FOR UAW-FORD RETIREES

1 health CARE benefits SUMMARY. FOR. UAW-FORD RETIREES . 2018. THE FOLLOWING INFORMATION IS AN ADDENDUM TO THE SUMMARY plan . DESCRIPTION PUBLISHED IN 2015. Unless otherwise noted, the information contained in this package is effective January 1, 2018. Dear Trust Member, The goal of the UAW retiree Medical benefits Trust (the Trust ) is to provide comprehensive medical benefits to our members. Each year, we focus on managing our health plan partners and aim to provide you with the best value in terms of quality, cost, and overall customer experience. The Trust's objective is to provide you with tools to make informed decisions about your health and health care plan options. The information contained within this package should assist you in making these decisions, as well as serve you in the future to review your benefits , along with important phone numbers and websites.

2 As always, we want to remind you and your family to establish a relationship with a primary care physician and visit him or her for your wellness check-ups and annual physical. Don't forget to discuss with your physician the need for any age-related tests such as mammograms, colonoscopies, and cancer screenings. Also make sure that you are up-to-date on your immunizations and get your annual flu shot. This document, along with plenty of other useful information, is available at We continue to update our website in order to make it a valuable resource for you. You can find videos detailing the history, structure, and funding of the Trust, as well an overview of each year's benefits in video form as they are released. If you have questions about the information contained in this document, contact retiree health Care Connect (RHCC) at 866-637-7555.

3 We wish all of our members the very best and many healthy years ahead. THE TRUST PROVIDES health CARE benefits FOR ALL CURRENT AND FUTURE ELIGIBLE UAW. retiree MEMBERS OF CHRYSLER, GENERAL MOTORS, AND FORD. THE TRUST IS AN INDEPENDENT. ENTITY AND NOT ADMINISTERED BY THE AUTOS OR THE UAW. 1. health Care benefits for UAW-FORD RETIREES TABLE OF CONTENTS. Pension Deduction .. 3. Monthly Contribution .. 3. health Plans & Cost Sharing .. 4-9. Traditional Care Network (TCN) .. 6. Medicare Advantage (MA) PPO Plans .. 7. health Maintenance Organizations (HMOs) .. 8. Prescription Drugs .. 9. Medicare Part B Premium Benefit .. 10. Outpatient Physical Therapy .. 11. Vision Coverage .. 12-15. Hearing Aid Coverage .. 16-20. Dental Coverage .. 21-25. health Programs.

4 26. Additional plan Provisions .. 27. Important Contact Information .. 28-29. If you are enrolled in an HMO or Medicare Advantage plan , the Carrier for the plan will provide you with a booklet, such as an Evidence of Coverage or Certificate of Coverage that describes the detailed terms of your coverage and the rules that govern your particular plan . If you have questions about any of this information, contact retiree health Care Connect at 866-637-7555 or the Carrier of your plan . 2. health Care benefits for UAW-FORD RETIREES PENSION DEDUCTION. Trust members are required to make a monthly contribution for health care benefits . Your contribution will be deducted monthly from your pension check. Your first pension check may have deductions retroactive to your Trust effective date.

5 If you do not have sufficient funds in your pension to cover your monthly contribution, or are not receiving a pension benefit, you may contact retiree health Care Connect (RHCC) at 866-637-7555 to enroll in the direct debit option. MONTHLY CONTRIBUTION. Single* $17. Family* $34 MEMBERS. ENROLLED IN A. MEDICARE. ADVANTAGE (MA). PPO OR MA HMO. *Protected Population: Single or Family $0. plan HAVE NO. MONTHLY. CONTRIBUTION. 3. health Care benefits for UAW-FORD RETIREES health PLANS & COST SHARING. health PLANS. Your health plans and/or benefits may change as a new retiree or Surviving Spouse. Depending on your geographic location and Medicare status, you may have several plan options available to you, including the Traditional Care Network (TCN) plan , a health Maintenance Organization (HMO) plan and for Medicare participants, a Medicare Advantage (MA) plan .

6 Non-Medicare Members If you are a non-Medicare Trust member, the Traditional Care Network (TCN) plan is the base plan available to all plan members in all 50 states. However, based on your geographical location, you may have other health plan options available to you. Medicare Members If you are a Medicare-enrolled Trust member, the Medicare Advantage (MA) PPO plan is your primary plan . This means, Medicare-enrolled members are automatically enrolled in the MA. PPO plan on January 1, following the year you qualify for Medicare.* The Blue Cross Blue Shield Traditional Care Network (TCN) plan remains an option, but you will have to contact RHCC to remain in the TCN plan following your Medicare eligibility. *Certain Medicare members, such as Protected Status members and those enrolled in an HMO, will not be automatically enrolled in the MA PPO plan .

7 MANDATORY MEDICARE PART A ENROLLMENT. All Trust members who are eligible are required to have Medicare Part A to be enrolled in Trust coverage. All Trust members must enroll in Medicare Part A at age 65. If the member does not enroll, he or she will no longer be eligible for enrollment in Trust coverage. Most Trust members are automatically enrolled in Medicare Part A when they turn age 65. 4. health Care benefits for UAW-FORD RETIREES Medicare plays a significant role in providing coverage for Trust members. Trust benefits coordinate with Medicare benefits for eligible members. Trust coverage works with Medicare Part A (hospital). and Part B (Medical). If you are not enrolled in both when eligible, it could significantly impact your Trust coverage and options.

8 The Trust will automatically enroll Medicare members in Express Scripts Medicare PDP (Part D) for prescription drug coverage. For additional information regarding Trust eligibility and rules on Medicare coverage, refer to your Summary plan Description (SPD) or visit To learn more about your choices or to make plan election changes, contact retiree health Care Connect (RHCC) at 866-637-7555. COST SHARING. The assets in the Trust must be used to provide health care benefits for all current and future eligible members. The level of covered benefits is set every year after balancing the Trust's available funds with members' contributions. You will find the current cost sharing details on the next several pages. 5. health Care benefits for UAW-FORD RETIREES TRADITIONAL CARE NETWORK (TCN) COST SHARE.

9 This plan utilizes a nationwide network of doctors and facilities, and allows services to be performed both in-network and out-of-network. All Trust members are eligible for this plan both Non- Medicare and Medicare. In-Network Out-of-Network Deductible1. (The amount you pay annually $400 Single $1,000 Single before the plan begins to pay a $675 Family $1,700 Family portion of the costs). Coinsurance1. (The amount you pay after your 10% 30%. deductible is met). Out-of-Pocket Max1. (The TOTAL amount you pay $800 Single $3,000 Single annually before the plan $1,475 Family $5,550 Family pays 100% of covered costs). Non-Medicare Medicare $25 per visit for six (6) Covered by Medicare at Primary Care Physician (PCP) routine PCP visits 80%, after Part B. and Specialist Office Visit deductible is met.

10 Copays* Specialist office visits Member pays not covered remaining 20%. Urgent Care Copay*. $50. (including Retail Clinics). Emergency Room Copay $125. (waived if admitted). Copay amounts are separate from the deductible and generally do not apply towards meeting your deductible or out-of-pocket maximum. 1 Cost share does not apply to Protected Population. * Reflects in-network costs. Refer to materials from the carrier for out-of-network costs. 6. health Care benefits for UAW-FORD RETIREES MEDICARE ADVANTAGE (MA) PPO COST SHARE. Medicare Advantage (MA) PPO plans are approved by Medicare and administered by private insurance companies. They provide all of your Original Medicare Part A (hospital) and Part B. (medical) benefits , and additional benefits .