Retiree's Welfare Trust--Medicare Supplemental Plan Comparison Printer Page

RETIREE'S WELFARE TRUST MEDICARE SUPPLEMENTAL PLAN COMPARISON RWT-29 vs RWT-PLUS
The information on this page is designed to provide a side-by-side comparison of Retiree Benefit Plan (RWT-29) and Retiree Benefit Plan (RWT-Plus). The information is for illustrative purposes only and is NOT intended to be construed as an all-inclusive description of the Plan benefits or any limitations/exclusions that may apply. It is NOT to be used for general distribution purposes or in lieu of a Plan booklet. To determine CURRENT Employee and Retiree Contribution Rates, please contact NW Administrators. Every effort has been made to insure the information is accurate as of the date of issue, however, in all cases the applicable Plan booklet(s) (inclusive of all revisions or modifications made subsequent to the latest printed editions) shall govern the eligibility for the benefits payable. The board of Trustees retains the right of final determination in question of interpretation and to increase contribution rates or implement benefit and eligibility modifications depending on the financial condition of the Trust. No Plan participant should believe they have a vested right in these Plans or that the benefits of the Plans will necessarily be granted indefinitely.
MEDICARE (PART A) HOSPITAL SERVICES—PER BENEFIT PERIOD
BENEFITS/SERVICES	MEDICARE PAY	RWT-29		RWT-PLUS
RETIREE CONTRIBUTION RATE *4 (Rates are per person)		Regular Plan	Expanded Plan
		$96 per Retiree/Spouse per month	$118.00 per Retiree/Spouse per month	$118.00 per Retiree/Spouse per month
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BENEFITS/SERVICES	MEDICARE PAY	RWT-29		RWT-PLUS
HOSPITALIZATION *1 Semiprivate room and board, general nursing and miscellaneous services and supplies		Regular Plan	Expanded Plan
		Pays up to:	Pays up to:	Pays up to:
First 60 days	All but $812.00 *2	$560.00	$560.00	$764.00
61st thru 90th day	All but $203.00 *2 per day	$123.00 per day	$123.00 per day	$191.00 per day
91st day and after
•While using 60 lifetime reserve days	All but $406.00 *2 per day	$246.00 per day	$246.00 per day	$382.00 per day
•Once lifetime reserve days are used:
—Additional 365 days	$0.00	$125.00 per day	$125.00 per day	$125.00 per day
—Beyond the additional 365 days	$0.00	$125.00 per day	$125.00 per day	$125.00 per day
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BENEFITS/SERVICES	MEDICARE PAYS	RWT-29		RWT-PLUS
SKILLED NURSING FACILITY CARE *1 You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.		Regular Plan	Expanded Plan
		Pays up to:	Pays up to:	Pays up to:
First 20 Days	All allowable amounts.	$0.00	$0.00	$0.00
21st thru 100th day	All but $105.00 *2 per day	$61.50 per day	$61.50 per day	$95.50 per day
101st day and after	$0.00	$0.00	$0.00	$0.00
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MEDICARE (PART B) MEDICAL SERVICES—PER CALENDAR YEAR
BENEFITS/SERVICES	MEDICARE PAYS	RWT-29		RWT-PLUS
MEDICAL EXPENSES— IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT Services covered by Medicare such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.		Regular Plan	Expanded Plan	Pays up to:
		Pays up to:	Pays up to:
First $100 of Medicare Allowable Amounts *3	$0.00	$75.00	$75.00	$100.00
Remainder of Medicare Allowable Amounts	80% of Medicare allowable amounts	20% of Medicare allowable amounts	20% of Medicare allowable amounts	20% of Medicare allowable amounts
Part B Excess Charges (Above Medicare allowable amounts)	$0.00	20% of amounts up to UCR limits when provider does not accept Medicare assignment and patient is responsible for these charges	100% of amounts up to UCR limits when provider does not accept Medicare assignment and patient is responsible for these charges	Not covered
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PRESCRIPTION DRUG
Prescription Drug	FWT-29 — Non-Medicare		RWT-PLUS — Non-Medicare
	Medicare Part D Prescription Drug Coverage Provided through CCRx Gold Plan		Medicare Part D Prescription Drug Coverage Provided through CCRx Gold Plan
	CCRx Monthly Premium Paid by Trust	Additional $180 in Coverage for co-pays, deductibles provided by Trust	CCRx Monthly Premium Paid by Trust	Additional $180 in Coverage for co-pays, deductibles provided by Trust
	You can visit the CCRx website @ www.communitycarerx.com or call CCRx toll free @ 1-(866)-684-5353 for details on the Gold Plan.		You can visit the CCRx website @ www.communitycarerx.com or call CCRx toll free @ 1-(866)-684-5353 for details on the Gold Plan.

*1 A Benefit Period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
*2 80% where no PPO access.
*3 Once billed for $100 of Medicare allowable amounts for covered services, your Part B deductible will have been met for the calendar year
*4 Higher "dropped employer" rates apply if a Retiree's employer ceases to contribute to the Trust.

NOTE: This worksheet is designed to provide a side by side comparison of the existing Retiree Benefit Plan, RWT-29, and Retiree Benefit Plan, RWT-Plus, which became available for negotiation July 1, 1998. The worksheet is for illustrative purposes only and is NOT intended to be construed as an all-inclusive description of the Plan benefits or any limitations/exclusions that may apply. It is not to be used for general distribution purposes or in lieu of a Plan booklet. Every effort has been made to insure the information is accurate as of the date of issue, however, in all cases the applicable Plan booklet(s) (inclusive of all revisions or modifications made subsequent to the latest printed editions) shall govern the eligibility for the benefits payable. The Board of Trustees retains the right of final determination in question of interpretation and to increase contribution rates or implement benefit and eligibility modifications depending on the financial condition of the Trust. No Plan participant should believe they have a vested right in these Plans or that the benefits of the Plans will necessarily be granted indefinitely.