ThyssenKrupp Elevator Corporation - e*source

1 SUMMARY PLAN DESCRIPTION BOOKLET For ThyssenKrupp Elevator Corporation EPO - Salaried Effective 4/1/09 NOTICE ThyssenKrupp Elevator Corporation is pleased to provide a comprehensive Medical and Prescription Drug Benefit Plan for its employees and their dependents. The Plan is designed to protect Plan participants against certain health care expenses. This booklet constitutes the Summary Plan Description for the Medical and Prescription Drug Benefits for the Salaried EPO plan, one plan option under the ThyssenKrupp Elevator Employee Health and Welfare Plan (the Plan ). This booklet provides detailed information about medical and prescription drug benefits as of April 1, 2009.

2 We encourage you to review this booklet in detail to understand the important eligibility provisions, covered benefits and limitations of the Plan. Coverage under the Plan will take effect for an eligible Employee and/or Dependents when the Employee and/or Dependent satisfies the eligibility requirements of the Plan. Failure to follow the eligibility or enrollment requirements of this Plan may result in delay of coverage or no coverage at all. Reimbursement from the Plan may be reduced or denied because of certain provisions in the Plan, such as coordination of benefits, subrogation, exclusions, timeliness of COBRA elections, utilization review or other cost management requirements, lack of medical necessity, untimely filing of claims, or lack of coverage.

3 These provisions are explained in more detail in this booklet. The Plan will pay benefits only for the expenses incurred while this coverage is in force. No benefits are payable for expenses incurred before coverage begins or after coverage terminates, even if the expenses are incurred as a result of an accident, injury or disease that occurs, begins or exists while coverage is in force. An expense for a service or supply is incurred on the date the service or supply is furnished. ThyssenKrupp Elevator Corporation may make changes at any time and for any reason in any or all parts of the Plan including benefit coverage, deductibles, maximums, copayments, exclusions, limitations, definitions, eligibility and the like.

4 Every effort has been made to accurately describe the Plan in this SPD Booklet. However, if there is a discrepancy between this SPD Booklet and the Plan document or if the Plan is required to operate in a different manner to comply with federal laws and regulations the Plan document or the appropriate federal laws and regulations will control. Important: This is not an insured benefit Plan. The benefits described in this SPD Booklet or any rider or amendment attached hereto are self-funded by ThyssenKrupp Elevator Corporation who is responsible for their payment. Anthem Insurance Companies, Inc.

5 , and Caremark provide claims administration services for the Plan, but do not insure the benefits described. Summary of Benefits .. i Summary Notice and Important Phone Numbers .. viii Eligibility .. 1 Coverage for the Employee: .. 1 When Coverage Begins/Waiting Period: .. 1 Waiving Coverage: .. 1 Opt-Out Credit: .. 1 Late Enrollment: .. 1 Coverage for the Employee s Dependents: .. 1 Paying for Benefits .. 4 Enrollment .. 4 Initial Enrollment .. 4 Annual Open Enrollment .. 4 Changes of Elections Due to Status Change .. 4 Special Enrollment .. 6 If You Are on Disability .. 6 Family and Medical Leave .. 7 How Medical Benefits Work .. 8 Introduction.

6 8 Copayment .. 8 Calendar Year Deductible .. 8 What the Medical Plan Pays .. 8 Coinsurance and Out-of-Pocket Limit .. 8 Eligible Charges .. 8 Maximum Benefit .. 9 Using Out-of-Network Providers .. 9 Health Care Management .. 9 Clinical Guidelines .. 9 Precertification .. 9 Concurrent Review .. 11 Retrospective Review .. 12 Case Management (includes Discharge Planning) .. 13 Covered Services .. 13 Mothers and Newborns .. 22 Women s Health and Cancer Rights Act .. 22 Limitations and Exclusions .. 23 Prescription Drug Benefits .. 28 Retail Pharmacy Drug Service: .. 28 Mail Order Prescription Drug Service: .. 28 Specialty Prescription Drug Service.

7 28 Copayment: .. 29 Covered Prescription Drugs: .. 29 Expenses Not Covered: .. 29 Coordination of Benefits (COB) .. 30 Subrogation .. 32 Claims and General Information .. 33 Right to Appeal .. 35 Terms of Your Coverage .. 35 When Coverage Terminates .. 38 When Employee Coverage Terminates: .. 38 When Dependent Coverage Terminates: .. 38 Extension of Benefits Continuation During Family and Medical Leave: .. 38 If You Terminate Employment as the Result of a Layoff: .. 39 If You Terminate Employment and Are Rehired: .. 39 Employees on Military Leave: .. 39 Continuation of Coverage (Federal Law-COBRA) .. 39 Continuation of Coverage (Federal Law USERRA).

8 41 Definitions .. 43 Notice of Privacy Practices .. 54 Summary Plan Information .. 58 Responsibilities of the Plan Administrator .. 59 Rights of Plan Participants .. 60 Claims Disclosure Notice .. 61 Urgent Care .. 62 Non-Urgent Care Pre-Service (when care has not yet been received) .. 62 Concurrent Care Decisions .. 62 Non-Urgent Care Post-Service (reimbursement for cost of medical care) .. 63 Summary of Benefits In-Network All Services must be obtained by an In-network Provider (unless otherwise indicated) Maximum Benefits (All benefits combined) $1,000,000 All services and all calendar year maximums--whether for a number of days or visits, treatments or a yearly dollar limit--are subject to the Lifetime Maximum Benefit.

9 Calendar Year Deductible Individual Family All eligible Participants combined Copayments and charges in excess of the allowed amount (Eligible Charges) do not contribute to the Deductible. $200 $600 Percentage Payable (Unless Otherwise Specified) Plan Pays Participant Pays Percentage payable after the Out-of-Pocket Limit is met All payments are based on Eligible Charges and negotiated arrangements. 90% 10% 100% Out-of-Pocket Maximum Per Calendar Year (Includes Coinsurance. Does NOT include all other copayments, the Calendar Year Deductible, charges in excess of the allowed amount or Coinsurance paid toward Behavioral Health, Substance Abuse Treatment, or Bariatric Surgery) Individual Family All eligible Participants combined $1,800 $4,400 Hospital Inpatient Services Subject to the calendar year Deductible.

10 NOTE: Out-of-network hospital covered for a Medical Emergency Room and Board (Semi-Private or ICU/CCU; Private room when Medically Necessary) Hospital Services and Supplies (x-ray, lab, anesthesia, surgery, inpatient physical therapy etc.) Physician Services (surgeon, Medically Necessary assistant surgeon, anesthesiologist, radiologist, pathologist, etc.) 90% 90% 90% i ThyssenKrupp Elevator Salaried EPO Summary of Benefits In-Network Outpatient Hospital Services Facility Charges Calendar Year Deductible applies to: Outpatient lab, x-ray and anesthesia services Outpatient Physician Services (surgeon, anesthesiologist, radiologist, pathologist, etc.)