator with proof of expense or any other
requested information.
Always keep copies of proof of expense documents,
including receipts and itemized statements. You will need
these documents to meet plan requirements and/or IRS
requirements.
Filing Claims After Your Employment Terminates
Expenses incurred after your participation in the plan
ends are not eligible for reimbursement. However, you
may continue to file claims for reimbursement of expenses
that you incur before your participation ends (including
participation during a period of COBRA continuation
coverage). You must file those claims before March 31 of
the following calendar year. Any unclaimed balance in your
account after March 31 of the following calendar year is
forfeited.
Claim Review
The claim administrator will review your claim within
30 days of receipt and determine whether or not your
expense is reimbursable in accordance with the terms
and provisions of the plan.
The claim administrator may require more time to review
your claim if necessary due to circumstances beyond its
control. If this should happen, you will be notified in writing
that the review period is being extended for up to an
additional period of 15 days.
If an extension is necessary because you need to furnish
additional information, you will have up to 45 days to
furnish the requested information, and the extension
period will be further extended by the number of days it
takes you to provide the additional information. Failure to
cooperate with a claim administrator request for additional
information may invalidate your claim.
Reimbursement of Claims
Claims are reimbursed based on your elected annual
contribution amount. Claims for reimbursement in excess
of your elected annual contribution amount will not be
paid and may not be carried over into the following
calendar year. This is because expenses incurred
during one calendar year may not be reimbursed from
contributions made during a different calendar year.
If Your Claim Is Denied
If your claim is denied, in whole or in part, you will receive
written notice from the claim administrator during the
review period (or the extended review period if applicable).
The notice will include the following information:
■■ The reasons for the denial and the plan provisions on
which the denial is based.
■■ A description of any additional information necessary
for your claim to be reconsidered, why the information
is necessary, and your time limit for submitting the
information.
■■ A description of the appeal procedures and applicable
time limits.
■■ Your right to request all documentation relevant to your
claim.
First Level Appeal Procedure
If the claim is denied, you have the right to appeal the
decision. You must make your written request for appeal
to the claim administrator within 180 days from the date
you receive the notice of claim denial. Include all additional
information necessary for your claim to be reconsidered
(as identified in the notice of claim denial) and any other
information that you believe will support your appeal.
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives
your appeal. If your appeal is denied, the notice will
include the same type of information that was provided in
the initial claim denial.
Second Level Appeal Procedure
If your first level appeal is denied, you have the right to a
second level claim appeal. To file your second level appeal,
take the same action that you took in filing your initial claim
appeal. You must make your written request for a second
level appeal to the claim administrator within 180 days from
the date you receive the initial claim appeal denial. If you do
not make the request within that time period, you will have
waived your right to a second level appeal.
Submit all additional information necessary for your claim to
be reconsidered (as identified in the notice of claim appeal
denial) and any other information that you believe will
support your second level appeal.
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives your
second level appeal. If your second level appeal is denied,
the notice will include the same type of information that was
provided in the initial claim denial.
Additional Appeal Information
Each level of appeal will be independent from the previous
level. For example, the review will not be conducted by
persons who made the previous claim determination or by
subordinates of those persons.
During each level of appeal, the claim reviewer will review
relevant information that you submit including any new
information.
You cannot file suit in federal court until you have
exhausted the plan’s appeal procedures.
Dental/vision fsa
Incorrect or Excess Reimbursement
If it is determined that an incorrect or excess
reimbursement has been made, the claim administrator
may do any of the following:
■■ Notify you of the error and require you to repay the
amount within sixty days of receipt of the notification.
■■ Reduce a future reimbursement to you.
■■ Withhold the amount from your pay (to the extent
permitted by law).
If none of the above results in adequate repayment, the
remaining amount will be reported to CMC as a bad
business debt and treated accordingly.
109
 Dependent Day Care Fsa
Introduction
Many of us have dependents who need care during our
working hours. The CMC Dependent Day Care Flexible
Spending Account (FSA) Plan provides a way for you to
pay some of these expenses on a pretax basis.
The plan is administered by WageWorks (the claim
administrator). When you need assistance or have
specific questions regarding this plan, contact the claim
administrator at 1-877-924-3967 or www.wageworks.com.
Refer to the glossary at the end of this handbook for
definitions of key terms.
Dependent Day Care
FSA Benefits
Participating in the Dependent Day Care
FSA
The plan allows you to make contributions on a pretax
basis to pay for eligible dependent day care expenses
– such as those for child or elder care while you are
working – that are not reimbursed by any other source.
As you incur eligible dependent day care expenses during
the year, you are reimbursed from your account.
Your contributions are deducted from your pay before
federal income taxes, Social Security taxes, and in most
states, before state income taxes are withheld.
When you elect to participate in the Dependent Day Care
FSA:
■■ You elect how much to contribute to the plan and your
contributions are deducted from your pay on a pretax
basis.
■■ You have access to the balance in your account at
the time of reimbursement. If you do not have enough
money in your account to reimburse a claim, checks
for partial reimbursements will be sent to you as you
dependent day
make contributions to your account until you receive full
care fsa
reimbursement for the expense.
■■ As you incur eligible dependent day care expenses
during the year, you can either:
• Use the Pay My Provider feature of the plan,
which is similar to an online bill paying service.
You request direct payment to your provider via
www.wageworks.com.
• Submit traditional claim forms and receipts/
statements to the claim administrator.
110
• Keep in mind that expenses are not eligible if they
are incurred before your participation begins or after
the end of the current calendar year (e.g., if your
participation begins on April 1, expenses incurred
on or before March 31 and on or after December 31
are not eligible). In addition, any expenses incurred
for a dependent during a period in which he/she
does not qualify as your eligible dependent are not
eligible expenses.
■■ You must keep copies of your itemized receipts/
statements for each purchase whether you use the
Pay My Provider feature or file traditional claims. You
will need these documents to satisfy requirements
established by the plan and/or the IRS.
■■ You must submit claims for reimbursement of
expenses incurred during a calendar year by March 31
of the following year.
■■ Any unclaimed balance in your account after March 31
of the following calendar year is forfeited.
You must make a Dependent Day Care FSA enrollment
election each year during the Open Enrollment period if
you wish to participate in the plan during the following
calendar year - participation is not automatically renewed.
If you are currently a plan participant and you do not elect
to participate in the plan during an Open Enrollment period,
your participation will end on the December 31 following
that Open Enrollment period.
Contributions
The minimum contribution amount under the plan is $120
each calendar year. Current IRS regulations establish
maximum contribution amounts based on your federal
income tax filing status, as follows:
Maximum Contribution Amounts
Federal Income Tax Maximum Annual
Filing Status Contribution Amount
Married Filing Jointly or Single
$5,000
Head of Household
Married Filing Separately $2,500
If you are married and your spouse’s employer offers a similar pretax opportunity, the maximum combined amount you
and your spouse can contribute each year is $5,000. In addition, under current IRS regulations, reimbursements from
your account cannot exceed the income of the lower-paid spouse. If your spouse does not work and is either a full-
time student for at least five months during the year or is physically or mentally incapable of caring for himself/herself,
the IRS assumes an income of $250 a month if you have one dependent and $500 a month if you have two or more
dependents. You are responsible for reporting excess reimbursements as taxable income.

Your contributions are withheld from your pay – the deduction amounts per pay period for minimum and maximum
contributions are shown in the following table.

Minimum and Maximum Deductions Per Pay Period

Federal Income Pay Cycle
Tax Filing Status Annual Election Weekly* Biweekly**
Married Filing Minimum $120 $2.50 $5.00
Jointly or Maximum $5,000 $104.16 $208.33
Single Head of
Household
Married Filing Minimum $120 $2.50 $5.00
Separately Maximum $2,500 $52.08 $104.16
* Contributions are withheld from your first four pay checks each month.
**Contributions are withheld from your first two pay checks each month.

Your contribution amount may be reduced as follows: Advantages and Disadvantages of

■■ Your maximum contribution amount will be prorated if
you are newly eligible and begin participation at a time
other than the beginning of a calendar year.
■■ The Company may reduce your contribution
amount if the plan fails one of several IRS benefit
limitation tests. You will be advised if this occurs.
Before you make your election, consider the plan
advantages, disadvantages, eligible and ineligible
expenses, and other Dependent Day Care FSA
information. Also contact your tax advisor or the IRS to
discuss how your contribution amount (if any) will affect
your specific tax situation.
Participation
Participating in the Dependent Day Care FSA saves
you money by reducing your income taxes. Since your
contributions are deducted from your pay on a pretax
basis – before federal, state, and Social Security (FICA)
taxes are calculated and withheld – you can expect
to see tax savings in your paycheck. For example, if
you earn $3,000 a month and contribute $500 to the
Dependent Day Care FSA, you will pay taxes on $2,500
per month. Your actual savings will depend on your
personal tax situation.
In exchange for the tax advantages provided under the
Dependent Day Care FSA, the IRS imposes significant
restrictions. It is important that you carefully read all of
the plan information before you decide whether or not to
participate. You are also encouraged to contact your tax
advisor or the IRS to discuss how participation will affect
your specific tax situation. dependent day
care fsa

111
 Potential disadvantages of participating in the Dependent
Day Care FSA are summarized in the following table.
Potential Disadvantages of Participating in the Dependent
Day Care FSA
Use It or Lose It The Internal Revenue Code requires that
Rule you forfeit any contribution amount that you
do not use for expenses incurred during the
same calendar year. Any balance remaining
in your account at the end of the year cannot
be refunded to you or carried over to the next
calendar year. Forfeited amounts are used to
help pay administrative costs under the plan.
Irrevocable The amount you elect to contribute is
Elections irrevocable for the entire calendar year. You
cannot change your election unless you
experience a qualified status change as
summarized in the Eligibility and Enrollment
section of this handbook.
Effect on Social Pretax contributions reduce the amount of your
Security earnings that are reported for Social Security
purposes. Therefore, if you earn less than
the Social Security wage base or if pretax
contributions reduce your earnings below the
Social Security wage base, your Social Security
withholding will be reduced. Because Social
Security benefits are based on your career
earnings history, this reduced withholding could
decrease any Social Security benefits you may
receive.
Effect on Other Pretax contributions may affect other statutory
Statutory benefits (such as unemployment insurance,
Benefits workers’ compensation, and state disability
insurance) for the same reasons that they
affect Social Security benefits. Because
statutory benefits are also based on taxable
earnings, benefits for which you may become
eligible could be reduced as a result of pretax
contributions to the Dependent Day Care FSA.
Loss of Income The IRS does not allow you to take a dependent
Tax Deductions care tax credit for expenses reimbursed through
the plan. (Under current tax laws, the credit is
based on your adjusted gross income, ranges
from 20% to 35% of your eligible dependent
care expenses, and is limited to $3,000 a year
for one dependent or $6,000 a year for two
or more dependents.) Additional information
dependent day
on dependent care tax credits is summarized
care fsa
below.
No Guarantee There is no guarantee that any amounts
of Tax reimbursed under the Dependent Day Care
Consequences FSA will be excludable from your income
taxes. For example, if the IRS audits your
tax return, you may be required to show that
expenses reimbursed through the plan meet the
applicable tax requirements. Reimbursement
does not guarantee that the Dependent Day
Care FSA payments will not be declared
taxable by the IRS at some time in the future.
If reimbursements are subject to taxation,
including any reimbursements paid in error, you
will be liable for any taxes or penalties.
112
Effect of Dependent Day Care FSA Participation
on the Dependent Care Tax Credit
As previously stated, participating in the Dependent Day
Care FSA can save you money by reducing your income
taxes. However, an alternate way to reduce your income
taxes is by using the dependent care tax credit when you
file your annual income tax return. As you consider your
options, it is important to keep in mind that the amount
you may claim for a tax credit is reduced dollar-for-dollar
by the amount reimbursed to you through the Dependent
Day Care FSA.
This information is provided to you as a courtesy only, as
CMC does not provide tax advice. You should contact your
tax advisor before you decide to participate in the plan.
The dependent care tax credit allowed on your income
tax return is based on your adjusted gross income,
ranges from 20% to 35% of your eligible dependent
care expenses, and is limited to $3,000 a year for one
dependent or $6,000 a year for two or more dependents.
Determining which option – participating in the
Dependent Day Care FSA or using the tax credit – is right
for you depends on your personal situation. Generally, if
your adjusted gross income is less than $39,000, it may
be to your advantage to use the tax credit. However, if
your adjusted gross income is more than $39,000, you
may realize greater tax savings by using the Dependent
Day Care FSA. If you participate in the plan and you have
more than $5,000 of dependent care expenses, you may
be able to claim a dependent care tax credit of up to
$1,000 on the amount in excess of $5,000.
Other Items to Consider Before You Enroll
Other items to consider before you enroll in the plan are:
■■ Only expenses that are incurred after your participation
in the plan begins and before the calendar year ends
are eligible for reimbursement from amounts you
contribute to the Dependent Day Care FSA during that
calendar year.
■■ You cannot transfer money from one flexible spending
account to another. If you are also participating in the
Health Care Flexible Spending Account or the Dental/
Vision Flexible Spending Account, you cannot transfer
money between the two plans. Your Dependent Day Care
FSA contributions will apply only to eligible dependent day
care expenses and may not be used to reimburse health
care expenses for your dependents.
■■ Some individuals experience cash flow concerns when
participating in the plan. You may be able to avoid this
concern by paying your providers through the Pay
My Provider feature of the plan. However, if you file
traditional paper claims, you will need to make out-of-
pocket payments for dependent day care expenses at
the same time Dependent Day Care FSA contributions
are being deducted from your pay. Reimbursement
requires a reasonable period of time for claim
processing.
■■ You will not normally be taxed on your Dependent Day
Care FSA contributions as long as your family’s total
contribution to this plan and any other Dependent Day
Care FSA-type plan (e.g., if your spouse participates
in a similar plan offered by his/her employer) does not
exceed the maximum annual limits summarized in the
Contributions provision. However, to qualify for tax-free
treatment, you will be required to submit with your
annual tax return (using IRS Form 2441) the names and
taxpayer identification numbers of any persons who
provided dependent day care services for which you
have claimed reimbursement.
If you decide to enroll in the plan, estimate your expenses
carefully and elect to contribute only the amount that you
are confident you will spend during the calendar year to
avoid forfeiture of your contributions. If you are unsure if an
expense will be eligible, contact the claim administrator for
clarification before you make your contribution election.
Effect of Contributions on Other Company
Benefits
Your Dependent Day Care FSA contributions will not
affect any Company benefits that are based on pay,
such as life and disability insurance. These benefits
will continue to be based on your salary before pretax
contributions are deducted.
Eligible Expenses
Eligible expenses are those expenses you incur for
dependent day care that allows you – and, if you’re
married, your spouse – to work. Work includes actively
looking for work, but not unpaid volunteer work or
volunteer work for a nominal salary. For purposes of the
plan, your spouse is considered to have worked if he/
she is a full-time student for at least five months during
the calendar year or if he/she is physically or mentally
incapable of self-care.
Expenses must be incurred after your participation in
the Dependent Day Care FSA begins and in the same
calendar year in which you make contributions to be
eligible for reimbursement. Expenses are considered
incurred on the day the service is provided, regardless of
when you are billed or pay for the service.
Eligible Dependents
Only dependent day care expenses incurred for the
following individuals who share your residence for at least
half of the applicable calendar year and qualify as your
dependents for federal income tax purposes are eligible:
■■ Dependent children* under age 13.
■■ Parents, grandparents, children* age 13 or older, or
other relatives or members of your household who:
• Spend at least eight hours each day in your home,
• Receive more than half of their support from you,
and
• Are physically or mentally incapable of caring for
themselves.
■■ Your spouse who is incapable of caring for himself/
herself. Inability to engage in substantial gainful activity
or perform normal functions does not alone make your
spouse an eligible dependent. He/she must:
• Have a physical or mental condition that does not
allow him/her to take care of personal, hygienic, or
nutritional needs, or
• Require full-time attention for safety reasons.
* If you are divorced or separated, only your children for
whom you have custody are eligible.
Eligible Dependent Day Care Providers
To be eligible, the care must be provided by one of the
following:
■■ A care provider (including a housekeeper) who cares for
your eligible dependents in your home and who is not
your dependent.
■■ A care provider who cares for your eligible dependents
outside your home and who is not your dependent.
■■ A qualified dependent care center. To be considered
qualified, the facility must provide care for more than six
individuals who do not reside at the facility and comply
with all applicable laws and regulations.
You must provide the taxpayer ID number (either a
federal tax ID number or Social Security number) for each
dependent day care provider to the IRS with your annual dependent day
care fsa
tax return.
The Dependent Day Care FSA may not be used to
reimburse expenses for care or services provided by:
■■ Your spouse.
■■ Any of your children under age 19 at the end of the
calendar year in which the services are provided.
■■ Anyone whom you or your spouse could legally claim
as a dependent on your federal income tax return.
■■ Any care provider that does not have either a valid
federal tax ID number or a Social Security number.
113
 Eligible Expense Examples
Following are some common eligible dependent day
care expenses. For more information about eligible and
ineligible expenses, refer to IRS Publication 503, Child
and Dependent Care Expenses or contact the claim
administrator.
Although IRS Publication 503 is a good resource, you
are encouraged to contact the claim administrator
to determine whether a particular expense will be
reimbursable before you incur the expense.
Eligible expense examples are:
■■ The cost of care provided in or out of your home
(including Social Security taxes you pay on behalf of
your provider) by an eligible babysitter.
■■ The cost of care provided at a qualified dependent care
center that provides care for more than six individuals
who do not reside at the facility and complies with all
applicable laws and regulations.
■■ The cost of care provided at a summer camp (but not
tuition and other fees unrelated to day care).
■■ The cost of care provided at a private school (but not
tuition and other fees unrelated to day care if the child
is in kindergarten or above).
■■ Any nonrefundable fees to secure your dependent’s
place in a dependent care center.
■■ Other expenses that are considered eligible for a
dependent care tax credit for federal income tax
purposes. (Refer to IRS Publication 503).
Keep in mind that only those services that provide care
for your eligible dependents are eligible. For example,
the services of a housekeeper are eligible only if his/her
primary responsibility is the well-being and protection of
your eligible dependent.
dependent day
care fsa
114
Ineligible Expenses
Ineligible dependent day care expenses include – but are
not limited to – the following:
■■ Costs for food or clothing for an eligible dependent.
■■ Dependent care expenses from a dependent care
center that does not provide care for more than six
individuals who do not reside at the facility or does not
comply with all applicable laws and regulations.
■■ Dependent care expenses that you claim on your
federal income tax return.
■■ Education expenses for a child in kindergarten or
above.
■■ Expenses for overnight stays such as overnight camp
expenses.
■■ Housekeeping expenses not related to dependent day
care.
■■ Transportation expenses to and from a dependent care
site.
■■ Expenses for dependent day care while you or your
spouse is not working due to illness.
In addition, any expenses that you pay during one
calendar year may not be reimbursed from contributions
made to the Dependent Day Care FSA during a different
calendar year.
If you have any questions regarding ineligible expenses,
contact the claim administrator.
IRS regulations governing eligible and ineligible expenses
under dependent day care flexible spending accounts
have changed in the past and may change again in the
future. It is your responsibility to determine whether your
anticipated expenses will be eligible for reimbursement
under the plan. If the IRS audits your individual income tax
return, you may be required to show that your reimbursed
expenses meet the applicable requirements.
Reimbursement does not guarantee that Dependent Day
Care FSA payments will not be declared taxable by the IRS
at some time in the future. If reimbursements are subject
to taxation, including any reimbursements paid in error,
you will be liable for any taxes or penalties.

Dependent Day Care
FSA Reimbursement
(Claims)
Reimbursement Options
Two reimbursement options are available under the plan.
You may:
■■ Use the Pay My Provider feature of the plan.
■■ File traditional paper claims.
Pay My Provider
The Pay My Provider feature of the plan is similar to an
online bill paying service. You request direct payment to
your provider via www.wageworks.com.
Pay My Provider provides a simple method for paying
your dependent day care expenses. You submit
information regarding the payee and the services
provided and indicate whether your payment is a one
time only payment or a recurring payment (e.g., pay once
per month).
Funds are transferred from your account to your provider
promptly. Simply set up your direct payment request at
least ten days prior to the payment due date.
As with traditional claim processing, requests for payment
of ineligible expenses will be denied.
Traditional Paper Claim
For purposes of filing claims and claim appeals, the term
“you” includes you or an authorized representative who is
filing a claim on your behalf.
Filing a Claim
Claim forms are available from Employee Services. Send
your claim form to:
WageWorks Claims Administrator
P.O. Box 14053
Lexington, KY 40512
Or via facsimile to 1-877-353-9236
Submit a claim whenever you incur an eligible expense,
but no later than the March 31 following the year in which
you incur the expense. Your claim will be denied if it is not
received by the claim administrator by the deadline. Any
unclaimed balance in your account after March 31 will be
forfeited.
Proof of Expense
When you submit your claim, you must include
documentation to prove that your expense is eligible for
reimbursement:
■■ If the participant and provider certifications on your
claim form are completed and signed, additional
documentation is not required.
■■ If the provider certification on your claim form is not
completed and/or signed, you must provide an itemized
statement from the dependent care provider that includes
all of the following information:
• Nature of expense (i.e., what service was provided).
• Provider name, address, and taxpayer ID number
(either a federal tax ID number or Social Security
number).
• Dependent name and birth date.
• Date(s) of service.
• Expense amount.
Your claim will be denied if you fail to provide the
claim administrator with proof of expense or any other
requested information.
Always keep copies of proof of expense documents,
including receipts and itemized statements. You will need
these documents to meet plan requirements and/or IRS
requirements.
Filing Claims After Your Employment Terminates
Your participation in the plan ends on the date your
employment terminates. However, you may continue to file
claims for reimbursement of expenses that you incur during
the calendar year in which your employment terminates.
You must file those claims before March 31 of the following
calendar year. Any unclaimed balance in your account after
March 31 of the following calendar year is forfeited.
Claim Review
The claim administrator will review your claim within
30 days of receipt and determine whether or not your
expense is reimbursable in accordance with the terms
and provisions of the plan.
The claim administrator may require more time to review
your claim if necessary due to circumstances beyond dependent day
its control. If this should happen, you will be notified in
care fsa
writing that the review period is being extended for up to
an additional period of 15 days.
If an extension is necessary because you need to furnish
additional information, you will have up to 45 days to furnish
the requested information, and the extension period will
be further extended by the number of days it takes you to
provide the additional information. Failure to cooperate with
a claim administrator request for information may invalidate
your claim.
115

WageWorks (the claim administrator) is the named
fiduciary for adjudicating claims for benefits under the
plan, and for deciding any appeals of denied claims.
WageWorks has the authority, in its discretion, to interpret
the terms of the plan, to decide questions of eligibility
for coverage or benefits under the plan, and to make any
related findings of fact. All decisions made by WageWorks
are final and binding on participants and beneficiaries to
the full extent permitted by law.
Reimbursement of Claims
Claims are reimbursed based on the balance in your
account at the time of reimbursement. If you do not have
enough money in your account to reimburse a claim,
checks for partial reimbursements will be sent to you as
you make contributions to your account until you receive
full reimbursement for the expense.
For example, assume you contribute $25 each pay period
to the Dependent Day Care FSA and your current balance
is $50. If you submit a claim for $75, a check will be
issued to you in the amount of $50, and the balance of
$25 will be pended and reimbursed to you following your
next contribution.
If you do not have enough money in your account to
reimburse a claim that is pending at the end of the year,
your claim will not be reimbursed in full. The claim cannot
be carried over to the next year because expenses
that you incur during one calendar year may not be
reimbursed from contributions made during a different
calendar year.
Incorrect or Excess Reimbursement
If it is determined that an incorrect or excess
reimbursement has been made, the claim administrator
may do any of the following:
■■ Notify you of the error and require you to repay the
amount within sixty days of receipt of the notification.
■■ Reduce a future reimbursement to you.
dependent day
■■ Withhold the amount from your pay (to the extent
care fsa
permitted by law).
If none of the above results in adequate repayment, the
remaining amount will be reported to CMC as a bad
business debt and treated accordingly.
If Your Claim Is Denied
If your claim is denied, in whole or in part, you will
receive written notice from the claim administrator
during the review period (or the extended review period
if applicable). The notice will include the following
information:
116
■■ The reasons for the denial and the plan provisions on
which the denial is based.
■■ A description of any additional information necessary
for your claim to be reconsidered, why the information
is necessary, and your time limit for submitting the
information.
■■ A description of the appeal procedures and applicable
time limits.
■■ Your right to request all documentation relevant to your
claim.
First Level Appeal Procedure
If your claim is denied, you have the right to appeal
the decision. You must make your written request for
appeal to the claim administrator within 180 days from
the date you receive the notice of claim denial. Include
all additional information necessary for your claim to be
reconsidered (as identified in the notice of claim denial)
and any other information that you believe will support
your appeal.
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives
your appeal. If your appeal is denied, the notice will
include the same type of information that was provided in
the initial claim denial.
Second Level Appeal Procedure
If your first level appeal is denied, you have the right
to a second level claim appeal. You must make your
written request for a second level appeal to the claim
administrator within 180 days from the date you receive
the claim appeal denial. Include all additional information
necessary for your claim to be reconsidered (as identified
in the notice of claim appeal denial) and any other
information that you believe will support your second level
appeal.
The claim administrator will review your claim and notify
you of its decision within 30 days of the date it receives
your second level appeal. If your second level appeal
is denied, the notice will include the same type of
information that was provided in the initial claim denial.
Additional Appeal Information
• During each level of appeal, the claim reviewer will
review relevant information that you submit including
any new information.
• You cannot file suit in federal court until you have
exhausted the plan’s appeal procedures.
Employee Assistance Program
Introduction
The CMC Employee Assistance Program (EAP) is
designed to help you and your household members
identify and find resources to solve personal problems –
such as managing stress, juggling deadlines and
responsibilities, handling child or parental concerns, or
developing a budget that works – which if not resolved,
could adversely affect the quality of your life.
Services are available under the EAP, which is
administered by Horizon. When you need assistance
or have specific questions regarding this plan, contact
Horizon at 1-866-486-4334 or go to the Horizon website at
www.horizoncarelink.com, User ID: CMC, Password: eap.
EAP Benefits
EAP Services
EAP services provide resources and assistance to help
you manage life’s challenges. Through the EAP you have
access to services such as:
■■ Telephone support to discuss your concerns.
■■ Professional assessment and short-term problem
resolution sessions.
■■ Consultations with legal and financial specialists.
■■ Referrals to work/life resources such as child care
providers and elder care services.
■■ Locating community resources such as Alcoholics
Anonymous.
■■ Accessing specialized and/or long-term services under
your health insurance benefits.
When you access free services that have been approved
by Horizon, you do not have to file any claims.
EAP Services Available
24 Hours a Day, 365 Days a Year
Access the EAP via a toll-free number that provides immediate
support in times of crisis or through the website:
1-866-486-4334
www.horizoncarelink.com User ID: CMC, Password: eap
Professional Services
The EAP offers professional and confidential assessment
and short-term problem resolution services designed to
help address the personal concerns and life issues you
are facing. This free service is staffed by experienced
clinicians and is available 24 hours a day, seven days a
week. An EAP professional will listen to your concerns
and may refer you to local resources in your community
or other counselors that can help you deal with a variety
of personal issues, including:
■■ Alcohol and drug abuse
■■ Depression
■■ Grief and loss
■■ Relationship problems
■■ Marital or family conflicts
■■ Stress and anxiety
Up to five free in-person sessions will be available to you
and your household members for each assessed problem.
Face-to-face sessions are available for individuals age
16 and older. Individuals under age 16 are referred to
appropriate specialists using health insurance benefits or
community referrals.
The EAP network of clinical professionals includes
licensed counselors, social workers, and marital family
therapists who are trained to deal with a wide variety
of personal and emotional problems. EAP referrals
are treated with the highest degree of confidentiality
consistent with applicable federal and state laws.
If an EAP counselor determines that a problem requires
either more than five sessions or another type of
treatment, such as inpatient care, you will be referred to
an appropriate resource for treatment. If you decide to
continue services beyond the number of sessions allowed
under the EAP or obtain treatment outside of the EAP
after the EAP assessment has been made, the cost of the
additional sessions or treatment will not be paid for by the
EAP. In this event, you may wish to contact the medical
plan in which you are enrolled to determine if benefits are
available for the additional services/treatment.
eap
117
 Financial
Financial issues can arise at any time, from dealing
with debt to saving for your child’s college education.
Financial professionals are available to discuss your
issues and provide you with the tools and information you
need to meet your financial goals. From family budgets
and tax questions to credit issues and investments,
you can consult directly with financial specialists about
your personal money management concerns. Financial
specialists can help you sort through the issues and
provide the resources you need to find answers. Call
anytime you have issues such as:
■■ Buying a home
■■ Getting out of debt
■■ Saving for college
■■ Tax questions
Legal
Everyone faces a legal issue or problem at some time in
their life, whether it’s a divorce, bankruptcy or buying real
estate. The EAP provides confidential access to attorneys
who are dedicated to providing practical information and
assistance. Legal staff will listen to your concerns and
provide information and tools to assist you in resolving
the issue. If you require assistance, you will be referred to
an attorney in your area for a free 30-minute telephone or
face-to-face consultation. Thereafter, a 25% reduction in
customary legal fees is available to you. Call anytime you
have legal issues such as:
■■ Bankruptcy
■■ Civil lawsuits
■■ Contracts
■■ Criminal actions
■■ Debt obligations
■■ Divorce and family law
■■ Landlord and tenant issues
■■ Real estate transactions
Legal services are not available for any action, proceeding
or dispute between an employee and his/her employer,
co-worker, union, labor management trust fund, EAP
provider, or group insurance carrier.
Family
Everyone could use a little more assistance in their lives.
Whether you are a new parent, a caregiver for an elder,
or sending a child off to college, you may come across
concerns that need to be addressed. The EAP can help
you sort out the issues and provide you with information
based on your specific criteria to help you make a decision.
An EAP professional will help you explore options and offer
eap
solutions as well as provide helpful literature for additional
background information.
118
You will receive information that can help you address
needs such as:
■■ Choosing day care
■■ Learning about schools in your area
■■ Locating summer or day camps
■■ Planning for college
■■ Finding elder care
■■ Exploring adoption
Online Resources
Online resources give you the power of the internet to get
solutions for the issues that matter to you, from personal
or relationship issues to legal and financial concerns.
Access the EAP website anytime you need trusted,
expert information, resources, referrals, or an answer to
an everyday question.
■■ Get helpful answers to your questions quickly and easily.
■■ Watch a video or take a self-assessment.
■■ Review and print in-depth help sheet topics.
EAP Limitations and Exclusions
Services that are not covered under the EAP include –
but are not limited to – the following:
■■ Any service that has not been approved by Horizon.
■■ Consultation regarding labor, immigration, employment,
or international law.
■■ Counseling paid for by workers’ compensation.
■■ Counseling required by law or a court.
■■ Services beyond the five sessions provided for each
assessed problem.
■■ Drug or alcohol testing.
■■ Fitness for duty evaluations or opinions.
■■ Formal diagnostic or psychological evaluations.
■■ Inpatient hospital treatment.
■■ Legal services beyond an initial 30-minute consultation.
■■ Long-term outpatient treatment.
■■ Prescriptions for medications or services for mental
insufficiency or autism.
■■ Residential care.
■■ Services by counselors who are not Horizon EAP
providers.
With the exception of services related to labor, immigration,
employment, or international law, the EAP does provide
referrals to resources for the services listed above. However,
you are responsible for payment for these services.
If you have questions regarding covered services, contact
Horizon.
 plan administration
Plan Administration
Administrative Information
This section contains important administrative information regarding the Commercial Metals Company Welfare Benefit
Plan and its component plans.
Plan Administration Information
Plan Name Commercial Metals Company Welfare Benefit Plan
Employer, Plan Administrator and Plan Sponsor Commercial Metals Company.
6565 N. MacArthur Blvd., Suite 800
Irving, TX 75039
Employer Identification Number 75-0725338
Type of Plan The Plan is a welfare benefit plan providing Medical, Vision, Dental, Disability, Life,
Accident, Employee Assistance, Health Care flexible spending account, Dental/Vision
Flexible Spending Account, and pretax contribution benefits. Note: The Plan also includes
a cafeteria plan under Code §125 and Dependent Day Care Flexible Spending Account
(DCAP) under Code §129. The cafeteria plan and DCAP are not subject to ERISA
Plan Number 501
Agent for Service of Legal Process Commercial Metals Company.
6565 N. MacArthur Blvd., Suite 800
Irving, TX 75039
Plan Year January 1 through December 31
Effective Date The effective date of the Plan amendment/restatement is January 1, 2013. The plan has
been amended several times since its original effective date of January 1, 2007.
Insurance Company/ Policy/Contract/
Component Plan Arrangement Type Funded By
Claim Administrator Agreement
Medical Blue Cross and Blue Shield of Texas Premium: 009123 Self-insured CMC and participant
P.O. Box 660044 Consumer: 070509 contributions
Dallas, TX 75266
Kaiser Permanente HMO North: 602827 Insured CMC and participant
Claims Department South: 101708 contributions
P.O. Box 7004
Downey, CA 90242
Information about the Kaiser Permanente HMO plan is not included in this handbook. If you are enrolled in Kaiser, you
will receive information about your plan directly from Kaiser.
Vision Vision Service Plan 12247388 Insured CMC and participant
3333 Quality Drive contributions
Rancho Cordova, CA 95670
Dental Delta Dental Insurance Company 44-5838 Self-insured CMC and participant
P.O. Box 1809 contributions
Alpharetta, GA 30023-1809
Short Term Disability The Standard 646908 Self-insured CMC
900 SW Fifth Avenue
Portland, OR 97204-1282
Long Term Disability The Standard 646907 Insured CMC
900 SW Fifth Avenue
Portland, OR 97204-1282
Life ING ReliaStar Life Insurance Company 66717-0 Insured CMC and participant
20 Washington Avenue South contributions
Minneapolis, MN 55401
Accidental Death & ING ReliaStar Life Insurance Company 66717-0 Insured CMC and participant
Dismemberment 20 Washington Avenue South contributions
Minneapolis, MN 55401
Business Travel Metropolitan Life Insurance Company 29353-1-BTA Insured CMC
Accident Insurance 200 Park Avenue
New York, NY 10166
Employee Assistance Horizon Behavioral Services, LLC Not Applicable Insured CMC
Program 4300 Centreway Place
Arlington, TX 76018

119
plan administration
Insurance Company/
Component Plan
Claim Administrator
Health Care Flexible WageWorks
Spending Account P.O. Box 14053
Lexington, KY 40512
Dental/Vision Flexible WageWorks
Spending Account P.O. Box 14053
Lexington, KY 40512
Dependent Day Care WageWorks
Flexible Spending P.O. Box 14053
Account Lexington, KY 40512
Pretax Contributions Pretax contributions under the medical, vision, dental, health care flexible spending account, dental/vision flexible
spending account, dependent day care flexible spending account plans, and health savings account contributions are
administered by CMC under a pretax contribution plan in accordance with Section 125 of the Internal Revenue Code.
COBRA Administrator CMC Employee Services
6565 N MacArthur Blvd, Suite 800
Irving, TX 75039
Plan Administration
CMC has contracted with claim administrators and
insurance companies to administer the plan as follows:
■■ Medical Plan, Dental Plan and Short Term
Disability Plan: Pursuant to administrative services
only agreements, Blue Cross and Blue Shield of Texas
(BCBSTX) provides administrative services with respect
to benefits provided under the Medical Plan, Delta
Dental provides administrative services with respect
to benefits provided under the Dental Plan, and The
Standard provides administrative services with respect
to benefits provided under the Short Term Disability
Plan. Claims are sent directly to BCBSTX, Delta Dental
and The Standard as applicable; however, benefits are
paid from funds provided by CMC on behalf of the plan
in accordance with the agreements.
■■ Health Care FSA Plan, Dental/Vision FSA Plan,
and Dependent Day Care FSA Plan: WageWorks
provides administrative services with respect to
benefits provided under the Health Care FSA, Dental/
Vision FSA, and Dependent Day Care FSA plans
pursuant to an administrative services agreement.
Claims are sent directly to WageWorks; however,
reimbursements are made from employee contributions
that are collected and submitted to WageWorks by
CMC on behalf of the plan in accordance with the
agreement.
■■ Other Component Plans: Other plans are insured
and CMC has entered into agreements with the
insurance companies to provide benefits. Claims for
benefits are sent directly to the applicable insurance
company, which is financially responsible for paying
claims.
120
Policy/Contract/
Arrangement Type Funded By
Agreement
24699 Self funded Participant
contributions
24699 Self funded Participant
contributions
24699 Self funded Participant
contributions
Lockbox address for payments:
PO Box 139031
Dallas, TX 75313-9031
Note: Not all of the component benefit programs are
subject to ERISA. They are described as part of the
Plan for purposes of convenience and because there
may be other applicable laws (for example, the Internal
Revenue Code) that require a written document.
Plan Funding
The plan is funded by direct payment from the general
assets of CMC. Where employee contributions are
required, CMC collects those contributions. CMC as
plan sponsor/administrator pays Company contributions,
together with any employee contributions, to the
insurance companies and claim administrators as
required under each of the respective policies/
agreements.
Plan Sponsor/Plan Administrator Duties
CMC as plan sponsor/administrator has exclusive and
final discretionary authority to determine eligibility for
participation in the plan and to determine related facts.
The plan sponsor/administrator maintains records of
plan participants, collects any required participant
contributions and pays the contributions, together with
any Company contributions, to the insurance companies
and claim administrators as required in each of the
respective policies/agreements.
Except for specified claim dispute resolution authority
under the Medical, Dental or Short Term Disability plans,
the plan sponsor/administrator does not have the right to
award benefits under the plan or to reverse the insurance
company’s or claim administrator’s denial of a claim
for benefits. For component plans that are insured, the
plan sponsor/administrator reserves the right to insure
these plans with any licensed insurance company.
For component plans that are administered under
administrative service agreements, the plan sponsor/
administrator reserves the right to appoint any claim
administrator.

Participating Companies
Companies designated by Commercial Metals Company
as participating companies in the plan are:
■■ Commercial Metals Company
Electronic Forms
To facilitate efficient operation of the Plan, the Plan may
allow forms (including, for example, election forms and
notices), whether required or permissive, to be sent and/
or made by electronic means.
Important Disclaimer
Benefits hereunder are provided pursuant to an insurance
contract or governing written plan document adopted by
the Company. If the terms of this SPD document conflict
with the terms of such insurance contract or governing
plan document, then the terms of the insurance contract
or governing plan document will control, rather than this
SPD document, unless otherwise required by law.
Insurance Company/
Claim Administrator Duties
For component plans that are insured, the applicable
insurance company is the claims fiduciary and has
exclusive and final discretionary authority to interpret
and apply plan provisions and to determine related facts
with regard to any claim or claim appeal. The insurance
company has the right to cancel the group insurance
policy at the end of the contract term after providing the
required notice of cancellation to CMC.
For component plans that are administered under
administrative services agreements (except for the
Medical Plan), the applicable claim administrator has
exclusive and final discretionary authority to interpret and
apply plan provisions and to determine related facts with
regard to:
■■ Determining a participant’s eligibility to receive benefits.
■■ Processing claims.
■■ Reimbursing claims.
■■ Making determinations on appeals of claim denials.
For the Medical Plan, Blue Cross and Blue Shield of
Texas has authority to interpret and apply plan provisions
and to determine related facts with regard to:
■■ Determining a participant’s eligibility to receive benefits.
■■ Processing claims.
■■ Reimbursing claims.
■■ Making determinations on appeals of claim denials
(except for specified claim dispute resolution authority).
plan administration
Insurance companies or HMOs provide benefits under
the terms of insurance policies or similar contracts. Any
benefits specified in those insurance policies/contracts
will be provided solely by the insurance companies/
HMOs that issued the policies/contracts. Under no
circumstances will CMC or the plan be liable to pay any
benefits specified in those insurance policies/contracts.
COBRA Administrator Duties
The COBRA administrator has exclusive and final
discretionary authority to:
■■ Determine an individual’s eligibility for COBRA
continuation coverage.
■■ Advise qualified beneficiaries of their responsibilities
and premium amounts due for COBRA coverage.
■■ Collect COBRA premiums and send them to
the appropriate insurance companies and claim
administrators.
■■ Advise qualified beneficiaries when COBRA coverage
terminates.
■■ Respond to qualified beneficiaries questions regarding
COBRA coverage.
No Vested Interest
No individual has any rights under the plan except as and
only to the extent expressly provided in the official plan
documents.
No Employment Contract
Nothing in the plan or the Summary Plan Description
confers any rights of continued employment on any
employee or in any way prohibits changes in the terms
and conditions of, or the termination of, employment of
any employee covered under the plan.
Misrepresentation
It is a crime to knowingly and with intent injure, defraud,
or deceive the Company or the plan, or to provide any
false information, including filing a claim that contains
any false, incomplete, or misleading information. These
actions will result in denial of claims and may subject
you to criminal and/or civil prosecution and punishment
under state and/or federal law. The plan reserves the right
to pursue all appropriate legal remedies in the event of
misrepresentation. Any material misrepresentation by you
and/or your dependents in enrolling for coverage or filing
claims for benefits will render your coverage under the
plan null and void.
121
plan administration
Third Party Liability
Certain component plans do not cover expenses if it
is determined that another party may have caused or
contributed to an injury or sickness which results in the
use of plan services. (For example, if injuries sustained in
a car accident are determined to be the fault of the other
driver.) If expenses are incurred under a component plan
for which another party may be responsible, that plan
may take actions such as:
■■ Recovering from the other party expenses for which
that party is determined to be liable. This is referred
to as a plan’s subrogation rights. The covered person
will be required to execute any documents required to
secure the plan’s subrogation rights.
■■ Choosing to pay benefits that would otherwise be
payable if the covered person agrees in writing that he/
she will reimburse the plan for those benefits when the
other party’s liability is determined and paid.
Further information is provided in the sections
summarizing benefits under the component plans.
Recovery of Overpayments
If an overpayment is made under the plan due to a
circumstance such as fraud, third party liability, or a
plan administration/claim processing error, the plan has
the right to full reimbursement. An overpayment may be
recovered by methods such as requiring a lump sum
payment of the overpaid amount or taking appropriate
collection actions, including legal actions. Further
information is provided in the sections summarizing
benefits under the component plans.
Plan Interpretation and Authority to
Delegate
The plan administrator has the sole and exclusive right
and discretion to interpret the terms and provisions of the
plan and to determine any and all questions arising under
the plan or in connection with the administration of the
plan. The plan administrator may delegate this authority
and discretion to a designated person or persons.
Conformity with Statutes
Any provision in the CMC Welfare Benefit Plan (and
any of its component plans) that is in conflict with the
requirements of any state or federal law that applies
to the provision is automatically changed to satisfy the
minimum requirements of the applicable law.
122
Plan Amendment and Termination
Nothing in the plan or Summary Plan Description will
prevent any future amendments to the benefits provided
under the plan, or the contributions or eligibility criteria
required for participation in the plan. The Company
reserves the right to amend or terminate the plan at any
time and for any reason. This includes, but is not limited
to, increasing contributions or reducing benefits. The
Company may delegate this authority and discretion to a
designated person or persons.
The plan may be amended or terminated by the
Company or its designee. A designee may sign insurance
policies or agreements for the plan on behalf of the
Company, including amendments to those policies/
agreements.
Future of the Plan
CMC reserves the right at any time and from time to
time to add provisions to the CMC Welfare Benefit
Plan (and any of its component plans) and to modify in
whole or in part, or end any or all provisions of the CMC
Welfare Benefit Plan (and any of its component plans)
with or without prior notice. CMC does not promise the
continuation of any benefits nor does it promise any
specific level of benefits at or during retirement.
COBRA Continuation
Coverage
Right to COBRA Continuation Coverage
A covered person whose coverage would otherwise
end under a plan may be entitled to elect continuation
coverage in accordance with the Consolidated Omnibus
Budget Reconciliation Act (COBRA). The entire cost of
COBRA continuation coverage is payable by the covered
person.
CMC component plans that provide for COBRA
continuation coverage are:
■■ Medical
■■ Vision
■■ Dental
■■ Health Care FSA
■■ Dental/Vision FSA
■■ Employee Assistance Program
COBRA continuation coverage is provided only as
required by law. If the law changes, the rights of covered
persons will change accordingly.

COBRA coverage under the Health Care FSA or Dental/
Vision FSA will be offered only to qualified beneficiaries
losing coverage who have underspent accounts. A
qualified beneficiary has an underspent account if the
annual limit elected by the covered employee, reduced by
the reimbursable claims submitted up to the time of the
qualifying event, is equal to or more than the amount of
the premiums for Health FSA COBRA coverage that will
be charged for the remainder of the plan year. COBRA
coverage will consist of the Health Care FSA or Dental/
Vision FSA coverage in force at the time of the qualifying
event (i.e. the elected annual limit reduced by reimbursable
claims submitted up to the time of the qualifying event).
The use-it-or-lose-it rule will continue to apply, so any
unused amounts will be forfeited at the end of the plan
year, and COBRA coverage will terminate at the end of
the the plan year. Unless otherwise elected, all qualified
beneficiaries who were covered under the Health Care FSA
or Dental/Vision FSA will be covered together for Health
Care FSA or Dental/Vision FSA COBRA coverage.
Eligibility
To be eligible for continuation coverage, the covered
person must meet the definition of a qualified beneficiary.
A qualified beneficiary is any of the following persons
who are covered under the plan on the day before the
qualifying event:
■■ An employee
■■ An employee’s enrolled dependents
■■ An employee’s former spouse
Newly Eligible Child
If the qualified beneficiary has a child (either by birth,
adoption, or placement for adoption) during the
continuation coverage period, the new child also
becomes a qualified beneficiary. The child can be added
to COBRA continuation coverage by providing the
COBRA administrator with notice of the newly eligible
child within 30 days of birth, adoption, or placement for
adoption.
Qualifying Events
COBRA qualifying events are:
■■ Termination of the eligible employee from employment
with the Company (for any reason other than gross
misconduct) or reduction in hours of employment
■■ Death of the eligible employee
■■ Divorce
■■ Loss of eligibility by a covered dependent child
If a qualified beneficiary’s coverage terminates because
of a qualifying event, he/she may elect to continue the
coverage that he/she had on the day before the qualifying
event.
plan administration
Coverage may be continued for 18 months or 36 months,
depending on the qualifying event.
Coverage Period
Individuals Eligible From Initial
for Continuation Qualifying
Qualifying Event Coverage Event*
Employment ends for Employee, spouse, 18 months
reasons other than children
gross misconduct
Hours of employment Employee, spouse, 18 months
are reduced children
Divorce Spouse, children 36 months
Child loses Child losing coverage 36 months
dependent status
Death Spouse, children 36 months
* COBRA continuation coverage under the Health Care FSA Plan or
the Dental/Vision FSA Plan will terminate at the end of the plan year
in which the employee’s coverage as an active employee ends.
Extension of Continuation Coverage
If a qualified beneficiary is entitled to 18 months of
continuation coverage, the continuation coverage period
may be extended if any of the following events occur.
Disability
A qualified beneficiary may be eligible for up to an
11-month extension of continuation coverage (for a total
continuation coverage period of up to 29 months) if he/
she is determined by the Social Security Administration
to have become disabled within the first 60 days of
continuation coverage. If proper notification is provided,
covered family members who are qualified beneficiaries
as a result of the same qualifying event and who elect
continuation coverage will be entitled to the 11-month
extension.
Extension of Continuation Coverage for Spouse
and Dependent Children
In certain circumstances, an 18- or 29-month
continuation coverage period may be extended up to 36
months. These include:
■■ Second Qualifying Event
Second qualifying events are the employee’s death,
divorce, or a covered child’s loss of dependent status.
These events are considered second qualifying events
only if they would have caused the qualified beneficiary
to lose coverage if the first qualifying event had not
occurred. If any of these qualifying events occur during
the 18- or 29-month continuation coverage period
and proper notification is provided, the period of
continuation coverage for the spouse and dependent
children may be extended for up to a total of 36 months
measured from the date of the original qualifying event.
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■■ Medicare Entitlement of Employee
If proper notification is provided of the employee
becoming entitled to and enrolling in Medicare (under
Part A, Part B or both) within 18 months prior to the
employee’s termination of employment or reduction
in hours of employment, the period of continuation
coverage for the employee’s spouse and dependent
children is 36 months from the date of the employee’s
Medicare enrollment. For example, if the employee
became enrolled in Medicare eight months prior to the
qualifying event, the employee’s spouse and dependent
children would be eligible for 28 months of continuation
coverage (36 months – 8 months = 28 months).
Notification Requirements
Notice of Initial Qualifying Event
The COBRA Administrator will provide a COBRA election
notice within 44 days of these qualifying events:
■■ Is terminated from employment
■■ Has a reduction in hours of employment
■■ Dies while employed
Notice of Initial Qualifying Event by Employee or
Qualified Beneficiary
The covered employee or qualified beneficiary must notify
the COBRA Administrator within 60 days of:
■■ Divorce
■■ A covered child’s loss of dependent status
The COBRA Administrator will provide a COBRA election
notice within 14 days of the timely receipt of the notice. If
the COBRA Administrator does not receive timely notice,
the right to continuation coverage will be lost.
Notice of Disability
To be entitled to the disability extension, the qualified
beneficiary must notify the COBRA administrator of the
entitlement to Social Security disability benefits before the
end of the initial 18-month continuation coverage period
and within 60 days of the Social Security Administration’s
determination of the qualified beneficiary’s disabled status.
The notification must include a copy of the Social Security
Administration award determination. If the notice is
provided, the qualified beneficiary’s coverage may be
extended up to a maximum of 29 months from the date
of the qualifying event or until the first of the month that
begins more than 30 days after the date of any final
determination by the Social Security Administration that
the qualified beneficiary is no longer disabled. If the
COBRA administrator does not receive timely notice of
disability, the right to the disability extension will be lost.
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Each qualified beneficiary must provide notice of any final
determination that the qualified beneficiary is no longer
disabled within 30 days of the determination by the Social
Security Administration.
Notice of Second Qualifying Events
To be entitled to a second qualifying event extension,
the qualified beneficiary must notify the COBRA
administrator within 60 days of divorce, or a covered
child’s loss of dependent status during a period of
continuation coverage. If the eligible employee dies
while covered under continuation coverage, a surviving
qualified beneficiary must notify the COBRA administrator
within 60 days of the death. The COBRA administrator
may require a copy of the divorce decree, separation
agreement, child’s birth certificate, or death certificate.
If the COBRA administrator does not receive timely
notice of an event, the right to extension of continuation
coverage will be lost.
Notice of Medicare Enrollment
To be entitled to the Medicare extension, the qualified
beneficiary must provide notice of the eligible employee’s
enrollment in Medicare (Part A, Part B or both) within
60 days of the enrollment. The eligible employee will be
required to provide a copy of his/her Medicare card to the
COBRA administrator. If the COBRA administrator does
not receive timely notice of Medicare enrollment, the right
to extension of continuation coverage will be lost.
If, after electing continuation coverage, a qualified
beneficiary becomes enrolled in Medicare Part A or
Part B, the qualified beneficiary must notify the COBRA
administrator within 30 days of the enrollment. The
qualified beneficiary will be required to provide a copy of
his/her Medicare card to the COBRA administrator.
Notice of a Newly Eligible Child
A qualified beneficiary who acquires a child through
birth, adoption, or placement for adoption during the
continuation coverage period must notify the COBRA
administrator within 30 days of the birth, adoption, or
placement for adoption to obtain continuation coverage
for the child. If the COBRA administrator does not receive
timely notice of the newly eligible child, the right to
continuation coverage will be lost.
Notice Requirements
Notification of any event must include the following:
■■ Name of the individual experiencing the event (the
qualified beneficiary)
■■ The employee’s name and Social Security Number
■■ Date of the event
■■ Type of event
■■ Address of the qualified beneficiary

Additional documentation indicated above (e.g., a
Medicare card or death certificate) as well as any other
documentation requested by the COBRA administrator
must be provided.
Submitting Notices
All required notices that relate to continuation coverage
must be provided to the COBRA administrator at the
following address:
CMC Employee Services
PO Box 139031
Dallas, TX 75313-9031
The qualified beneficiary should keep a copy of any
notices sent to the COBRA administrator.
Notice of Unavailability of Continuation Coverage
If the COBRA administrator determines that an individual
who provides notice is not entitled to continuation
coverage or extended continuation coverage, the COBRA
administrator will send the individual a notice explaining
the reasons why continuation coverage is not available.
Termination Events for Continuation
Coverage
Continuation coverage will end on the earliest of the
following dates:
At the end of the applicable maximum continuation
coverage period (18, 29 or 36 months).
■■ The date coverage terminates under the plan for failure
to make timely payment of the required contribution
amounts (after the initial payment, payments must be
made no later than 30 days after their due dates).
■■ The date, after electing continuation coverage, that
coverage is obtained under any other group health
plan. If the new coverage contains a limitation or
exclusion for any preexisting condition of the qualified
beneficiary, continuation coverage will end on the date
the limitation or exclusion ends. The other group health
plan coverage will be primary for all health services
except those health services that are subject to the
preexisting condition limitation or exclusion.
■■ The date, after electing continuation coverage, that the
qualified beneficiary becomes entitled to Medicare (and
actually enrolls in Medicare).
■■ The date the Company stops providing any group
health plan for its employees.
■■ The date coverage would otherwise terminate under
the plan.
plan administration
If continuation coverage ends prior to the 18-, 29- or
36-month continuation coverage period, the COBRA
administrator will provide a notice to the affected individuals
as soon as practicable following the COBRA administrator’s
determination of the early termination of continuation
coverage. The notice will explain the reason for the early
termination, the date of the termination, and the availability
of alternative group individual coverage, if any.
Paying for Continuation Coverage
The qualified beneficiary must pay for continuation
coverage. Continuation coverage premiums will not
exceed 102% of the applicable premium for similarly
situated individuals who have not had a qualifying event.
The initial payment covers the cost of continuation
coverage retroactive to the date coverage ended. The
qualified beneficiary is responsible for ensuring that
the amount of the initial payment is enough to cover
this entire period. The COBRA administrator may be
contacted to confirm the correct initial payment amount.
The initial payment must be made within 45 days of the
election of continuation coverage.
The qualified beneficiary will receive a billing for each
subsequent period of coverage. The billing will indicate
the payment amount, the due date, and where to send
the payment. Payments must be postmarked within
30 days of their due dates. If any payment is late,
continuation coverage rights will be lost.
Continuation Coverage Payment Shortfalls
If a timely monthly contribution is submitted to the
COBRA administrator that is significantly less than
the actual payment due for the month, the qualified
beneficiary’s continuation coverage will be terminated
immediately. If payment is submitted that is not
significantly less than the actual payment due for the
month, the payment will be deemed to satisfy the
requirement for the amount that must be paid, unless the
COBRA administrator notifies the qualified beneficiary of
the amount of the deficiency and permits him/her to pay
the deficiency within 30 days of the date of the notice
of deficiency. The qualified beneficiary is responsible for
paying all deficiencies.
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Electing Continuation Coverage
Continuation coverage must be elected within 60 days
after the qualified beneficiary receives notice of the
continuation right from the COBRA administrator. If he/
she fails to timely elect continuation coverage, the right
to continuation coverage will be permanently lost. To
elect continuation coverage, the qualified beneficiary
must submit a COBRA election form to the COBRA
administrator. A qualified beneficiary who does not elect
continuation coverage may change his/her prior rejection
anytime within the 60-day election period by submitting a
new COBRA election form.
Each qualified beneficiary may elect continuation coverage
independently. If the employee declines to cover his/
her dependent children, the dependents’ parent (the
employee’s spouse or other parent or legal guardian) may
elect continuation coverage for them. If the employee and
spouse decline to cover a dependent child, that child has
an independent right to elect continuation coverage for him/
herself. Furthermore, a child who is born to the employee
or placed for adoption with the employee during a period
of continuation coverage may be considered a qualified
beneficiary provided that the COBRA administrator is
notified within 30 days of birth or placement for adoption.
The employee or his/her spouse may elect continuation
coverage on behalf of all eligible individuals.
Special COBRA Election Rights for Trade
Displaced Employees
If your coverage ends because the Company shuts down
a plant to shift production to another country or because
of an increase in imports, you may qualify for federal
trade adjustment assistance (TAA) or alternative trade
adjustment assistance (ATAA). If you qualify for TAA or
ATAA within six months of losing coverage and you did
not elect continuation coverage when you were initially
eligible, you may be entitled to a second election period.
To be eligible for this second election period, you must
provide the COBRA administrator with a copy of the
certificate that shows you qualify for TAA or ATAA. Upon
receipt, the COBRA administrator will send you a COBRA
election notice. Your election to continue coverage must
be made during the 60-day period that begins on the
first day you become eligible for TAA or ATAA, but no
later than six months after you lost coverage. If you elect
continuation coverage during this period, coverage will
begin on the first day of the second election period.
However, the second election period does not extend
the continuation coverage period available to you. Your
continuation coverage period will be measured from the
date you lost coverage.
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If you have questions about these special election
rights, contact the Health Care Tax Credit customer
contact center toll-free at 1-866-628-4282 (TTD/TTY
1‑866‑626‑4282) or visit www.doleta.gov/tradeact on
the internet.
Carefully Consider Your Election of
Continuation Coverage
In considering whether to elect continuation coverage,
you should take into account that failure to continue your
coverage will affect your future rights under federal law.
■■ First, you can lose the right to avoid having preexisting
condition exclusions applied to you by other group
health plans if you have more than a 63-day gap in
health coverage.
■■ Second, you will lose the guaranteed right to purchase
individual health insurance policies that do not impose
preexisting condition exclusions if you do not elect
continuation coverage for the maximum time available
to you. This guaranteed right will be preserved only if
you elect continuation coverage.
■■ Finally, you should take into account that you have
special enrollment rights under federal law. You have
the right to request special enrollment in another
group health plan for which you are otherwise eligible
(such as a plan sponsored by your spouse’s employer)
within 30 days after your group health coverage ends
because of the qualifying event that entitles you to elect
continuation coverage. You will also have the same
special enrollment right at the end of the maximum
continuation coverage period available to you.
Examine your options carefully before declining
continuation coverage. Keep in mind that companies
which sell individual health insurance typically require a
review of your medical history before approving coverage.
This could result in a higher premium or denial of
coverage.
Keep CMC Informed of Address
Changes
To protect your and your family’s rights, you must keep
CMC informed of any changes in your address and the
addresses of covered family members.
For More Information
If you have questions concerning your rights to COBRA
continuation coverage, call the COBRA administrator at
1-877-252-8050 or write to:
CMC Employee Services
PO Box 139031
Dallas, TX 75313-9031

Your Rights Under
the Plans
As a participant in the following component plans, you
are entitled to certain rights and protections under the
Employee Retirement Income Security Act of 1974
(ERISA):
■■ Medical
■■ Vision
■■ Dental
■■ Short Term Disability
■■ Long Term Disability
■■ Life Insurance
■■ Accidental Death & Dismemberment Insurance
■■ Business Travel Accident Insurance
■■ Health Care FSA
■■ Dental/Vision FSA
■■ Employee Assistance Program
ERISA provides that all plan participants shall be entitled to:
■■ Receive Information About Your Plan and Benefits
• Examine, without charge, at the plan administrator’s
office and at other specified locations, such as
worksites and union halls, all documents governing
the plan, including insurance contracts and
collective bargaining agreements, and a copy of
the latest annual report (Form 5500 Series) filed
by the plan with the U.S. Department of Labor
and available at the Public Disclosure Room of the
Employee Benefits Security Administration.
• Obtain, upon written request to the plan
administrator, copies of documents governing the
operation of the plan, including insurance contracts
and collective bargaining agreements, and copies
of the latest annual report (Form 5500 Series)
and updated Summary Plan Description. The
administrator may make a reasonable charge for the
copies.
• Receive a summary of the plan’s annual financial
report. The plan administrator is required by law to
furnish each participant with a copy of this summary
annual report.
plan administration
■■ Continue Group Plan Coverage
• Continue health care coverage for yourself, your
spouse or your dependents if there is a loss of
coverage under a plan as a result of a qualifying
event. You or your dependents will have to pay
for such coverage. Review the Summary Plan
Description and the documents governing the plan
on the rules governing your COBRA continuation
coverage rights.
• Reduction or elimination of exclusionary periods
of coverage for preexisting conditions under your
group plan, if you have creditable coverage from
another plan. You should be provided a certificate
of creditable coverage, free of charge, from your
group plan or health insurance issuer when you lose
coverage under the plan, when you become entitled
to elect COBRA continuation coverage, when your
COBRA continuation coverage ends, if you request
it before losing coverage, of if you request it up to
24 months after losing coverage. Without evidence
of creditable coverage, you may be subject to a
preexisting condition exclusion for 12 months (18
months for late enrollees) after your enrollment date
in your coverage.
Prudent Actions by Plan Fiduciaries
In addition to creating rights for plan participants, ERISA
imposes duties upon the people who are responsible for
the operation of the employee benefit plan. The people
who operate your plan, called “fiduciaries” of the plan,
have a duty to do so prudently and in the interest of you
and other plan participants and beneficiaries. No one,
including your employer, your union, or any other person,
may fire you or otherwise discriminate against you in any
way to prevent you from obtaining a welfare benefit or
exercising your rights under ERISA.
Enforce Your Rights
If your claim for a welfare benefit is denied or ignored,
in whole or in part, you have a right to know why this
was done, to obtain copies of documents relating to the
decision without charge, and to appeal any denial, all
within certain time schedules.
Under ERISA, there are steps you can take to enforce the
above rights. For instance, if you request a copy of plan
documents or the latest annual report from the plan and
do not receive them within 30 days, you may file suit in
a federal court. In such case, the court may require the
plan administrator to provide the materials and pay you
up to $110 a day until you receive the materials, unless
the materials were not sent because of reasons beyond
the control of the plan administrator.
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If you have a claim for benefits which is denied or ignored,
in whole or in part, you may file suit in a state or federal
court. In addition, if you disagree with the plan’s decision
or lack thereof concerning the qualified status of a
medical child support order, you may file suit in federal
court.
If it should happen that plan fiduciaries misuse the plan’s
money, or if you are discriminated against for asserting
your rights, you may seek assistance from the U.S.
Department of Labor, or you may file suit in a federal
court. The court will decide who should pay court costs
and legal fees. If you are successful the court may order
the person you have sued to pay these costs and fees. If
you lose, the court may order you to pay these costs and
fees, for example, if it finds your claim is frivolous.
Assistance with Your Questions
If you have any questions about your plan, you should
contact the plan administrator. If you have any questions
about this statement or about your rights under ERISA,
or if you need assistance in obtaining documents from
the plan administrator, you should contact the nearest
office of the Employee Benefits Security Administration,
U.S. Department of Labor, listed in your telephone
directory or the Division of Technical Assistance and
Inquiries, Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue N.W.,
Washington, D.C. 20210. You may also obtain certain
publications about your rights and responsibilities under
ERISA by calling the publications hotline of the Employee
Benefits Security Administration.
128
Important Notices
Medicare Part D (Prescription Drug) Creditable
Coverage
CMC has determined that the prescription drug coverage
provided under the Company-sponsored medical plans
is on average at least as good as the standard Medicare
prescription drug coverage. As a result, you do not
need to enroll for Medicare Part D coverage when you
become eligible for Medicare. You may continue to use
your Company-sponsored coverage and you will not be
subject to a Medicare penalty if you later decide to enroll
in Medicare Part D coverage.
For additional information, contact Employee Services.
Special Rights Upon Childbirth
Newborns’ and Mothers’ Health Protection Act
Group plans and health insurance issuers generally may
not, under federal law, restrict benefits for any hospital
length of stay in connection with childbirth for the mother
or newborn child to less than 48 hours following a vaginal
delivery, or less than 96 hours following a cesarean
section. However, federal law generally does not prohibit
the mother’s or newborn’s attending provider, after
consulting with the mother, from discharging the mother
or her newborn earlier than 48 hours (or 96 hours as
applicable). In any case, plans and issuers may not, under
federal law, require that a provider obtain authorization
from the plan or the insurance issuer for prescribing a
length of stay not in excess of 48 hours (or 96 hours).
Special Rights Following Mastectomies
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy, you
may be entitled to certain benefits under the Women’s
Health and Cancer Rights Act (WHCRA). For individuals
receiving mastectomy-related benefits, coverage will be
provided in a manner determined in consultation with the
attending physician and the patient for:
■■ All stages of reconstruction of the breast on which the
mastectomy was performed.
■■ Surgery and reconstruction of the other breast to
produce a symmetrical appearance.
■■ Prostheses.
■■ Treatment of physical complications of all stages of
mastectomy, including lymphedemas.

Your Rights Under the Family and
Medical Leave Act of 1993 (FMLA)
FMLA requires covered employers to provide up to
12 weeks of unpaid, job-protected leave to eligible
employees for certain family and medical reasons.
Employees are eligible if they have worked for their
employer for at least one year, and for 1,250 hours over
the previous 12 months, and if there are at least 50
employees within 75 miles. FMLA permits employees to
take leave on an intermittent basis or to work a reduced
schedule under certain circumstances.
Reasons for Taking Leave
Unpaid leave must be granted for any of the following
reasons:
■■ To care for the employee’s child after birth, or
placement for adoption or foster care.
■■ To care for the employee’s spouse, son or daughter, or
parent who has a serious health condition.
■■ For a serious health condition that makes the employee
unable to perform the employee’s job.
■■ At the employee’s or employer’s option, certain kinds of
paid leave may be substituted for unpaid leave.
Military Family Leave Entitlements
Eligible employees with a spouse, son, daughter, or
parent on active duty or call to active duty status in the
National Guard or Reserves in support of a contingency
operation may use their 12-week leave entitlement
to address certain qualifying exigencies. Qualifying
exigencies may include attending certain military events,
arranging for alternative childcare, addressing certain
financial and legal arrangements, attending certain
counseling sessions, and attending post-deployment
reintegration briefings.
FMLA also includes a special leave entitlement that permits
eligible employees to take up to 26 weeks of leave to care
for a covered servicemember during a single 12-month
period. A covered servicemember is a current member
of the Armed Forces, including a member of the National
Guard or Reserves, who has a serious injury or illness
incurred in the line of duty on active duty that may render
the servicemember medically unfit to perform his or her
duties for which the servicemember is undergoing medical
treatment, recuperation, or therapy; or is in outpatient
status; or is on the temporary disability retired list.
plan administration
Advance Notice and Medical Certification
The employee may be required to provide advance leave
notice and medical certification. Taking of leave may be
denied if requirements are not met.
■■ The employee ordinarily must provide 30 days advance
notice when the leave is foreseeable.
■■ An employer may require medical certification to
support a request for leave because of a serious health
condition, and may require second or third opinions (at
the employer’s expense) and a fitness for duty report to
return to work.
Job Benefits and Protection
■■ For the duration of FMLA leave, the employer must
maintain the employee’s health coverage under any
group health plan.
■■ Upon return from FMLA leave, most employees must
be restored to their original or equivalent positions with
equivalent pay, benefits, and other employment terms.
■■ The use of FMLA leave cannot result in the loss of any
employment benefit that accrued prior to the start of an
employee’s leave.
Unlawful Acts by Employers
FMLA makes it unlawful for any employer to:
■■ Interfere with, restrain, or deny the exercise of any right
provided under FMLA.
■■ Discharge or discriminate against any person for
opposing any practice made unlawful by FMLA or for
involvement in any proceeding under or relating to
FMLA.
Enforcement
■■ The U.S. Department of Labor is authorized to
investigate and resolve complaints of violations.
■■ An eligible employee may bring a civil action against an
employer for violations.
■■ FMLA does not affect any federal or state law
prohibiting discrimination, or supersede any state
or local law or collective bargaining agreement that
provides greater family or medical leave rights.
For Additional Information
If you have access to the internet, visit the FMLA
website at http://www.dol.gov/whd/fmla. To
locate the nearest Wage-Hour Office, telephone
the Wage-Hour toll-free information and help line at
1-866-4USWAGE (1-866-487-9243): a customer service
representative is available to assist you with referral
information from 8 a.m. to 5 p.m. in your time zone;
or log onto http://www.wagehour.dol.gov.
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Your Rights Under the Uniformed
Services Employment and
Reemployment Rights Act (USERRA)
USERRA protects the job rights of individuals who
voluntarily or involuntarily leave employment positions
to undertake military service or certain types of service
in the National Disaster Medical System. USERRA also
prohibits employers from discriminating against past
and present members of the uniformed services, and
applicants to the uniformed services. The rights listed
here may vary depending on the circumstances.
Reemployment Rights
You have the right to be reemployed in your civilian job
if you leave that job to perform service in the uniformed
service and:
■■ You ensure that your employer receives advance
written or verbal notice of your service,
■■ You have five years or less of cumulative service in the
uniformed services while with that particular employer,
■■ You return to work or apply for reemployment in a
timely manner after conclusion of service, and
■■ You have not been separated from service with a
disqualifying discharge or under other than honorable
conditions.
If you are eligible to be reemployed, you must be restored
to the job and benefits you would have attained if you had
not been absent due to military service or, in some cases,
a comparable job.
Right To Be Free From Discrimination and
Retaliation
An employer may not discriminate or retaliate against a
person because of his/her status as:
■■ A past or present member of the uniformed service,
■■ An applicant for membership in the uniformed service,
or
■■ A person obligated to serve in the uniformed service.
This includes decisions regarding initial employment,
reemployment, retention in employment, promotion, or
any benefit of employment.
In addition, an employer may not retaliate against anyone
assisting in the enforcement of USERRA rights, including
testifying or making a statement in connection with a
proceeding under USERRA, even if that person has no
service connection.
Health Insurance Protection
■■ If you leave your job to perform military service,
you have the right to elect to continue your existing
employer-based health plan coverage for you and your
dependents for up to 24 months while in the military.
130
■■ Even if you don’t elect to continue coverage during your
military service, you have the right to be reinstated in
your employer’s health plan when you are reemployed,
generally without any waiting periods or exclusions
(e.g., preexisting condition exclusions) except for
service-connected illnesses or injuries.
Enforcement
The U.S. Department of Labor, Veterans Employment and
Training Service (VETS) is authorized to investigate and
resolve complaints of USERRA violations.
■■ For assistance in filing a complaint, or for any other
information on USERRA, contact VETS
at 1-866-4-USA-DOL or visit its website at
http://www.dol.gov/vets. An interactive
online USERRA Advisor can be viewed at
http://www.dol.gov/elaws/userra.htm.
■■ If you file a complaint with VETS and VETS is unable to
resolve it, you may request that your case be referred
to the Department of Justice for representation.
■■ You may also bypass the VETS process and bring
a civil action against an employer for violations of
USERRA.
Notice of Grandfathered Status for the Premium
Medical Plan
CMC believes the Premium Medical Plan is a
“grandfathered health plan” under the Patient Protection
and Affordable Care Act (the Affordable Care Act). As
permitted by the Affordable Care Act, a grandfathered
health plan can preserve certain basic health coverage
that was already in effect when that law was enacted.
Being a grandfathered health plan means that the
Premium Plan may not include certain consumer
protections of the Affordable Care Act that apply to other
plans, for example, the requirement for the provision
of preventive health services without any cost sharing.
However, grandfathered health plans must comply with
certain other consumer protections in the Affordable
Care Act, for example, the elimination of lifetime limits on
benefits.
Questions regarding which protections apply and which
protections do not apply to a grandfathered health
plan and what might cause a plan to change from
grandfathered health plan status can be directed to the
plan administrator through CMC’s Employee Services
Department. You may also contact the Employee Benefits
Security Administration, U.S. Department of Labor at
1‑866‑444-3272 or www.dol.gov/ebsa/healthreform.
This website has a table summarizing which protections
do and do not apply to grandfathered health plans.
Glossary of Terms
This section defines words and phrases for purposes of
the CMC Welfare Benefit Plan. An entry that is specific
to a component plan(s) is followed by the name of the
component plan(s) to which it applies.
Accidental Death & Dismemberment Insurance Plan
The Commercial Metals Company Accidental Death &
Dismemberment Insurance Plan. Also referred to as the
AD&D Insurance Plan.
Accidental Injury - Medical Accidental bodily injury
resulting, directly and independently of all other causes,
in initial necessary care provided by a physician or other
professional provider.
Acquired Brain Injury - Medical A neurological
injury to the brain that is not hereditary, congenital, or
degenerative. The injury must occur after birth and
result in a change in neuronal activity that impairs
physical functioning, sensory processing, cognition, or
psychosocial behavior.
Air Bag – AD&D A passive restraint device in an
automobile that inflates automatically upon collision to
provide protection in automobile accidents. The air bag
must meet the Federal Vehicle Safety Standards of the
National Highway Traffic Safety Administration and be
installed by the manufacturer.
Air Bag - BTA An inflatable restraint device that meets
published United States government safety standards, is
properly installed, and is not altered after the installation.
Allowable Amount - Medical The maximum amount
determined by the claim administrator to be eligible for
consideration of payment for a particular service, supply,
or prescription drug as follows:
■■ Network providers An amount based on the terms of
the provider contract and the payment methodology
in effect on the date of service. The payment
methodology used may include diagnosis-related
groups (DRG), fee schedule, package pricing, global
pricing, per diems, case-rates, discounts, or other
payment methodologies.
■■ Non-network hospitals and other facilities The
amount the claim administrator would consider
for payment for the same service or supply at an
equivalent network hospital or other network facility
using Texas regional or state fee schedules or rate
and payment methodologies. For hospitals or other
facilities where fee schedules or rate payments are not
appropriate, the allowable amount is the lesser of the
billed charge or a per diem established by the claim
administrator.
■■ Services or supplies provided in Texas by non-
network physicians and other professional
providers The lesser of the billed charge or the
amount the claim administrator would consider for
payment for the same service or supply if performed
or provided by a physician or other professional
glossary
provider with similar experience and/or skill. If the claim
administrator does not have sufficient data to calculate
the allowable amount for a particular service or supply,
the allowable amount is based on the complexity of
the service or supply and any unusual circumstances
or medical complications specifically brought to the
claim administrator’s attention that require additional
experience, skill, and/or time.
■■ Services or supplies provided outside of Texas by
non-network physicians and other professional
providers An amount established by the claim
administrator using Texas regional or state allowable
amounts applicable to services or supplies provided by
physicians or other professional providers with similar
skills and experience.
■■ Multiple surgeries The allowable amount for all
surgical procedures performed on the same patient on
the same day is the amount for the single procedure
with the highest allowable amount plus one-half of
the allowable amount for each of the other covered
procedures performed.
■■ Drugs administered by a home infusion therapy
provider The lesser of the actual charge or the
average wholesale price (AWP) plus a predetermined
percentage mark-up or mark-down from the AWP
established by the claim administrator and updated on
a periodic basis.
■■ Services or supplies provided to Medicare
recipients The allowable amount will not exceed
Medicare’s limiting charge.
■■ Covered drugs The allowable amount for network
pharmacies and the mail service pharmacy is based
on the provisions of the contract between the claim
administrator and the pharmacy in effect on the date of
service.
Allowable Expense - Dental Coordination of Benefits
Provision A necessary dental expense that a covered
person is required to pay and which is at least partly
covered by one or more of the plans that provide benefits
to the covered person.
131
 If a plan provides fixed benefits for specified events
or conditions (instead of benefits based on expenses
incurred) those benefits are allowable expenses. If a plan
provides benefits in the form of services, the reasonable
cash value of each service performed is treated as both
an allowable expense and a benefit paid by that plan.
glossary
Allowable expenses do not include:
■■ Expenses for services performed because of a job-
related injury or sickness.
■■ Any amount of expenses in excess of the higher
reasonable and customary fee for a service if two or
more plans calculate their benefit payments on the
basis of reasonable and customary fees.
■■ Any amount of expenses in excess of the higher
negotiated fee for a service if two or more plans
calculate their benefit payments on the basis of
negotiated fees.
■■ Any amount of benefits that a primary plan does not
pay because the covered person fails to comply with
the primary plan’s managed care or utilization review
provisions including provisions requiring second
surgical opinions, pre-certification of services, use of
providers in a plan’s network of providers, or any other
similar provisions.
Annual Pay – AD&D, BTA, Life For other than
commission employees and mileage-paid truck drivers,
the covered employee’s current annualized base rate
of pay received from CMC in the prior calendar year.
For commission employees (if 25% or more of your
total annual base pay in the prior calendar year), annual
earnings also include the amount of commissions
received in the prior year. For mileage-paid truck drivers,
CMC performs a special annual earnings calculation that
recognizes a number of components including mileage
and load hauled.
Appropriate Available Treatment - LTD, STD You
must be under the ongoing care of a physician in the
appropriate specialty as determined by The Standard.
Automobile – AD&D A private passenger motor vehicle
licensed for use on public highways.
Average Wholesale Price - Medical Any one of the
recognized published averages of the prices charged by
wholesalers in the United States for drug products sold to
pharmacies.
Benefit Authorization - Vision Authorization issued by
VSP identifying the individual named as a covered person
of VSP, and identifying those plan benefits to which a
covered person is entitled.
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Business Travel Accident Insurance Plan The
Commercial Metals Company Business Travel Accident
Insurance Plan. Also referred to as the BTA Insurance
Plan.
Calendar Year The period commencing on January 1
and ending on the next December 31.
Cast Restoration - Dental An inlay, onlay, or crown.
Certificate of Airworthiness - BTA The standard
airworthiness certificate issued by the Federal Aviation
Agency (or successor agency) of the United States or the
equivalent issued by the governmental authority having
jurisdiction over civil aviation in the country of registry.
Chartered Aircraft - BTA An aircraft that is hired by the
Company for a period of time that is less than 10 days.
Chemical Dependency Treatment Center - Medical
A facility that provides a program for the treatment of
chemical dependency pursuant to a written treatment
plan approved and monitored by a physician. The facility
must be:
■■ Affiliated with a hospital under a contractual agreement
with an established system for patient referral,
■■ Accredited as such a facility by the Joint Commission
on Accreditation of Healthcare Organizations,
■■ Licensed as a chemical dependency treatment
program by the Texas Commission on Alcohol and
Drug Abuse, or
■■ Licensed, certified, or approved as a chemical
dependency treatment program or center by any other
state agency that has the legal authority to issue the
license, certification, or approval.
Child Care Program – AD&D A center of child care that:
■■ If licensing is required, holds a license as a day care
center, or is operated by a licensed day care provider
– or – if licensing is not required, operates primarily for
the care of children on a daily basis for 12 months a
year.
■■ Is operated in a private home, school or other facility.
■■ Customarily charges for the care provided.
A child care program does not include a hospital, the
dependent child’s home, or care provided during normal
school hours while a dependent child is attending grades
one through three.
Claim Administrator - Medical Blue Cross and Blue
Shield of Texas (BCBSTX). As part of its duties as claim
administrator, BCBSTX may subcontract portions of its
responsibilities.
Clinical Ecology - Medical The inpatient or outpatient
diagnosis or treatment of allergic symptoms by one of the
following methods:
■■ Cytotoxicity testing (testing the result of food or inhalant
by whether or not it reduces or kills white blood cells).
■■ Urine auto injection (injecting one’s own urine into the
tissue of the body).
■■ Skin irritation by Rinkel method.
■■ Subcutaneous provocative and neutralization testing
(injecting the patient with allergen).
■■ Sublingual provocative testing (placing droplets of
allergenic extracts in the patient’s mouth).
COBRA The Consolidated Omnibus Budget
Reconciliation Act (COBRA) of 1985, as amended.
Coinsurance - Dental, Vision The percentage of
charges for covered expenses that a covered person is
required to pay under the plan.
Common Carrier - AD&D A public conveyance that
is operated by a licensed common carrier for the
transportation of the general public for a fare and
which operates on regular passenger routes within the
continental United States, Alaska and Hawaii, with a
definite schedule of departures and arrivals.
Common Carrier - BTA A government-regulated
entity that is in the business of transporting fare-paying
passengers. The term does not include chartered
or other privately-arranged transportation, taxis, or
limousines.
Community Reintegration Services - Medical Services
that facilitate the continuation of care when an affected
individual transitions into the community.
Company Commercial Metals Company. Also referred to
as CMC.
Company-sponsored Retirement Plan - LTD Includes
any retirement plan:
■■ That is part of any federal, state, municipal or
association retirement system, or
■■ For which the employee is eligible as a result of
employment with the Company.
Consumer Price Index (CPI) - LTD The Consumer Price
Index for Urban Wage Earners and Clerical Workers
published by the U.S. Department of Labor. If the index
is discontinued or changed, another nationally published
index that is comparable to the CPI will be used.
Contract Allowance - Dental
The maximum amount Delta Dental will use for calculating
the Benefits for a Single Procedure. The Contract
Allowance for services provided:
■■ By Delta Dental PPO Dentists is the lesser of the
Dentist’s submitted fee, the Delta Dental PPO Dentist’s
glossary
Fee or the Dentist’s filed fee with Delta Dental in the
Contracting Dentist Agreement.
■■ By Delta Dental Premier Dentists (who are not PPO
Dentists) is the lesser of the Dentist’s submitted fee, the
Dentist’s filed fee with Delta Dental in the Contracting
Dentist Agreement or the Maximum Plan Allowance
(MPA); or
■■ By Non-Delta Dental Dentists is the lesser of the
Dentist’s submitted fee or the MPA.
Copay An amount required to be paid by or on behalf of
a covered person for benefits that are not fully covered.
Cosmetic, Reconstructive, or Plastic Surgery -
Medical
Surgery that:
■■ Can be expected or is intended to improve the physical
appearance of a participant,
■■ Is performed for psychological purposes, or
■■ Restores form but does not correct or materially restore
a bodily function.
Covered Accident - AD&D A sudden, unforeseeable,
external event that results directly and independently of
all other causes in a covered loss and meets all of the
following conditions:
■■ Occurs while the covered person is covered under the
plan.
■■ Is not contributed to by disease, sickness, or mental or
bodily infirmity.
■■ Is not otherwise excluded under the terms of the plan.
Covered Accident - BTA An unexpected, unintentional
or unforeseeable event or occurrence that happens
suddenly and violently, results directly and independently
of all other causes in a covered loss, occurs during
business travel while the covered employee is insured
under the plan, and is not otherwise excluded under the
plan.
Covered Loss - AD&D, BTA A loss that meets all of the
following conditions. It is:
■■ The result, directly and independently of all other
causes, of a covered accident.
■■ One of the losses specified in the plan as a covered
loss.
■■ Suffered by a covered person within the applicable
time period specified in the plan.
133
 Covered Person An individual who is covered under a
plan.
Creditable Coverage - Medical Coverage provided
under:
■■ A self-funded or self-insured employee group health
glossary
plan.
■■ An individual or group health insurance indemnity or
HMO plan.
■■ Medicare Part A or Part B.
■■ Medicaid (except coverage solely for pediatric
vaccines).
■■ Armed forces health coverage.
■■ A medical care program of the Indian Health Service or
of a tribal organization.
■■ A state health benefits risk pool.
■■ The federal employees health benefits program.
■■ A public health plan established or maintained by a
state, the U.S. government, a foreign country, or any
political subdivision of a state, the U.S. government,
or a foreign country that provides health coverage to
individuals who are enrolled in the plan.
■■ The Peace Corps Act health benefit plan.
■■ The State Children’s Health Insurance Program.
Creditable Coverage does not include:
■■ Coverage only for accident (including accidental death
and dismemberment).
■■ Disability income coverage.
■■ Liability insurance, including general liability insurance
and automobile liability insurance.
■■ Coverage issued as a supplement to liability insurance.
■■ Workers’ compensation or similar coverage.
■■ Automobile medical payment insurance.
■■ Credit-only insurance (for example, mortgage
insurance).
■■ Coverage for onsite medical clinics.
■■ Limited scope dental benefits, vision benefits, or long-
term care benefits if they are provided under a separate
policy, certificate, or contract of insurance.
■■ Flexible spending accounts (FSAs) if they meet the
definition of a health FSA under the Internal Revenue
Code and (a) the maximum annual benefit payable
for the employee does not exceed two times the
employee’s salary reduction election under the FSA
for that year, and (b) the employee has other coverage
available under a group health plan of the employer
for the year, and (c) the other coverage is not limited to
benefits that are excepted benefits.
134
■■ Coverage for only a specified disease or illness or
hospital indemnity or other fixed indemnity insurance.
■■ Medicare supplemental health insurance (as defined
under the Social Security Act), also referred to as
Medigap or MedSupp insurance.
■■ Coverage supplemental to the coverage provided
under Chapter 55, Title 10, United States Code (also
known as TRICARE supplemental programs).
■■ Similar supplemental coverage provided to coverage
under a group health plan.
Crisis Stabilization Unit or Facility - Medical An
institution that is appropriately licensed and accredited
as a crisis stabilization unit or facility for the provision of
mental health care and serious mental illness services
to persons who are demonstrating acute demonstrable
psychiatric crises of moderate to severe proportions.
Custodial Care - Medical Care comprised of services
and supplies, including room and board and other
institutional services, provided to a participant primarily
to assist in activities of daily living and to maintain life
and/or comfort with no reasonable expectation of cure
or improvement of sickness or injury. Custodial care is
not a necessary part of medical treatment for recovery.
It includes, but is not limited to, helping a participant
walk, bathe, dress, eat, prepare special diets, and take
medication.
Custodial Parent - Dental A parent awarded custody,
other than joint custody, by a court decree. In the
absence of a court decree, the parent with whom the
child resides more than half of the year without regard to
any temporary visitation.
Dental Hygienist - Dental A person trained to remove
calcareous deposits and stains from the surfaces of
teeth and provide information on the prevention of oral
disease. A dental hygienist does not include the covered
person, his/her spouse or any member of the covered
person’s immediate family including his/her or his/her
spouse’s parents, children (natural or adopted), siblings,
grandparents, or grandchildren.
Dental Plan The Commercial Metals Company Dental
Plan.
Dental/Vision Flexible Spending Account Plan - The
Commercial Metals Company Dental/Vision Flexible
Spending Account Plan. Also referred to as the Dental/
Vision FSA Plan.
Dentally Necessary - Dental A dental service or
treatment that is performed in accordance with generally
accepted dental standards as determined by Delta Dental
and which is:
■■ Necessary to treat decay, disease or injury of the teeth,
or
■■ Essential for the care of the teeth and supporting
tissues of the teeth.
Dentist - Dental Refers to:
■■ A person licensed to practice dentistry in the
jurisdiction where the services are performed, or
■■ Any other person whose services, according to
applicable law, must be treated as dentist’s services for
purposes of the plan. Each person must be licensed in
the jurisdiction where the services are performed and
must act within the scope of that license. The person
must also be certified and/or registered if required by
the applicable jurisdiction.
A dentist also includes a physician who performs a
service that is covered under the plan.
Dentures - Dental Fixed partial dentures (bridgework),
removable partial dentures, and removable full dentures.
Dependent Day Care Flexible Spending Account
Plan - The Commercial Metals Company Dependent Day
Care Flexible Spending Account Plan. Also referred to as
the Dependent Day Care FSA Plan.
Diabetes Self-Management Training - Medical The
development of an individualized management plan
that is created for and in collaboration with the diabetic
participant (and/or his or her family) to understand the
care and management of diabetes, including nutritional
counseling and proper use of diabetes equipment and
diabetes supplies.
Diabetic Management Services - Medical Initial and
follow-up instruction for a diabetic participant or his/her
caretaker concerning:
■■ The physical cause and process of diabetes.
■■ Nutrition, exercise, medications, monitoring of
laboratory values and the interaction of these in the
effective self-management of diabetes.
■■ Prevention and treatment of special health problems for
the diabetic patient.
■■ Adjustment to lifestyle modifications.
■■ Family involvement in the care and treatment of the
diabetic patient. (The family is included in certain
sessions of instruction for the patient.)
Diabetic Participant - Medical A participant who has
been diagnosed with insulin dependent or non-insulin
dependent diabetes, elevated blood glucose levels
induced by pregnancy, or another medical condition
associated with elevated blood glucose levels.
glossary
Dietary and Nutritional Services - Medical The
education, counseling, or training of a participant
(including printed material) regarding diet, regulation or
management of diet, or the assessment or management
of nutrition.
Direct and Sole Cause - BTA The covered loss occurs
within 12 months of the date of an accidental injury
sustained in a covered accident and is the direct result of
that accidental injury independent of other causes.
Disability Benefits Under a Retirement Plan - LTD
Money that:
■■ Is payable under a retirement plan due to disability as
defined in that plan, and
■■ Does not reduce the amount of money that would
have been paid as retirement benefits at the normal
retirement age under the plan if the disability had not
occurred. (If the payment does cause a reduction, it will
be deemed a retirement benefit under a retirement plan
as defined in this glossary.)
Durable Medical Equipment Provider - Medical
A provider that provides therapeutic supplies and
rehabilitative equipment and is accredited by the
Joint Commission on Accreditation of Healthcare
Organizations.
Eligible Expenses - Medical Inpatient hospital
expenses, medical-surgical expenses, extended care
expenses, and other covered expenses as specified
under the plan.
Eligible Individual - Medical You must meet the
following requirements:
■■ You must be covered under a high deductible health
plan (HDHP)
■■ You have no other health coverage except what is
permitted by law.
■■ You are not enrolled in Medicare.
■■ You cannot be claimed as a dependent on someone
else’s tax return.
135
 Emergency Care - Medical Health care services
provided in a hospital emergency facility (emergency
room) or comparable facility to evaluate and stabilize
medical conditions of a recent onset and severity,
including but not limited to severe pain, that would lead
a prudent lay person possessing an average knowledge
glossary
of medicine and health to believe that the person’s
condition, sickness, or injury is of such a nature that
failure to get immediate care could result in one or more
of the following:
■■ Placing the patient’s health in serious jeopardy.
■■ Serious impairment of bodily functions.
■■ Serious dysfunction of any bodily organ or part.
■■ Serious disfigurement.
■■ In the case of a pregnant woman, serious jeopardy to
the health of the fetus.
Employee Assistance Program T he Commercial Metals
Company Employee Assistance Program. Also referred to
as the EAP.
Environmental Sensitivity - Medical The inpatient or
outpatient treatment of allergic symptoms by: controlled
environment; sanitizing the surroundings, removal of toxic
materials; or use of special non-organic, non-repetitive
diet techniques.
ERISA The Employee Retirement Income Security Act of
1974, as amended.
Evidence of Insurability (EOI) - Life, LTD A statement
of proof of an individual’s medical history upon which
acceptance for insurance is determined by an insurance
company. Evidence of insurability must be obtained at the
individual’s expense.
Experimental or Investigational - Medical The use
of any treatment, procedure, facility, equipment, drug,
device, or supply not accepted as standard medical
treatment for the applicable condition or that require
federal or other governmental agency approval if it is not
granted at the time services are provided. Approval by
a federal agency means that the treatment, procedure,
facility, equipment, drug, device, or supply has been
approved for the applicable condition and, in the case of
a drug, in the dosage used on the patient. For purposes
of this definition, medical treatment includes medical,
surgical, or dental treatment.
Standard medical treatment means the services or
supplies that are in general use in the medical community
in the United States and:
136
■■ Have been demonstrated in peer reviewed literature to
have scientifically established medical value for curing
or alleviating the condition being treated,
■■ Are appropriate for the hospital or other facility in which
they are performed, and
■■ The physician or other professional provider has had
the appropriate training and experience to provide the
treatment or procedure.
The claim administrator determines whether any
treatment, procedure, facility, equipment, drug, device, or
supply is experimental or investigational, and will consider
the guidelines and practices of Medicare, Medicaid,
or other government-financed programs in making its
determination.
Although a physician or other professional provider may
have prescribed treatment, and the services or supplies
may have been provided as the treatment of last resort,
the claim administrator still may determine the services or
supplies to be experimental or investigational under this
definition. Treatment provided as part of a clinical trial or a
research study is experimental or investigational.
Experimental Nature - Vision Procedure or lens that
is not used universally or accepted by the vision care
profession, as determined by VSP.
Extended Care Expenses - Medical The allowable
amount of charges incurred for medically necessary
services and supplies provided by a skilled nursing
facility, a home health agency, or a hospice.
FDA The United States Food and Drug Administration.
Generic Drug - Medical A drug that is approved by the
FDA as pharmaceutically and therapeutically equivalent
for a particular use or purpose to the brand name drug
prescribed.
Government Plan - Dental Any plan, program, or
coverage that is established under the laws or regulations
of any government. The term does not include Medicare
or any plan, program or coverage provided by a
government as an employer.
Hazardous Activity - BTA An activity that exposes
a covered employee to dangerous conditions and
significantly increases risk of death or bodily injury.
Health Benefit Plan - Medical A group, blanket, or
franchise insurance policy; a certificate issued under
a group policy; a group hospital service contract; or a
group subscriber contract or evidence of coverage issued
by a health maintenance organization that provides
benefits for health care services. The term does not
include:
■■ Accident only or disability income insurance, or a
combination of accident-only and disability income
insurance.
■■ Credit-only insurance.
■■ Disability insurance coverage.
■■ Coverage for a specified disease or illness.
■■ Medicare services under a federal contract.
■■ Medicare supplement and Medicare Select policies
regulated in accordance with federal law.
■■ Long-term care coverage or benefits, home health care
coverage or benefits, nursing home care coverage or
benefits, community-based care coverage or benefits,
or any combination of those coverages or benefits.
■■ Coverage that provides limited-scope dental or vision
benefits.
■■ Coverage provided by a single service health
maintenance organization.
■■ Coverage issued as a supplement to liability insurance.
■■ Workers’ compensation or similar insurance.
■■ Automobile medical payment insurance coverage.
■■ Jointly managed trusts authorized under 29 U.S.C.
Section 141, et seq., that:
• Contain a plan of benefits for employees,
• Are negotiated in a collective bargaining agreement
governing wages, hours, and working conditions of
the employees, and
• Are authorized under 29 U.S.C. Section 157.
■■ Hospital indemnity or other fixed indemnity insurance.
■■ Reinsurance contracts issued on a stop-loss, quota-
share, or similar basis.
■■ Short-term major medical contracts.
■■ Liability insurance, including general liability insurance
and automobile liability insurance.
■■ Other coverage that is:
• Similar to the coverage described in these
exclusions under which benefits for medical care are
secondary or incidental to other insurance benefits,
and
• Specified in federal regulations.
■■ Coverage for onsite medical clinics.
■■ Coverage that provides other limited benefits specified
by federal regulations.
Health Care Flexible Spending Account Plan T  he
Commercial Metals Company Health Care Flexible
Spending Account Plan. Also referred to as the Health
glossary
Care FSA Plan.
Health Savings Account (HSA) - Medical A tax-
exempt trust or custodial account that you set up with a
qualified HSA trustee to pay or reimburse certain medical
expenses you incur. You must be an eligible individual to
qualify for an HSA.
Home Health Agency - Medical A business that
provides home health care and is licensed, approved, or
certified by the appropriate agency of the state in which
it is located or is certified by Medicare as a supplier of
home health care.
Home Health Care - Medical Health care services
provided during a visit by a home health agency to
patients confined at home due to a sickness or injury
requiring skilled health services on an intermittent, part-
time basis.
Home Infusion Therapy - Medical The administration of
fluids, nutrition, or medication (including all additives and
chemotherapy) by intravenous or gastrointestinal (enteral)
infusion or by intravenous injection in the home setting.
Home infusion therapy includes:
■■ Drugs and IV solutions.
■■ Pharmacy compounding and dispensing services.
■■ Equipment and ancillary supplies necessitated by the
defined therapy.
■■ Delivery services.
■■ Patient and family education.
■■ Nursing services.
Over-the-counter products that do not require a
physician’s or other professional provider’s prescription,
including but not limited to standard nutritional
formulations used for enteral nutrition therapy, are not
included.
Home Infusion Therapy Provider - Medical An entity
that is duly licensed by the appropriate state agency to
provide home infusion therapy.
Hospice - Medical A facility or agency primarily engaged
in providing skilled nursing services and other therapeutic
services for terminally ill patients and that is:
■■ Licensed in accordance with state law (where state law
provides for such licensing), or
■■ Certified by Medicare as a supplier of hospice care.
137
 Hospice Care - Medical Services provided by a hospice
to patients confined at home or in a hospice facility due
to a terminal sickness or terminal injury requiring skilled
health care services.
Hospital - Medical A short-term acute care facility that
glossary
meets all of the following requirements. It:
■■ Is duly licensed as a hospital by the state in which
it is located and meets the standards established
for that licensing, and is either accredited by the
Joint Commission on Accreditation of Healthcare
Organizations or is certified as a hospital provider
under Medicare.
■■ Is primarily engaged in providing inpatient diagnostic
and therapeutic services for the diagnosis, treatment,
and care of injured and sick persons by or under the
supervision of physicians for compensation from its
patients.
■■ Has organized departments of medicine and major
surgery, either on its premises or in facilities available
to the hospital on a contractual prearranged basis, and
maintains clinical records on all patients.
■■ Provides 24-hour nursing services by or under the
supervision of a registered nurse.
■■ Has in effect a hospital utilization review plan.
■■ Is not, other than incidentally, a skilled nursing facility,
nursing home, custodial care home, health resort, spa
or sanitarium, place for rest, place for the aged, place
for the treatment of chemical dependency, hospice, or
place for the provision of rehabilitative care.
Hospital - LTD A legally operated hospital providing
full-time medical care treatment under the direction of a
full-time staff of licensed physicians. Rest homes, nursing
homes, convalescent homes for the aged, and facilities
primarily affording custodial, educational, or rehabilitative
care are not hospitals.
Hospital Admission - Medical The period between the
time of a participant’s entry into a hospital or a chemical
dependency treatment center as a bed patient and the
time of discontinuance of bed-patient care or discharge
by the admitting physician or other professional provider,
whichever occurs first. The day of entry, but not the day
of discharge or departure, is considered in determining
the length of a hospital admission. If a participant is
admitted to and discharged from a hospital within a
24-hour period but is confined as a bed patient in a
bed accommodation during the period of time he/she is
confined in the hospital, the admission is considered a
hospital admission.
138
Bed patient means confinement in a bed accommodation
of a chemical dependency treatment center on a 24-hour
basis or in a bed accommodation located in a portion of a
hospital that is designed, staffed, and operated to provide
acute, short-term hospital care on a 24-hour basis. The
term does not include confinement in a portion of a
hospital (other than a chemical dependency treatment
center) designed, staffed, and operated to provide long-
term institutional care on a residential basis.
Identification (ID) Card - Medical The card issued
to the employee by the claim administrator indicating
pertinent coverage information.
Imaging Center - Medical A provider that furnishes
technical or total services with respect to diagnostic
imaging services and is licensed through the Texas State
Radiation Control Agency.
Independent Laboratory - Medical A Medicare certified
laboratory that provides technical and professional
anatomical and/or clinical laboratory services.
Injury - AD&D, Life Bodily impairment resulting directly
from an accident and independently of all other causes.
Injury - LTD An injury to the body.
Injury - STD Bodily impairment resulting directly from an
accident and independently of all other causes.
For the purpose of determining benefits under the plan:
■■ Any disability that begins more than 60 days after an
injury is considered a sickness, and
■■ Any injury that occurs before the employee is covered
under the plan, but which accounts for a medical
condition that arises while the employee is covered
under the plan is treated as a sickness.
Inpatient Hospital Expenses - Medical The allowable
amounts incurred for medically necessary services and
supplies for the care of a participant provided that the
items are:
■■ Furnished at the direction or prescription of a physician
or other professional provider,
■■ Provided by a hospital or a chemical dependency
treatment center, and
■■ Furnished to and used by the participant during an
inpatient hospital admission.
Inpatient hospital expenses include:
■■ Room accommodation charges. If the patient is in a
private room, the amount of the room charge in excess
of the hospital’s average semiprivate room charge is
not an eligible expense.
■■ Other usual hospital services, including drugs and
medications that are medically necessary and
consistent with the condition of the patient. Charges for
personal items are not eligible expenses.
An expense is considered to be incurred on the date the
service or supply is provided.
Charges for medically necessary mental health care or
treatment of serious mental illness in a psychiatric day
treatment facility, a crisis stabilization unit or facility, or a
residential treatment center for children and adolescents,
in lieu of hospitalization, are considered inpatient hospital
expenses.
Insulin Pumps - Medical For purposes of coverage
under the plan, refers to external and implantable insulin
pumps and associated accessories, which include
insulin infusion devices, batteries, skin preparation items,
adhesive supplies, infusion sets, insulin cartridges,
durable and disposable devices to assist in the injection
of insulin, and other required disposable supplies.
Also includes repairs and necessary maintenance of
insulin pumps not otherwise provided for under the
manufacturer’s warranty or purchase agreement,
rental fees for pumps during the repair and necessary
maintenance of insulin pumps, neither of which may
exceed the purchase price of a similar replacement
pump.
Intoxication - BTA A blood alcohol level that meets or
exceeds the level that creates a legal presumption of
intoxication under the laws of the jurisdiction in which the
incident occurs.
Leased or Controlled Aircraft - BTA An aircraft that:
■■ Has been leased, rented or borrowed by the Company
for at least 10 consecutive days,
■■ Subject to the terms of the lease agreement, can be
used at the Company’s discretion, and
■■ Cannot be altered or sold by the Company without the
consent of the owner or lessor.
Legend Drugs - Medical Drugs, biologicals, or
compounded prescriptions that are required by law to
have a label stating “Caution - Federal Law Prohibits
Dispensing Without a Prescription,” and which are
approved by the FDA for a particular use or purpose.
Life Insurance Plan T he Commercial Metals Company
Life Insurance Plan.
Long Term Disability Plan T
 he Commercial Metals
Company Long Term Disability Plan. Also referred to as
the LTD Plan.
Marriage and Family Therapy - Medical The provision
of professional therapy services to individuals, families,
or married couples, singly or in groups, and involves
the professional application of family systems theories
and techniques in the delivery of therapy services to
those persons. The term includes the evaluation and
glossary
remediation of cognitive, affective, behavioral, or relational
dysfunction within the context of marriage or family
systems.
Material Duties - LTD, STD The essential tasks,
functions and operations, and the skills, abilities,
knowledge, training and experience, generally required by
employers from those engaged in a particular occupation
that cannot be reasonably modified or omitted. In no
event will working an average of more than 40 hours per
week be considered a material duty.
Maternity Care - Medical Care and services provided
for treatment of the condition of pregnancy, other than
complications of pregnancy.
Maximum Plan Allowance (MPA) - Dental
The maximum amount Delta Dental will reimburse for a
covered procedure. Delta Dental establishes the MPA for
each procedure through a review of proprietary filed fee
data and actual submitted claims. MPAs are set annually
to reflect charges based on actual submitted claims from
providers in the same geographical area with similar
professional standing. The MPA may vary by the type of
contracting Dentist.
Medicaid A state program of medical aid for needy
persons established under Title XIX of the Social Security
Act of 1965, as amended.
Medical Plan T
 he Commercial Metals Company Medical
Plan.
Medical Social Services - Medical Social services
relating to the treatment of a participant’s medical
condition. Services include, but are not limited to,
assessment of the:
■■ Social and emotional factors related to the participant’s
sickness, need for care, response to treatment, and
adjustment to care, and
■■ Relationship of the participant’s medical and nursing
requirements to the home situation, financial resources,
and available community resources.
Medical-Surgical Expenses - Medical
The allowable amount for charges incurred for medically
necessary services or supplies for the care of a
participant provided the items are:
■■ Furnished by or at the direction or prescription of a
physician or other professional provider, and
139
 ■■ Not included as an inpatient hospital expense or
extended care expense under the plan.
A service or supply is furnished at the direction of a
physician or other professional provider if the service or
supply is:
glossary
■■ Provided by a person employed by the directing
physician or other professional provider,
■■ Provided at the usual place of business of the directing
physician or other professional provider, and
■■ Billed to the patient by the directing physician or other
professional provider.
An expense is considered to be incurred on the date the
service or supply is provided.
Medicare T  he program of medical care benefits provided
under Title XVIII of the Social Security Act of 1965, as
amended.
Mental Health Care - Medical Any one or more of the
following:
■■ The diagnosis or treatment of a mental disease, disorder,
or condition listed in the Diagnostic and Statistical
Manual of Mental Disorders of the American Psychiatric
Association, as revised, or any other diagnostic coding
system as used by the claim administrator, whether or
not the cause of the disease, disorder, or condition is
physical, chemical, or mental in nature or origin.
■■ The diagnosis or treatment of any symptom,
condition, disease, or disorder by a physician or other
professional provider (or by any person working under
the direction or supervision of a physician or other
professional provider) when the eligible expense is:
• Individual, group, family, or conjoint psychotherapy,
• Counseling,
• Psychoanalysis,
• Psychological testing and assessment,
• The administration or monitoring of psychotropic
drugs, or
• Hospital visits or consultations in a hospital, other
facility, or other licensed facility or unit providing the
service.
■■ Electroconvulsive treatment.
■■ Psychotropic drugs.
■■ Any of the services listed above, performed in or by a
hospital, other facility, or other licensed facility or unit
providing the service.
140
Mental Disorder - LTD, STD Any mental, emotional,
behavioral, psychological, personality, cognitive, mood
or stress-related abnormality, disorder, disturbance,
dysfunction or syndrome, regardless of cause (including
any biological or biochemical disorder or imbalance
of the brain) or the presence of physical symptoms.
Mental disorder includes, but is not limited to, bipolar
affective disorder, organic brain syndrome, schizophrenia,
psychotic illness, manic depressive illness, depression
and depressive disorders, anxiety and anxiety disorders.
Morbid Obesity - Medical A body mass index (BMI) of
greater than or equal to 40 kg/meter2 or a BMI greater
than or equal to 35 kg/meters2 with at least two of the
following co-morbid conditions that have not responded
to a maximum medical management and which are
generally expected to be reversed or improved by
bariatric treatment:
■■ Hypertension
■■ Dyslipidmia
■■ Type 2 diabetes
■■ Coronary heart disease
■■ Sleep apnea
National Drug Code (NDC) - Medical A national
classification system for the identification of drugs.
Network Benefits - Medical The benefits available under
the plan for services and supplies that are provided by a
network provider or a non-network provider if authorized
by the claim administrator.
Network Dentist - Dental A dentist who participates in
the Premier and/or PPO network and has a contractual
agreement with Delta Dental to accept the maximum
allowed charge as payment in full for a dental service.
Network Doctor - Vision A Choice Network optometrist
or ophthalmologist licensed and otherwise qualified to
practice vision care and/or provide vision care materials
who has contracted with VSP to provide vision care
services and/or vision care materials on behalf of covered
persons.
Network Facility - Medical A hospital or any other
facility or institution with which the claim administrator
has executed a written contract for the provision of care,
services, or supplies furnished within the scope of its
license for benefits available under the plan. A contracting
facility also includes a hospital or other facility located
outside the state of Texas, and with which any other Blue
Cross Plan has executed a written contract; however, any
such hospital or other facility that fails to satisfy each and
every requirement under that plan will be deemed a non-
network facility regardless of the existence of a written
contract with another Blue Cross Plan.
Network Pharmacy - Medical An independent retail
pharmacy or chain of retail pharmacies that have entered
into an agreement to provide prescription drug services
to participants under the plan.
Network Specialty Drug Pharmacy - Medical
An independent retail pharmacy or chain of retail
pharmacies that have entered into an agreement to
provide certain intramuscular injectable specialty
prescription drugs to participants under the plan.
Neurobehavioral Testing - Medical An evaluation of the
history of neurological and psychiatric difficulty, current
symptoms, current mental status, and pre-morbid history,
including the identification of problematic behavior and
the relationship between behavior and the variables
that control behavior. This may include interviews of the
individual, family, or others.
Neurocognitive Rehabilitation - Medical Services
designed to assist cognitively impaired individuals
to compensate for deficits in cognitive functioning
by rebuilding cognitive skills and/or developing
compensatory strategies and techniques.
Neurofeedback Therapy - Medical Services that
utilize operant conditioning learning procedure based on
electroencephalography (EEG) parameters, and which are
designed to result in improved mental performance and
behavior, and stabilized mood.
Neurophysiological Testing - Medical An evaluation of
the functions of the nervous system.
Neuropsychological Testing - Medical The
administering of a comprehensive battery of tests to
evaluate neurocognitive, behavioral, and emotional
strengths and weaknesses and their relationship to
normal and abnormal central nervous system functioning.
Non-Network Benefits - Medical The benefits available
under the plan for services and supplies that are provided
by a non-network provider.
Non-Network Dentist - Dental Non-Network Dentist
– Dental A Dentist who is neither a Premier nor a PPO
Dentist and who is not contractually bound to abide by
Delta Dental’s administrative guidelines.
Non-Network Facility - Medical A hospital or any
glossary
other facility or institution that has not executed a written
contract with the claim administrator for the provision of
services or supplies for which benefits are provided under
the plan. Also, a hospital or any other facility or institution
that has an expired or canceled contract with the claim
administrator.
Non-Network Pharmacy - Medical A retail pharmacy
that has not entered into an agreement to provide
prescription drug services to participants under the plan.
Non-Network Provider - Medical A hospital, physician,
or other provider who has not entered into an agreement
with the claim administrator (or other participating Blue
Cross and/or Blue Shield plan) as a network provider.
Non-Network Provider - Vision Any optometrist,
optician, ophthalmologist, or other licensed and qualified
vision care provider who has not contracted with VSP to
provide vision care services and/or vision care materials
to covered persons.
Non-preferred Brand Name Drug - Medical A brand
name drug that does not appear on the preferred brand
name drug list.
Other Limited Conditions - LTD Chronic fatigue
conditions (such as chronic fatigue syndrome, chronic
fatigue immunodeficiency syndrome, post viral
syndrome, limbic encephalopathy, Epstein-Barr virus
infection, herpes virus type 6 infection, or myalgic
encephalomyelitis), any allergy or sensitivity to chemicals
or the environment (such as environmental allergies,
sick building syndrome, multiple chemical sensitivity
syndrome or chronic toxic encephalopathy), chronic
pain conditions (such as fibromyalgia, reflex sympathetic
dystrophy or myofascial pain), carpal tunnel or repetitive
motion syndrome, temporomandibular joint disorder,
or craniomandibular joint disorder. However, other
limited conditions does not include neoplastic diseases,
neurologic diseases, endocrine diseases, hematologic
diseases, asthma, allergy-induced reactive lung disease,
tumors, malignancies, or vascular malformations,
demyelinating diseases, or lupus.
Other Provider - Medical
A person or entity, other than a hospital or physician,
that is licensed where required to furnish to a participant
a service or supply for which charges are considered
eligible expenses under the plan. Other providers include:
141
 ■■ Other Facility – an institution or entity only as listed:
• Chemical dependency treatment center
• Crisis stabilization unit or facility
• Durable medical equipment provider
• Home health agency
• Home infusion therapy provider
glossary
• Hospice
• Imaging center
• Independent laboratory
• Prosthetics/orthotics provider
• Psychiatric day treatment facility
• Renal dialysis center
• Residential treatment center for children and
adolescents
• Skilled nursing facility
• Therapeutic center
■■ Other Professional Provider – a person or practitioner,
when acting within the scope of his/her license and
who is appropriately certified, only as listed:
• Advanced practice nurse
• Doctor of chiropractic
• Doctor of dentistry
• Doctor of optometry
• Doctor of podiatry
• Doctor of psychology
• Licensed audiologist
• Licensed chemical dependency counselor
• Licensed dietitian
• Licensed hearing instrument fitter and dispenser
• Licensed marriage and family therapist
• Licensed clinical social worker
• Licensed occupational therapist
• Licensed physical therapist
• Licensed professional counselor
• Licensed speech-language pathologist
• Licensed surgical assistant
• Licensed/certified nurse-midwife
• Nurse first assistant
• Orthoptic technician
• Physician assistant
• Psychological associates who work under the
supervision of a doctor in psychology
In states where there is a licensure requirement, other
providers must be licensed by the appropriate state
administrative agency.
142
Own Occupation - LTD, STD Any employment,
business, trade, profession, calling or vocation that
involves material duties of the same general character
as the occupation you are regularly performing for your
Employer when Disability begins. In determining your own
occupation, The Standard is not limited to looking at the
way you perform your job for your employer, but may also
look at the way the occupation is generally performed in
the national economy. If your own occupation involves the
rendering of professional services and you are required
to have a professional or occupational license in order to
work, your own occupation is as broad as the scope of
your license.
Parent - Medical, Dental A person who covers a child
as a dependent under a plan.
Participant - Medical An employee or dependent who is
covered under the plan.
Passenger - AD&D An individual other than a pilot,
operator or crew member who is riding in or on, boarding,
or dismounting from a public conveyance.
Pharmacy - Medical A state and federally licensed
establishment where the practice of pharmacy occurs,
that is physically separate and apart from any provider’s
office, and where legend drugs and devices are
dispensed under prescriptions to the general public by a
pharmacist licensed to dispense those drugs and devices
under the laws of the state in which he/she practices.
Physical Disease – LTD, STD Entity or process that
produces structural or functional changes in the body as
diagnosed by a physician.
Physician – AD&D, Life A person who is:
■■ Licensed to practice medicine and is practicing within
the terms of his/her license, or
■■ A licensed practitioner of the healing arts in a category
specifically favored under the health insurance laws
of the state where the treatment is received and is
practicing within the terms of his/her license.
A physician does not include a covered person or any
member of his/her family.
Physician - BTA Refers to:
■■ A person licensed to practice medicine in the
jurisdiction where the medical services are performed,
or
■■ Any other person whose services, according to
applicable law, must be treated as physician’s services
for purposes of the plan. The person must be licensed
in the jurisdiction where the service is performed and
must act within the scope of that license. The person
must also be certified and/or registered if required in
his/her jurisdiction.
Physician does not include the covered employee, his/
her spouse, or any member of the covered employee’s
immediate family including his/her or his/her spouse’s
parents, children (natural, step or adopted), siblings,
grandparents, or grandchildren.
Physician - Dental Refers to:
■■ A person licensed to practice medicine in the
jurisdiction where the services are performed, or
■■ Any other person whose services, according to
applicable law, must be treated as physician’s services
for purposes of the plan. The person must be licensed
in the jurisdiction where the service is performed and
must act within the scope of that license. The person
must also be certified and/or registered if required by
the applicable jurisdiction.
A physician does not include the covered person, his/
her spouse or any member of the covered person’s
immediate family including his/her or his/her spouse’s
parents, children (natural or adopted), siblings,
grandparents, or grandchildren.
Physician - LTD, STD A licensed M.D. or D.O., acting
within the scope of the license. Physician does not
include you or your spouse, or the brother, sister, parent,
or child of either you or your spouse.
Physician - Medical A person, when acting within the
scope of his/her license, who is a doctor of medicine or a
doctor of osteopathy.
Plan - this Commercial Metals Company Welfare Benefit
Plan.
Plan - Dental Coordination of Benefits Provision Any
of the following that provides benefits or services for an
allowable expense: a group insurance plan; an HMO; a
blanket plan; uninsured arrangements of group or group
type coverage; a group practice plan; a group service
plan; a group prepayment plan; any other plan that covers
people as a group; motor vehicle no fault coverage if
the coverage is required by law; and any other coverage
required or provided by any law or any governmental
program, except Medicaid.
The term does not include any of the following: individual
or family insurance or subscriber contracts; individual
or family coverage through closed panel plans or other
prepayment, group practice or individual practice plans;
hospital indemnity coverage; a school blanket plan that
provides only accident-type coverage on a 24-hour basis,
or a “to and from school basis” to students in a grammar
school, high school or college; disability income protection
coverage; accident only coverage; specified disease or
glossary
specified accident coverage; nursing home or long term
care coverage; or any government program or coverage if,
by state or federal law, its benefits are excess to those of
any private insurance plan or other non-government plan.
Post-acute Transition Services - Medical Services
that facilitate the continuation of care beyond the initial
neurological trauma through rehabilitation and community
reintegration.
Plan Administrator - Commercial Metals Company
Preferred Provider Organization (PPO) Dentist -
Dental A contracting Delta Dental Dentist who agrees
to accept Delta Dental’s PPO Dentist’s Fees as payment
in full and to comply with Delta Dental’s administrative
guidelines. All PPO Dentists are also Delta Dental Premier
Dentists. All PPO Dentists must be contracted in the Delta
Dental Premier network.
Predisability Earnings - LTD
■■ Mileage-paid Truck drivers: If you are a mileage-paid
truck driver with 1 or more calendar years of service,
predisability earnings means your average monthly
earnings from your Employer for the prior calendar
year of your employment. Any change in your earnings
after your last full day of active work will not affect your
predisability earnings.
If you are a mileage-paid truck driver with less than
1 calendar year of service, your monthly predisability
earnings means $30,000 divided by 12 (provided your
prior year earnings were less than $30,000).
For a mileage-paid truck driver with 1 or more calendar
years of service, predisability earnings includes vacation
pay, holiday pay, funeral leave, jury duty, short term
disability, and earnings under the following pay codes:
1060 Trucking other-Joist
1262 Trucking-Back Haul
1265 Trucking-Driver Meeting
1267 Trucking-Driver Misc.
1266 Trucking-Driver Training
1260 Trucking-Mileage Pay
1261 Trucking-Pay By Load
1263 Trucking-T & E
1264 Trucking-Tarping Trucks
1268 Trucking-Trucking Bonus
143
 ■■ All other members: your Predisability Earnings will be
based on your annualized base rate of pay in effect
on your last full day of Active Work. Any subsequent
change in your earnings after that last full day of Active
Work will not affect your Predisability Earnings.
glossary
Predisability Earnings means your annual base pay, as
defined by your Employer, divided by 12, including:
1. Contributions you make through a salary reduction
agreement with your Employer to:
a. An Internal Revenue Code (IRC Section
401(k), 403(b), 408(k), 408(p), or 457 deferred
compensation arrangement; or
b. An executive nonqualified deferred compensation
arrangement.
2. Amounts contributed to your fringe benefits
according to a salary reduction agreement under an
IRC Section 125 plan.
3. Average monthly commissions in the prior calendar
year (if total commissions were equal to or more than
25% of your annual base pay in the prior calendar
year). For a mileage-paid truck driver, amounts
calculated by CMC in recognition of a number of
components including mileage and load hauled. The
amounts are divided by 12 to reflect the monthly
average for LTD benefit calculation purposes.
Predisability Earnings does not include:
1. Bonuses.
2. Commissions (if less than 25% of your total annual
base pay in the prior calendar year).
3. Overtime pay.
4. Shift differential pay.
5. Profit sharing
6. Performance pay
7. Stock options or stock bonuses.
8. Your Employer’s contributions on your behalf to any
deferred compensation arrangement or pension
plan.
9. Any other extra compensation.
If you are paid on an annual contract basis, your monthly
rate of earnings is one-twelfth (1/12th) of your annual
contract salary.
144
■■ If you are paid hourly, your monthly rate of earnings is
based on your hourly pay rate multiplied by 2080 and
divided by 12. If you do not have regular work hours,
your monthly rate of earnings is based on the average
number of hours you worked per month during the
preceding 12 calendar months (or during your period of
employment if less than 12 months), but not more than
173 hours.
Predisability Earnings - STD
Mileage-paid Truck drivers: If you are a Mileage-paid
Truck Driver with 1 or more calendar years of service,
your weekly predisability earnings means 1/52 of your
earnings from your employer for the prior calendar year.
Any change in your earnings after your last full day of
active work will not affect your predisability earnings.
If you are a mileage-paid truck driver with less than
1 calendar year of service, your weekly predisability
earnings means 1/52 of $30,000.
For a mileage-paid truck driver with 1 or more calendar
years of Service, predisability earnings includes vacation
pay, holiday pay, funeral leave, jury duty, short term
disability, and earnings under the following pay codes:
1060 Trucking other-Joist
1262 Trucking-Back Haul
1265 Trucking-Driver Meeting
1267 Trucking-Driver Misc.
1266 Trucking-Driver Training
1260 Trucking-Mileage Pay
1261 Trucking-Pay By Load
1263 Trucking-T & E
1264 Trucking-Tarping Trucks
1268 Trucking-Trucking Bonus
■■ All other members: your Predisability Earnings will be
based on your earnings in effect on your last full day of
Active Work. Any subsequent change in your earnings
after that last full day of Active Work will not affect your
Predisability Earnings.
Predisability Earnings means your annual base pay, as
defined by your Employer, divided by 52, including:
1. Contributions you make through a salary reduction
agreement with your Employer to:
a. An Internal Revenue Code (IRC) Section
401(k), 403(b), 408(k), 408(p), or 457 deferred
compensation arrangement; or
b. An executive nonqualified deferred compensation
arrangement.
2. Amounts contributed to your fringe benefits
according to a salary reduction agreement under an
IRC Section 125 plan.
 3. Average weekly commissions received in the prior
calendar year (if total commissions were equal to or
more than 25% of your annual base pay in the prior
calendar year).
Predisability Earnings does not include:
1. Bonuses.
2. Commissions (if less than 25% of your total annual
base pay in the prior calendar year).
3. Overtime pay.
4. Shift differential pay.
5. Profit sharing
6. Performance pay
7. Stock options or stock bonuses.
8. Your Employer’s contributions on your behalf to any
deferred compensation arrangement or pension
plan.
9. Any other extra compensation.
If you are paid on an annual contract basis, your weekly
rate of earnings is one fifty-second (1/52nd) of your
annual contract salary.
If you are paid hourly, your weekly rate of earnings is
based on your hourly pay rate multiplied the number of
hours you are regularly scheduled to work per week,
but not more than 40 hours. If you do not have regular
work hours, your weekly rate of earnings is based on
the average number of hours you worked per week
during the preceding 52 weeks (or during your period of
employment if less than 52 weeks), but not more than 40
hours.
Preferred Brand Name Drug - Medical A brand name
drug that appears on the preferred brand name drug list.
Pregnancy - LTD, STD Your pregnancy, childbirth, or
related medical conditions, including complications of
pregnancy.
Premier Dentist - Dental A Dentist who contracts with
Delta Dental or any other member company of the Delta
Dental Plans Association and who agrees to abide by
certain administrative guidelines. Not all Premier Dentists
are PPO Dentists; however, all Premier Dentists agree to
accept Delta Dental’s Maximum Plan Allowance for each
Single Procedure as payment in full.
Prescription - Medical A written or verbal order from a
physician or other professional provider to a pharmacist
for a drug or device to be dispensed. Prescriptions
written by physicians or other professional providers
located outside the United States to be dispensed in the
United States are not covered under the plan.
Prosthetic Appliances - Medical Artificial devices
including limbs or eyes, braces or similar prosthetic or
orthopedic devices, that replace all or part of an absent
body organ (including contiguous tissue) or replace all
or part of the function of a permanently inoperative or
malfunctioning body organ (excluding dental appliances
glossary
and the replacement of cataract lenses). For purposes
of this definition, a wig or hairpiece is not considered a
prosthetic appliance.
Prosthetics/Orthotics Provider - Medical A certified
prosthetist that supplies both standard and customized
prostheses and orthotic supplies.
Provider - Medical A hospital, physician, other provider,
or any other person, company, or institution furnishing a
service or supply that is covered under the plan.
Psychiatric Day Treatment Facility - Medical An
institution that is appropriately licensed and is accredited
by the Joint Commission on Accreditation of Healthcare
Organizations as a psychiatric day treatment facility for
the provision of mental health care and serious mental
illness services to participants for periods of time not to
exceed eight hours in any 24-hour period. Any treatment
in a psychiatric day treatment facility must be certified
in writing by the attending physician to be in lieu of
hospitalization.
Psychophysiological Testing - Medical An evaluation
of the interrelationships between the nervous system and
other bodily organs and behavior.
Regular Attendance - STD An employee’s personal
visits to a physician that are medically necessary
according to generally accepted medical standards to
effectively manage and treat the employee’s disability or
partial disability.
Remediation - Medical The process(es) of restoring or
improving a specific function.
Renal Dialysis Center - Medical A facility that is
Medicare certified as an end-stage renal disease facility
providing staff assisted dialysis and training for home and
self-dialysis.
Residential Treatment Center for Children and
Adolescents - Medical A child-care institution that
is appropriately licensed and accredited by the Joint
Commission on Accreditation of Healthcare Organizations
or the American Association of Psychiatric Services for
Children as a residential treatment center for the provision
of mental health care and serious mental illness services
for emotionally disturbed children and adolescents.
145
 Retirement Benefit under a Retirement Plan - LTD
Money that:
■■ Is payable under a retirement plan either in a lump sum
or in the form of periodic payments,
■■ Does not represent contributions made by an employee
glossary
(payments that represent employee contributions are
deemed to be received over the employee’s expected
remaining life regardless of when the payments are
actually received), and
■■ Is payable upon:
• Early or normal retirement, or
• Disability, if the payment reduces the amount of
money that would have been paid under the plan at
the normal retirement age.
Retirement Plan - LTD, STD A plan that provides
retirement benefits to employees and which is not funded
wholly by employee contributions. A retirement plan
does not include a profit-sharing plan, informal salary
continuation plan, registered retirement savings plan,
stock ownership plan, 401(K) or a non-qualified plan of
deferred compensation.
Riot - AD&D, STD All forms of public violence, disorder or
disturbance of the public peace by three or more persons
assembled together, whether or not acting with a common
intent and whether or not damage to persons or property
or unlawful act or acts is the intent or the consequence
of the disorder. Participation in a riot includes promoting,
inciting, conspiring to promote or incite, aiding, abetting,
and all forms of taking part in, but does not include actions
taken in defense of public or private property, or actions
taken in defense of the covered person, if the actions of
defense are not taken against persons seeking to maintain
or restore law and order including, but not limited to, police
officers and fire fighters.
Seat Belt - AD&D A combination lap and shoulder
restraint system that meets the Federal Vehicle Safety
Standards of the National Highway Traffic Safety
Administration and is installed by the manufacturer. A seat
belt will include a lap belt alone, but only if the automobile
did not have a combination lap and shoulder restraint
system when manufactured. Seat belt does not include a
shoulder restraint alone.
Seat Belt - BTA
Any non-inflatable restraint device that:
■■ Meets published United States Government safety
standards,
■■ Is properly installed, and
■■ Is not altered after the installation.
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A seat belt includes any child restraint device that meets
the requirements of state law.
Sickness - AD&D, Life Disease or illness including related
conditions and recurrent symptoms of the sickness.
Sickness also includes pregnancy.
Sickness - STD Illness, physical disease, mental
disorder, pregnancy or complications of pregnancy.
Skilled Nursing Facility - Medical A facility that is
primarily engaged in providing skilled nursing services
and other therapeutic services and which is:
■■ Licensed in accordance with state law (where state law
provides for licensing of such facility), or
■■ Medicare or Medicaid eligible as a supplier of skilled
inpatient nursing care.
Specialty Care Provider - Medical A physician or other
professional provider who has entered into an agreement
with the claim administrator (and in some instances with
other participating Blue Cross and/or Blue Shield plans)
to participate as a managed care provider of specialty
services.
Specialty Drugs - Medical Legend drugs that are
unique high cost medications which may be given by
any route of administration, benefit a limited patient
population, and typically require complex dispensing
techniques, delivery procedures and/or patient education
and support. A list of these drugs may be obtained by
contacting the Customer Service Helpline. The list is
reviewed periodically and is subject to change.
Substance Abuse - LTD Use of alcohol, alcoholism, use
of any drug, including hallucinogens, or drug addiction.
Terrorist Act - BTA A politically- or socially-motivated
act of violence carried out by an individual or group of
persons who may or may not be operating on behalf of
a sovereign state with the intent of changing political or
social policy. A terrorist act does not include any act of
violence carried out by a branch of the armed forces of a
sovereign state.
Therapeutic Center - Medical An institution that is
appropriately licensed, certified, or approved by the state
in which it is located and which is one of the following:
■■ An ambulatory (day) surgery facility.
■■ A freestanding radiation therapy center.
■■ A freestanding birthing center.
Treatment - STD Consulting, receiving care or services
provided by or under the direction of a physician including
diagnostic measures, being prescribed drugs and/or
medicines (whether the patient chooses to take them or
not), and taking drugs and/or medicines.

USERRA - the Uniformed Services Employment and

Reemployment Rights Act of 1994.

Violent Disorder - LTD Voluntarily placing yourself (and

actively participating) in a situation highly likely to result in
injury.

How Vision Plan - The Commercial Metals Company

Vision Plan.

Visually Necessary or Appropriate - Vision Services

and materials medically or visually necessary to restore or
maintain a patient’s visual acuity and health and for which
there is no less expensive professionally acceptable
alternative.

Work Earnings - LTD, STD Earnings from your Employer,

any other employer, or self‑employment, and any sick
pay, vacation pay, annual or personal leave pay or other
salary continuation earned or accrued while working.
Earnings from work you perform will be included in work
earnings when you have the right to receive them. If you
are paid in a lump sum or on a basis other than monthly,
The Standard will prorate your work earnings over the
period of time to which they apply. If no period of time is
stated, a reasonable one will be used.

If earnings vary substantially from month to month, work

earnings may be determined by averaging your earnings
over the most recent three-month period.

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CMC SPD 2013