Convalescent Nursing Home Expense Benefit Following Hospitalization
This coverage provides benefits for a covered convalescent nursing home confinement starting within fifteen days after you or a covered dependent have had a hospital stay of at least three days that was covered by this Retiree Plan. The confinement must be recommended by your doctor for the condition causing the hospitalization.

The Plan will pay 70% after the deductible of the daily Medicare co-insurance amount. This covers room, board and other services and supplies furnished by the home for necessary care. The patient must be under continuous care of his or her doctor and require 24-hour nursing care. Personal items and professional services such as private duty nursing are excluded.

Benefits for Convalescent Nursing Home Expenses are limited to 60 days for all care due to the same or related causes.

Home Health Care Benefit
The Plan will pay covered charges for home health care that is provided as part of a Home Health Care Treatment Plan to treat an illness or injury. The Home Health Care Benefit pays 20% of eligible expenses listed below for services and supplies furnished by a Home Health Care Agency. The benefits are subject to the following conditions:

• The patient is under the care of a doctor who submits a “home health care plan”. A “Home Health Care Threatment Plan” is a written program for care and treatment in the patient’s home; and
• The services and supplies are furnished while, if it were not for the home health care, inpatient confinement in a hospital, convalescent nursing home or skilled nursing facility would be required.

The eligible expenses are the Home Health Care Agency’s charges for the following services and supplies ordered by the doctor under the home health care plan and furnished in the patient’s home:

• Part-time or intermittent nursing provided or supervised by a Registered Nurse (R.N.).
• Part-time or intermittent home health aide services, primarily for the patient’s care.
• Physical, occupational, speech or respiratory therapy by a qualified therapist.
• Nutrition counseling provided by or under the supervision of a registered dietitian.
• Medical supplies, laboratory services, drugs and medications prescribed by a doctor.

Home Health Care benefits are limited to 130 visits, per person, in a calendar year. Each visit by a representative of a home health care agency, other than a home health aide, shall be counted as one visit. In the case of visits by home health aides, each visit lasting four hours or less is counted as one visit. If a visit exceeds four hours, each four hours or fraction thereof is counted as a separate visit.

Note: Payments made under this benefit will be applied to your Medical Maximum.

Hospice Care Benefit
Benefits are payable for hospice care for a terminally ill person. Under a hospice care program, treatment is normally rendered in the patient’s home. It offers a less expensive, and often more humane alternative to hospital confinement for the terminally ill. This benefit also provides for some of the needs of the other family members.

This coverage pays benefits for charges incurred for a terminally ill person while in a hospice care program. Certification of the terminal illness must be given to the Area Administrative Office in order for hospice coverage for a terminally ill person to be considered.

The benefits will be paid if the hospice services or the hospice stay is:

• Provided while the terminally ill person is an eligible individual;
• Ordered by the attending physician as part of the hospice care program;
• Charged by the hospice care program; and
• Provided within 6 months of the terminally ill person’s entry or re-entry (after a remission period) in the hospice care program.

The coverage will pay 20% of the charges incurred for all hospice services for one period of care in the hospice care program up to the Maximum Hospice Benefit of $5,000.

Bereavement Benefits for Families of Those in a Hospice Program
This part of the Hospice Care Benefit provides benefits for charges incurred for counseling services for the family unit (a retiree and any covered dependents), if ordered and received under the hospice care program.

The benefits will be paid if:

• On the day prior to death the terminally ill person was in the hospice care program;
• The person seeking bereavement benefits is a member of the family unit and a covered individual; and
• The charges are incurred by the family unit within three months following the date the terminally ill person dies.

The coverage will pay 20% of the charges up to the Maximum Bereavement Benefit Per Family Unit of $200.