Plan #5000

Early Retirement Plan

CLASSIFICATION OF MEMBERSHIP PLAN #5000 Early Retirement Plan Secondary to United Healthcare GA46000 Eligible Retiring Employees and/or Dependents

Eligible Retiring Employees

To qualify for coverage under the Early Retirement Plan, the eligible retiring union employee must retire at age 60 or over, (but not yet 65), with thirty years or more service. Eligible retiring employees should follow the guidelines set by the Comprehensive Plan administered by United Healthcare for coverage under GA46000 prior to applying for membership in this CARE Health Plan.

Eligible retiring employees are eligible for benefits under this Plan only until he or she reaches 65 years of age. At that time, eligible retiring employees may transfer coverage over to a Medicare supplement (Plan #4000 or Plan #4100).

Eligible Dependents

Eligible dependents of early retirees are eligible for coverage under this Plan. In order for dependents to qualify for GA46000, the eligible retiring employee must apply for his/her annuity within 30 days after leaving railway company employment.

Spouses enrolled in the Early Retirement Plan are eligible for benefits under that plan ONLY until the eligible retiree reaches, or in the case of a widow (er), would have reached 65 years of age, or until the spouse becomes 65 years of age, whichever comes first. Spouses of eligible retirees who are not yet eligible for Medicare, may apply for membership in the Plan #5100 when the eligible retiree becomes 65.

The CARE Health Plan offers a secondary plan for Early Retirement Major Medical retired employees & spouses whose primary coverage is through United Healthcare Plan GA46000 only.

PLAN #5000

This supplement will reimburse you for up to $100.00 of your deductible in full for covered services with the remainder of the deductible (if applicable) being reimbursed at 20%. This plan will reimburse the member for the difference between the Amount Allowed* and the Amount Paid by the Primary carrier until the Lifetime Maximum under United Healthcare GA46000 has been reached.

* The Amount Allowed must have been considered for payment by the Primary carrier in order for CARE to consider for supplemental payment. For Precertification and Utilization Review, members in the Plan MUST follow the criteria established by United Healthcare GA46000.

If you meet the Lifetime Maximum under United Healthcare GA46000, your coverage would then transfer to Plan #5500.

Claims must be submitted as soon as possible and received by CARE NO LATER than one (1) year from the date your Primary and/or Secondary Carrier processed the claim.

Incomplete information or an incorrect mailing address WILL result in the delay of payment.