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UNISYS

UNISYS SELF-INSURED MANAGED-CARE OPTION FOR UNISYS PARTICIPANTS IN DESIGNATED GEOGRAPHIC LOCATIONS January 2001 Supplement to the Summary Plan Description for Medical Plans Sponsored by UNISYS ABOUT THIS SUPPLEMENT This supplement describes the benefits provided through the self-insured managed-care medical options made available in designated geographic locations to eligible UNISYS employees, eligible former UNISYS employees and their eligible dependents. This supplement amends the Summary Plan Description (SPD) booklet referenced below, that applies to you based on your employment status.

ABOUT THIS SUPPLEMENT This supplement describes the benefits provided through the self-insured managed-care medical options made available in designated geographic locations to eligible Unisys employees, eligible former Unisys

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1 UNISYS SELF-INSURED MANAGED-CARE OPTION FOR UNISYS PARTICIPANTS IN DESIGNATED GEOGRAPHIC LOCATIONS January 2001 Supplement to the Summary Plan Description for Medical Plans Sponsored by UNISYS ABOUT THIS SUPPLEMENT This supplement describes the benefits provided through the self-insured managed-care medical options made available in designated geographic locations to eligible UNISYS employees, eligible former UNISYS employees and their eligible dependents. This supplement amends the Summary Plan Description (SPD) booklet referenced below, that applies to you based on your employment status.

2 For active employees eligible to participate in the UNISYS Flexible benefits Program SPD for health and welfare benefits , including amendments as may be made from time to time. For eligible retired or disabled former employees SPD for the UNISYS Post-Retirement and Extended Disability Medical Plan (PRM Plan), including amendments as may be made from time to time. Except where otherwise noted, this supplement modifies only the medical plan provisions for covered/non-covered services and administrative procedures reflected in your SPD.

3 Refer to your SPD for general information on eligibility, enrollment, changing your medical elections, when coverage begins and ends, and other important information, including the additional information section. Throughout this supplement, you generally refers to covered employees, covered former employees and covered dependents. The term you also is interchangeable, depending on the context of the sentence, with an eligible employee, eligible former employee or an eligible dependent. Retiree generally refers to UNISYS retirees or disabled former UNISYS employees and their covered dependents.

4 Keep this supplement handy as an ongoing reference. This supplement, your SPD, and any amendments constitute your health plan documents. This supplement contains Plan provisions as of January 1, 2001, unless otherwise noted. FOR QUICK REFERENCE, KEEP THESE NUMBERS HANDY Your primary care physician or clinic (PCP) your first contact for all of your health-care needs (does not apply to SelectAdvantage for services on or after July 1, 2001) (Fill in the name and telephone number above) Member Services general information regarding the Plan help you identify network providers respond to inquiries on claims For Aetna, HealthPartners and Medica Self-Insured members, also use these numbers to.

5 Report treatment for a medical emergency within 24 hours of treatment; also contact your PCP/PCC precertify services Aetna Healthcare Members: 1-800-238-3488 HealthPartners Members: 952-883-5000 in the Minneapolis/St. Paul metro area 1-800-883-2177 To report a medical emergency or urgent medical need after clinic daytime operating hours 612-339-3663 in the Minneapolis/St. Paul metro area 1-800-551-0859 outside the metro area Medica Self-Insured Members: 1-800-962-9497 952-992-3190 or 1-800-841-6753 for TTY connections for the hearing impaired To report a medical emergency or urgent medical need after clinic daytime operating hours call your PCC after-hours telephone number United Behavioral Health (UBH) for treatment of mental-health or substance abuse disorders 1-800-848-8327 SelectAdvantage Members, through June 30, 2001.

6 1-248-637-6777 1-888-302-0767 For treatment of mental-health or substance abuse disorders 1-800-888-9037 SelectAdvantage Members, on and after July 1, 2001: 1-800-521-1321 Self-Insured HMO 2001 i CONTENTS How the Plan NETWORK Your Primary Care Physician (PCP) for Aetna Your Primary Care Clinic (PCC) for HealthPartners and Medica Your Primary Care Physician (PCP) for Role of your Selecting your Changing your PCP/PCC **..9 Network Specialists ..9 IF YOUR PHYSICIAN OR CLINIC LEAVES THE WHAT TO DO FOR A MEDICAL EMERGENCY OR AN URGENT MEDICAL WHAT TO DO IF YOU OR YOUR DEPENDENT IS OUTSIDE THE SERVICE AREA WHEN MEDICAL CARE IS Aetna Healthcare Cost-Sharing HealthPartners Cost-Sharing Medica Self-Insured Cost-Sharing SelectAdvantage Cost-Sharing EMERGENCY NON-EMERGENCY Covered Special How to File a INFORMATION NEEDED FOR A ADDRESS FOR CLAIMS SOME EXPENSES ARE NOT FILING DELAYED RIGHT TO RECOVER EXCESS Complaint and Appeals

7 REGISTERING A COMPLAINT OR DISAGREEMENT WITH A APPEALS OF PRECERTIFICATION Additional Information About the RIGHT TO RECEIVE AND RELEASE NEEDED RIGHT TO DEVELOP ACCESS TO RECORDS AND AMENDMENTS TO THIS CASE EXTENSION OF INTRODUCTION Self-Insured HMO 2001 1 INTRODUCTION INTRODUCTION 2 Self-Insured Managed-Care Option 2001 INTRODUCTION UNISYS offers this self-insured managed-care option in designated geographic locations to eligible UNISYS employees, former employees, and their dependents. Under a fully-insured plan, UNISYS pays fixed monthly premiums set by the plan.

8 The plans bear the risk that expenses will not exceed the premiums collected. The premiums include projected benefit payments, state insurance taxes, administrative costs, and a profit margin. The benefits provided under the plan are subject to mandates specific to the states in which they operate. Under a self-insured plan, UNISYS makes benefit payments as services occur, including a fee for the use of the third-party administrator s network and the third-party administrator s services noted below. Costs are variable rather than fixed because UNISYS , not the plans, bears the risk of volatility of expenses.

9 State insurance taxes and state mandates do not apply. Instead, the plan is subject to the federal Employee Retirement Income Security Act. UNISYS has contracted with the following third-party administrators (TPAs) for claims processing, precertification, utilization review, member services, grievance resolution, and a provider network under the Plan. Use the group number noted below when asking questions about benefits under the Plan. Third-party administrators (TPAs) Group ID Number active employees and their covered dependents Group ID number retired or disabled former employees and their covered dependents or survivors Aetna Healthcare #00176C #00176C NOT eligible for Medicare HealthPartners Administrators, Inc.

10 (owner: HealthPartners, Inc.) #3493 #3493 Medica Self-Insured (MSI) #45935 non-bargaining #45936 bargaining #45936 bargaining to age 65 #45937 non-bargaining NOT eligible for Medicare #45938 non-bargaining eligible for Medicare SelectCare Systems Corporation through 6/30/01 (product: SelectAdvantage) Select Advantage on and after 7/01/01 PPOM networks ABS third-party administrator #095625-0001 #095625-0002 COBRA #095625-0004 NOT eligible for Medicare #095625-0003 eligible for Medicare Each third-party administrator.


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