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Prescription Drug Program The Plan provides prescription drug coverage for Non-Medicare Eligible Retirees, Non-Medicare Eligible Surviving Spouses, and Non-Medicare Eligible Dependents of Retirees and Surviving Spouses. See How the Prescription Drug Program Works for a description of the prescription drug coverage.

THE PLAN DOES NOT PROVIDE PRESCRIPTION DRUG COVERAGE FOR MEDICARE ELIGIBLE RETIREES, MEDICARE ELIGIBLE SURVIVING SPOUSES, OR MEDICARE ELIGIBLE DEPENDENTS OF RETIREES AND SURVIVING SPOUSES.

Limitations and Exclusions The limitations and exclusions are the same for all Plan participants, regardless of how Medicare pays.

Canceling Coverage A retiree must send a written request to Blue Cross & Blue Shield to cancel coverage under the Plan. The coverage will end at the end of the month in which the written request is received. Coverage will also end if any required contributions are not paid, or if the Plan is terminated for some reason. Dependent coverage ends at the same time or at the end of the month in which the Plan is made aware that a dependent is no longer eligible. Requests for retroactive cancellation are not allowed.

Termination of coverage ends all rights of the enrollee to benefits under the Plan as of the effective date of coverage termination.

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