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. 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.

2 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. 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.

3 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., 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.

4 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 .. 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.

5 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) .. 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).

6 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. 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.

7 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.) Second surgical opinion Primary Care Physician Second surgical opinion Specialist Care Physician $100 copay per visit then 90% 90% 90% $15 copay $20 copay Please note: Pre-certification of Inpatient and Outpatient Services is required. Benefits will be reduced by 20% if Pre-certification is not obtained.

8 Emergency Care out of network included for a Medical Emergency Emergency Room Visit (Copay waived if followed by hospital admission) Urgent Care Clinic Visit $100 copay then 90% $35 copay Ambulance Services Subject to the calendar year Deductible Land / Air 90% Behavioral Health Care Inpatient: Copayment Coinsurance Hospital Inpatient / Halfway House days per calendar year (combined maximum) Physician Hospital services days per calendar year Halfway House subject to calendar year Deductible Partial Hospitalization: subject to calendar year Deductible Maximum days per Calendar Year Outpatient: Copayment Maximum visits per calendar year $200 per admission 90% 30 30 90% 90% 60 $35 60 ii ThyssenKrupp Elevator Salaried EPO Summary of Benefits In-Network Substance Abuse Detoxification and Rehabilitation Inpatient: detoxification / rehabilitation Copayment Coinsurance Days per calendar year Physician Inpatient subject ot calendar year Deductible Days per calendar year Outpatient: Copayment Detoxification / rehabilitation combined maximum visits per calendar year $200 per admission 90% 30 90% 30 $35 30 Diagnostic Services in the Physician s Office Diagnostic services may be performed by a Primary Care Physician or Specialist Physician.

9 Primary Care Physician Copayment Specialist Physician Copayment Diagnostic X-ray and Lab Injections for the Treatment of a Specific, Non-Chronic Medical Condition Second Surgical Opinion Treatment of Accidental Injury Diagnostic Services in Freestanding Facility Independent Lab physician sends specimen to lab Independent Lab patient goes to Lab subject to the calendar year Deductible Imaging / X-ray Center subject to the calendar year Deductible $15 $20 100% 90% 90% iii ThyssenKrupp Elevator Salaried EPO Summary of Benefits In-Network Preventive Care in the Physician s Office Preventive services may be performed by a Physician or Specialist Physician In-Network: Primary Care Physician Copayment Specialist Physician Copayment For Frequency parameters, see Preventive Care under the Benefits Section Preventive Services for Children Age 18 and Under Services include, but are not limited to: Age appropriate periodic health assessments Development assessment of the child Age appropriate immunizations Preventive x-ray and laboratory testing Hearing evaluation / audiometric exam Preventive Services for Adults Services include, but are not limited to: Periodic health assessments.

10 Physical exam limited to one per calendar year Immunizations Flu Injections Osteoporosis Screening Hearing evaluation / audiometric exam Preventive Services for Women Annual Gynecological Exam limited to one per calendar year Mammography (appropriate office visit copayment applies whether in the physician s office, independent/freestanding facility or outpatient hospital) Preventive Mammogram Frequency: One baseline screening for ages 35-39 years; one screening every 24 months for ages 40-49 years; one screening every 12 months for ages 50 years and older. Pap Smear limited to one per calendar year Chlamydia Screening, one per calendar year Colorectal Screening Preventive Services for Men Prostate Screening for men aged 40-75 Colorectal Screening Preventive Services in Freestanding Facility Independent Lab physician sends specimen to lab Independent Lab patient goes to lab Imaging / x-ray Center subject to the calendar year Deductible Plan pays 100% after the Copayment $15 $20 100% 90% after Deductible 90% after Deductible iv ThyssenKrupp Elevator Salaried EPO Summary of Benefits In-Network Other Covered Services: Office Surgery subject to the calendar year Deductible Primary Care or Specialist Physician 90% Home Health Care Services- subject to calendar year Deductible Visits per calendar year (combined in and out of network) 90% 60 Maternity Care Physician s office.