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SUMMARY PLAN DESCRIPTION

mastectomy, including lymphedemas. This coverage will be provided in a manner
determined in consultation with the attending physician and the patient, subject to the
Fund’s general provisions relating to benefits, precertification and other applicable
limitations. This coverage is also subject to the Fund’s annual deductibles and
coinsurance provisions. If you have any questions about these coverages, please
contact the Fund Office.

BENEFITS FOR MOTHERS AND NEWBORN

Under federal and state law, when you or your dependent spouse enter
the hospital to give birth, the Fund will provide benefits for a hospital stay of at least
forty-eight (48) hours following birth if the birth is a normal vaginal delivery. The Fund
will provide benefits for a hospital stay of at least ninety-six (96) hours following birth if
the birth is by caesarian section. You will still be responsible for any deductibles or
copayments required under the Independence Blue Cross plan you have selected.

The Fund may provide benefits for a shorter stay if your attending
provider, in consultation with you, decides to discharge you earlier than 48 (or 96) hours after you give birth. You may, of course, elect to leave the hospital earlier than 48 or 96 hours after birth.

The Fund (as well as any insurance provider): - cannot deny you or your
child eligibility to enroll or to continue coverage under this Plan to avoid paying for the
hospital stays described above; - cannot give you or your attending provider any
financial or other incentives to encourage you to accept a shorter stay in the hospital
than the stays described above; - cannot limit the amount it pays your attending
provider because the attending provider determines that you should be in the hospital
for 48 or 96 hour periods described above; and - cannot pay lesser benefits or require
greater out-of-pocket costs for the 48 or 96 hour hospital stay for the period after birth than it pays for any hospital stay you have prior to the birth. The Fund may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to forty-eight (48) hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification.

CONTINUATION COVERAGE IF YOU TEMPORARILY SERVE
IN THE ARMED SERVICES

General. The Fund will provide continuation coverage pursuant to the
terms of the Uniformed Services Employment and Reemployment Rights Act
("USERRA"), 38 U . S . C . 4301 et seq., for all leaves while you are serving in the
uniformed services beginning on or after October 13, 1994. The Fund will provide

 

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