Schedule of Benefits

Benefits for Eligible Employees Only
(Not Provided for Utility Employees)

Insurance Benefits (pages 35-37)

Life Insurance - $20,000
Accidental Death & Dismemberment Insurance - $20,000

Weekly Income Benefit (pages 38-39)

Weekly Income Benefits are payable for non-occupational injuries and sicknesses only.

Amount of Weekly Benefit (effective April 1, 2006) - $400
Maximum Period that benefits are payable per period of disability - 26 weeks

Benefits start on the first day of a disability due to an accidental injury. For an illness, benefits start on the earlier of the first day of an inpatient hospital stay or the eighth day of disability.

Benefits for Eligible Employees, Retirees and Dependents

Plan payments shown are ONLY for covered medical expenses incurred by persons who are eligible for benefits and are subject to the precertification provisions and other limitations explained in this booklet.
All Plan payments, deductibles, maximums and limitations apply to each person separately except where stated otherwise.

Prescription Drug Programs (pages 54-57)

If Lineco is secondary to any other plan that provides coverage for prescription drugs, the person for whom Lineco is secondary cannot use these programs.

Drug Card Program - Your Express Scripts I.D. card enables you to purchase covered prescription drugs for you and your covered family members at local participating pharmacies for contracted prices. Contracted prices are usually lower than regular retail prices, so your total payment will generally be less than the normal

Mail Service Prescription Drug Program - The Express Scripts mail-service pharmacy will provide covered long-term or maintenance prescription drugs to eligible employees, retirees and dependents at discounted prices. You pay the following amounts for up to a 90-day supply or refill of a maintenance prescription drug obtained through the Mail Service Program. The Plan pays the rest.

Generic drugs - You pay $10 for each prescription/refill
Preferred brand name drugs - You pay $20 for each prescription/refill
Non-preferred brand name drugs - You pay $35 for each prescription/refill

If you choose a brand name drug when a generic equivalent is available, you must pay $10 plus the difference in cost between the brand name drug and its generic equivalent.

Prescription Drug Program for Medicare-Eligible Individuals - Medicare-eligible employees, retirees and dependents have co-pays of 20% retail and $10/$20/$35 mail service, with a $1,000 out-of-pocket limit per calendar year. Use of the mail-service pharmacy for a maintenance medication is mandatory after the original supply plus one refill. No benefits are provided for out-of-network pharmacy purchases. (See page 55 for more information.)

Specialty Drugs - Patients MUST go through CuraScript for all specialty drugs—even when the drugs are to be administered in the doctor's office. (See page 55 for details.)

Routine Physical Exam Benefit (page 40)
(For Employees, Retirees and Spouses Only)

For doctors' professional fees for routine physical examinations (no deductible) - 100% up to $125 per calendar year¹

Diagnostic X-Ray and Lab (DXL) Benefit (page 40)
(For Employees, Retirees and Spouses Only)

For outpatient diagnostic x-ray and lab procedures, including tests that are ordered by a doctor as part of a routine physical examination (no deductible) - 100% up to $150 per calendar year²

Comprehensive Major Medical Benefit
(Comprehensive Benefit) (pages 41-53)

No benefits are payable for substance abuse and mental or nervous disorders under the Comprehensive Benefit. Benefits for charges incurred for these conditions are payable ONLY under the Mental Health and Substance Abuse Benefit.

Lifetime Maximum Benefit Payable - $2,000,000³

Calendar Year Maximum Benefit Payable - $1,000,000

Deductibles:

Individual calendar year deductible - $300
Family calendar year deductible (2 or more family members) - $600
Hospital certification noncompliance deducible—Per admission, in addition to the calendar year deductible (page 41) - $250
Emergency room deductible for each occurrence of hospital emergency room treatment - $50

Plan Payment Percentages - For MOST covered medical expenses AFTER satisfaction of deductible(s). See Special Limitations for exceptions and additional limitations:

Covered services provided by PPO providers (except for chiropractic care), and covered prescription drugs not purchased through the Prescription Drug Mail Service Program:
- BEFORE the out-of-pocket maximum is met - 80%
- AFTER the out-of-pocket maximum is met - 100%
Covered services rendered by non-PPO providers:
- BEFORE the out-of-pocket maximum is met - 70%
- AFTER the out-of-pocket maximum for all other covered medical expenses is met - 100%

Out-of-Pocket Maximums per calendar year, AFTER satisfaction of all applicable deductibles. Amounts applied to out-of-pocket maximums include out-of-pocket payments made for a person's 20% and 30% co-pay share of covered medical expenses except for deductibles, chiropractic care, hearing care, non-surgical TMJ treatment and jaw surgery^4,5:

Per person, unless the person is eligible for Medicare - $1,500
Per person if the person is eligible for Medicare - $1,125
Per family - $3,000

Special Limitations

Unless stated otherwise, the Plan payment percentages for the following types of treatment are the percentages shown under Plan Payment Percentages above.

Outpatient Speech Therapy⁶ (page 46):

Maximum allowable covered medical expense per session - $90
Maximum allowable number of sessions per person per calendar year - 50

Non-Surgical TMJ Treatment⁷ (page 48) - Lifetime maximum benefit per person - $1,000

TMJ/Jaw Surgery⁸ (page 48) - Lifetime maximum benefit per person for jaw surgery that is:
(a) out-of-network, or (b) in-network but not precertified - $3,000

Chiropractic Care⁷ - Plan payment percentage and calendar year maximum benefit per person - 50% up to $600

Home Nursing Care (page 47) - Calendar year maximum benefit per person - $5,000

Hearing Care⁷ (page 49) - Maximum benefit payable per ear for hearing exams, tests and hearing aid devices (no deductible), every 5 years (60 months) for adults and every two years (24 months) for children - 80% up to $1,250

Skilled Nursing Facility Care (page 48) - Maximum number of days payable per person per calendar year - 30

Prenatal Care Program Well-Child Care Benefit (page 46) - Maximum payable per child for well-child expenses incurred from birth through age 4 if the mother (covered employee or spouse) completed the Prenatal Care Program (no deductible applies; excess expenses are not covered) - 100% up to $500

Childhood Immunizations (page 46) - Lifetime maximum benefit payable per child for routine immunization expenses (no deductible applies; excess expenses are not covered; in addition to $500 Prenatal Care Program benefit above) - 100% up to $1,000

Hospice Care (pages 52-53) - Lifetime maximum benefit per person - $20,000

Mental Health and Substance Abuse Benefit (pages 58-62)

Benefits for charges incurred for treatment of these conditions are paid ONLY under this benefit; and this benefit is ONLY for treatment of substance abuse and mental or nervous disorders.
All treatment of these conditions must be precertified by ValueOptions. No payment will be made for any treatment that has not been precertified.
If the Lineco Member Assistance Program (MAP) refers you to a MAP counselor, your first 6 office visits will cost you nothing regardless of the nature of the counseling. These short-term counseling services are separate from the benefits provided under the Mental Health and Substance Abuse Benefit.
Your benefits will be paid under the In-Network Schedule if the facility, doctor or counselor providing the treatment is a member of the ValueOptions Provider Network.

Your benefits will be paid under the Out-of-Network Schedule if the facility or doctor providing the treatment is NOT a member of the ValueOptions Provider Network.

Mental or Nervous Disorders

*In this section, "In-Network"; means the ValueOptions Network—not the Blue Card PPO Network.*	In-Network Schedule	Out-of-Network Schedule
Full-Time Inpatient Confinement
Individual calendar year deductible⁹	None	$250
Family calendar year deductible	None	$500
Maximum allowable days of confinement per person during a calendar year (or for a single confinement)	45 days¹⁰ (In- & Out-of-Network combined)
Plan payment percentage	80%	80%
Partial Inpatient Care (Day Care)
Maximum allowable days per calendar year	75 days¹¹ (In- & Out-of-Network combined)
Plan payment percentage	80%	80%
Outpatient Treatment¹²
Plan payment percentages per course of treatment:
First 8 visits	90%	80%
All subsequent visits	90%	50%

Substance Abuse

Inpatient confinements must be separated by 180 days.
Detoxification is covered only if followed by an approved treatment program that is completed by the patient. (Only inpatient detoxification is covered.)

Failure to complete a course of treatment recommended by your provider(s) and certified by ValueOptions (inpatient, intensive outpatient, or an inpatient/intensive outpatient combination) will result in non-payment of benefits for that course of treatment.

In this section, "In-Network" means the ValueOptions Network NOT the Blue Card PPO Network.	In-Network Schedule	Out-of-Network Schedule
Calendar Year Deductible per person (for all treatment for substance abuse)	None	$250
Inpatient:
Lifetime maximum allowable number of inpatient confinements per person	Two (In- & Out-of-Network combined)
Maximum allowable number of days per confinement	21 days¹³ (In- & Out-of-Network combined)
Plan payment percentage	80%	80%
Intensive Outpatient Treatment:
Lifetime maximum allowable days of treatment per person	45 days¹⁴ (In- & Out-of-Network combined)
Plan payment percentage	90%	80%
Non-Intensive Outpatient Treatment:
Calendar year maximum benefit payable per person (including family and group therapy)	$3,000 (In- & Out-of-Network combined)
Plan payment percentage	90%	80%

LINECO Member Assistance Program (MAP)

The Lineco Member Assistance Program (MAP) provides confidential, professional counseling, education and referral services to you and your eligible family members. The MAP, which is administered by ValueOp-tions, has thousands of experienced, professional counselors to help you with any kind of personal problem.

Telephone consultations are provided at no cost to you.
Depending on your situation, the MAP may recommend that you receive counseling services from a pro-fessional MAP counselor. You can receive MAP counseling services at no cost to you for up to 6 face-to- face office visits per problem. There are no deductibles, co-payments or claim forms involved.

The Lineco MAP is completely separate from the Mental Health and Substance Abuse Benefit. Please do not hesitate to use this valuable service whenever you need it. It's easy to access, free and confidential. A complete description of the MAP starts on page 62.

Dental Benefit (pages 65-69)

Calendar Year Deductible per person (applies to restorative care only) - $100

Calendar Year Maximum benefit per person - $2,000

Lifetime Maximum Orthodontia Benefit payable for dependent children only (orthodontia benefits do not apply to the Dental Benefit calendar year maximum; no deductible applies) - $2,000

Plan Payment Percentage - 80%

Vision Care Benefit (pages 70-71)

Vision Care Benefits are provided through VSP (Vision Service Plan).

The VSP Doctor column shows that you can receive an exam and eyewear at no cost to you when you use a VSP doctor. However, if you select eyewear that costs more than the amount allowed by VSP, you will pay an additional (discounted) charge directly to the VSP doctor.
The Out-of-Network column shows the maximum amount that you can be reimbursed by VSP if you use an out-of-network provider.

	VSP Doctor	Out-of-Network Vision Exam
Vision Exam - Every calendar year	Covered in full	Up to $35
Frame - Every two calendar years	Covered up to Up to $115 retail value	Up to $35
LENSES - Every calendar year:
Single vision	Covered in full	Up to $30/pair
Lined bifocal	Covered in full	Up to $40/pair
Lined trifocal	Covered in full	Up to $55/pair
Contacts	Covered up to $100/pair for exam, fitting, evaluation and lenses	Up to $100/pair for exam, fitting, evaluation and lenses

Footnotes

Covered routine physical exam expenses in excess of $125 per person per calendar year are not covered under any benefit provided by the Plan.

The expenses a person incurs for covered diagnostic x-ray and lab services which are in excess of $150 in a calendar year will be considered under the provisions of the Comprehensive Benefit.

If Comprehensive Benefits are paid on your behalf during a calendar year, the amount paid, up to $5,000, will be automatically restored to your remaining lifetime maximum benefit on January 1 of the following calendar year (see page 45 for more information).

Your co-pay shares for precertified in-network TMJ/jaw surgery DO apply to the out-of-pocket maximum.

Expenses for non-surgical TMJ treatment, chiropractic care, or non-precertified or out-of-network jaw surgery will NOT be paid at 100% even if your out-of-pocket maximum has been met.

Refer to No. 6 on page 46 for the types of speech therapy that are considered covered medical expenses. Covered inpatient speech therapy is paid the same as any other covered medical expense.

Your out-of-pocket co-pay shares for these expenses do not apply to any out-of-pocket maximums, and the Plan will not pay 100% for these expenses after your out-of-pocket maximum has been met.

The $3,000 lifetime maximum does not apply to precertified in-network jaw surgery. (See No. 18 on page 48 for more information.)

Mental or nervous disorder deductibles apply only once to any continuous inpatient confinement, even if the confinement continues into the following year.

No benefits are payable for days not precertified by ValueOptions as medically necessary. If fewer than 45 days are certified, benefits are payable ONLY for the number of days certified.

No benefits are payable for days not precertified by ValueOptions as medically necessary. If fewer than 75 days are certified, benefits are payable ONLY for the number of days.

Out-of-network outpatient services must be rendered by an M.D., D.O. or licensed clinical psychologist.

No benefits are payable for days not precertified by ValueOptions as medically necessary. If fewer than 21 days are certified, benefits are payable ONLY for the number of days certified.

No benefits are payable for days not precertified by ValueOptions as medically necessary. If fewer than 45 days are certified, benefits are payable ONLY for the number of days certified.

Line Construction Benefit Fund LINECo