Employee Compensation & Benefits Handbook · SERVICES COVERED BY THE HEALTH CARE PLAN ... Employee...

Employee Compensation

& Benefits Handbook

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H E A LTH C A RE P LA N

INTRODUCTION ......................................................................................................................................................... 4 GENERAL INFORMATION ........................................................................................................................................ 4 ELIGIBLE EMPLOYEES AND DEPENDENTS ......................................................................................................... 4

Eligible Employees .................................................................................................................................................... 4 Eligible Dependents ................................................................................................................................................... 4 Domestic Partners ...................................................................................................................................................... 5 Qualified Medical Child Support Orders ................................................................................................................... 5 Enrollment and Date of Coverage ............................................................................................................................. 6 Qualified Status Changes ........................................................................................................................................... 6 Annual Enrollment .................................................................................................................................................... 7 Special Enrollment Rights under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIP) .. 7 Employee Medical Contributions .............................................................................................................................. 7 Company Retiree Medical Contributions and Coverage after December 31, 2014 ................................................... 7 Spousal Premium ....................................................................................................................................................... 8

HEALTH CARE PLAN OPTIONS .............................................................................................................................. 8 PPO 500-90/10 (Local 1289) ..................................................................................................................................... 9 Summary of PPO 500-90/10 Benefits ....................................................................................................................... 9 PPO 500-70/30 ........................................................................................................................................................ 11 Summary of PPO 500-70/30 Benefits ..................................................................................................................... 12 Consumer High Deductible Health Plan (HDHP) ................................................................................................... 14 Summary of the Consumer HDHP Benefits ............................................................................................................ 15 Enhanced High Deductible Health Plan (HDHP) .................................................................................................... 17 Summary of the Enhanced HDHP Benefits ............................................................................................................. 18 Base PPO ................................................................................................................................................................. 20 Summary of the Base PPO Benefits ........................................................................................................................ 21 Medicare Preferred (LPPO) Base Plan .................................................................................................................... 23 Your Member ID Card............................................................................................................................................. 25 Member Services ..................................................................................................................................................... 25 Mental Health and Chemical Dependency Care ...................................................................................................... 25 Life Resources (Employee Assistance Program) ..................................................................................................... 25

PROGRAMS OFFERED BY THE HEALTH CARE PLAN ..................................................................................... 25 Quick Care Options ................................................................................................................................................. 26 AIM Imaging Cost & Quality Program ................................................................................................................... 26 24/7 NurseLine ........................................................................................................................................................ 26 Future Moms............................................................................................................................................................ 27 LiveHealth Online ................................................................................................................................................... 27 Health Care Management ........................................................................................................................................ 27 Types of Requests .................................................................................................................................................... 28

SERVICES COVERED BY THE HEALTH CARE PLAN ....................................................................................... 28 Hospital Benefits ..................................................................................................................................................... 28 Room and Board ...................................................................................................................................................... 28 Other Hospital Services and Supplies ...................................................................................................................... 28 Doctor’s Hospital Visits .......................................................................................................................................... 29 Newborn Care .......................................................................................................................................................... 29 Emergency Admissions ........................................................................................................................................... 29 Hospital Expenses Not Covered .............................................................................................................................. 29 Covered Surgical Benefits ....................................................................................................................................... 29 Outpatient Surgery ................................................................................................................................................... 30 OTHER BENEFITS ................................................................................................................................................ 30 Preadmission Testing ............................................................................................................................................... 30 Emergency Care ...................................................................................................................................................... 30


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Obstetrical Care ....................................................................................................................................................... 31 Out-Of-Area Care .................................................................................................................................................... 31 Doctor’s Office and Home Visits ............................................................................................................................ 31 Wellness Benefits .................................................................................................................................................... 31 Routine Gynecological Exams and Mammograms .................................................................................................. 32 Outpatient Short-Term Rehabilitation including Physical Therapy, Radiotherapy and Speech Therapy ................ 32 Outpatient Diagnostic X-rays and Lab Exams ......................................................................................................... 32 Treatment of Mouth Conditions .............................................................................................................................. 32 Miscellaneous Services and Supplies ...................................................................................................................... 32 Mental Health and Chemical Dependency Benefits ................................................................................................ 33

EXTENDED CARE SERVICES ................................................................................................................................ 33 Home Health Care ................................................................................................................................................... 33 Convalescent Care ................................................................................................................................................... 33 Hospice Care............................................................................................................................................................ 34 Vision Care .............................................................................................................................................................. 34 What the Health Care Plan Does Not Cover ............................................................................................................ 34

Definition of Terms ..................................................................................................................................................... 36 HOW TO SUBMIT A CLAIM .................................................................................................................................... 38

If You Are Hospitalized........................................................................................................................................... 39 Doctor’s Services ..................................................................................................................................................... 39 Coordination of Benefits.......................................................................................................................................... 39

COORDINATION WITH MEDICARE ..................................................................................................................... 40 When the FirstEnergy Health Care Plan is Primary ................................................................................................ 40 Third Party Liability and Subrogation ..................................................................................................................... 41 Assignment and Responsibility for Payment ........................................................................................................... 41 Notification of Payment ........................................................................................................................................... 41

BENEFIT CLAIMS AND APPEALS PROCEDURES .............................................................................................. 42 Claims Process ......................................................................................................................................................... 42 Appeals Process ....................................................................................................................................................... 43 Legal Claims ............................................................................................................................................................ 44

CLAIMS AND APPEALS OTHER THAN FOR BENEFITS .................................................................................... 44 Initial Claim Decision for Claims Relating to Eligibility and Participation ............................................................ 45 Appeals of Denied Claims Relating to Eligibility and Participation ....................................................................... 45 Legal Claims ............................................................................................................................................................ 46

BENEFITS UPON TERMINATION .......................................................................................................................... 46 Termination of Coverage ......................................................................................................................................... 46 Your Rights to Continued Health Care Coverage .................................................................................................... 46 How to Continue Coverage ..................................................................................................................................... 47 The Cost of Continued Coverage............................................................................................................................. 47 When Continued Coverage Ends ............................................................................................................................. 48 Conversion to an Individual Health Insurance Policy ............................................................................................. 48

HIPAA PRIVACY NOTICE ....................................................................................................................................... 48 Seeking assistance from Human Resources ............................................................................................................. 48

LEGISLATIVE CHANGES ........................................................................................................................................ 49 Mental Health Parity and Addiction Equity Act ...................................................................................................... 49

OTHER FACTS AND INFORMATION .................................................................................................................... 49 Certificate of Credible Coverage ............................................................................................................................. 49 Benefit Rights .......................................................................................................................................................... 49 Source of Benefits ................................................................................................................................................... 50 VEBA ...................................................................................................................................................................... 50 Participant’s Rights .................................................................................................................................................. 50 Plan is Not an Employment Contract ...................................................................................................................... 51 Right to Amend Plan ............................................................................................................................................... 51 Administration ......................................................................................................................................................... 51


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Plan Sponsor ............................................................................................................................................................ 52 Type of Plan............................................................................................................................................................. 52 Plan Number ............................................................................................................................................................ 52 Agent for Service of Legal Process ......................................................................................................................... 52 Fiscal Year ............................................................................................................................................................... 52

PARTICIPATING EMPLOYERS AND IDENTIFICATION NUMBERS ................................................................ 52 PARTICIPATING UNIONS ....................................................................................................................................... 53


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INTRODUCTION

Health care benefits are an important part of the FirstEnergy Corp. Flexible Benefits Program. The

FirstEnergy Health Care Plan and the FirstEnergy Prescription Drug Plan are separate plans. This document

contains the summary description for the FirstEnergy Health Care Plan (the Plan). There is a separate

summary plan description for the FirstEnergy Prescription Drug Plan.

For most employees the Plan consists of plan options for Preferred Provider Organizations (PPOs), two

High Deductible Health Plans (HDHP), a Health Reimbursement Account (HRA), and a retiree Medicare

Preferred (LPPO) Base Plan. Based on your status as either an active employee or retiree and your union

affiliation, the number of options available to you may differ. The information you receive each year as

part of the annual enrollment process will indicate the plan options that are available to you.

The following description of the Plan has been prepared to help you gain a better understanding of its terms

and conditions effective January 1, 2016. Each employee’s benefits and rights under the Plan are governed

at all times by the official contracts with the various medical plan administrators, and are in no way altered

or modified by the contents of this summary.

If you have questions after reviewing this material, contact the Human Resources Service Center or your

local Human Resources Office for assistance.

GENERAL INFORMATION

For the purposes of this summary, the term “Company” means the operating companies, subsidiaries and

affiliates of FirstEnergy Corp. to which the Plan has been extended (see section entitled “Participating

Employers”).

ELIGIBLE EMPLOYEES AND DEPENDENTS

Eligible Employees

All non-bargaining full-time regular, and part-time regular employees, and certain retired employees of

the Company are eligible to participate in this Plan. In addition, the surviving spouse of an employee or

eligible retiree may be eligible to participate. Employees represented by a labor union as indicated in the

section titled “Participating Unions” may participate to the extent provided by their respective collective

bargaining agreement with the Company.

Eligible Dependents

You may also enroll your eligible dependents, which include your legal spouse, and your child (ren) through

the end of the month of their 26th birthday, including adopted children and stepchildren and older children

who are incapable of self-support due to a physical or mental disability and children for which you’ve been

granted legal custody by a court of competent jurisdiction. Proof of disability and proof that the dependent

is financially dependent upon his or her parents must be provided to the administrator within 31 calendar

days of the date the child would otherwise become ineligible for Plan participation. Proof of incapacitation

must be provided to Anthem before the child becomes ineligible at or beyond age 26. Medical updates may

be required periodically. If your child is incapable of self-support, contact Anthem to complete necessary

forms.


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Same-sex spouses can be covered under the plan as long as valid marriage certificate is provided to the

Human Resources Service Center.

If both you and your spouse work for the Company, you may both choose single medical coverage or you

may elect coverage for yourself and your spouse. If you choose to cover your spouse, then your spouse

must elect no coverage. If both you and your spouse elect separate coverage, then only one parent may

elect to cover eligible dependent children.

It is fraudulent to enroll any dependent or other person not eligible for coverage or fail to notify the

Company of a change in eligibility for a covered dependent. Dismissal from employment, criminal or civil

penalties can result from such acts. The Plan retains the right to verify the eligibility of your dependents

and failure to provide sufficient documentation determined by the Plan Administrator to verify eligibility

will result in loss of coverage for the plan year.

Domestic Partners

Employees are eligible to cover their domestic partner on their health care coverage. Domestic partner

criteria requires that you and your partner must be at least age 18 and have lived together 12 months in an

exclusive relationship mutually responsible for each other’s welfare demonstrated by three or more of the

following:

o Common ownership of real property and/or a motor vehicle;

o Driver’s license with common address;

o Joint bank and/or credit accounts;

o Designation as primary beneficiary for life insurance or retirement benefits, or under a partner’s

will;

o Assignment of durable power of attorney or health care power of attorney.

In addition, you must not be related to each other to a degree of closeness that would prohibit legal marriage

in your residence state, married to anyone else or in the relationship for the sole purpose of obtaining

benefits coverage. You will be responsible for payment of applicable taxes as a result of FirstEnergy

providing health care benefits to your domestic partner. To add a domestic partner to your health care, you

will be required to complete a Domestic Partner Declaration form and provide appropriate documentation.

Qualified Medical Child Support Orders

The Consolidated Omnibus Budget Reconciliation Act of 1993 (COBRA) requires group health plans,

such as this Plan, to recognize “qualified medical child support orders” by providing benefits for

participants’ children in accordance with these orders. Upon receipt of an order, the Human Resources

Department will follow these procedures:

1. Promptly notify the participant and each Alternate Recipient (participant’s child) that the order has been

received and inform them of the procedures for determining if the order is a Qualified Medical Child

Support Order (QMCSO).

A QMCSO is one that:

Does not require the Plan to provide any type or form of benefit that is not already offered;

Either creates or recognizes the right of an Alternate Recipient to receive benefits for which a

participant is entitled under the group health plan;


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Includes the name and address of the participant and the Alternate Recipient;

Includes a description of the type of coverage to be provided by the group health plan or the manner

in which such coverage is to be determined; and

Specifies the period for which coverage must be provided and each plan to which it applies.

2. Review the Order to determine if it qualifies as a QMCSO. If necessary, the Order will be forwarded

to the Company’s Legal Department for review. The participant and any Alternate Recipient will be

notified of the determination.

3. If the Order is determined to be a QMCSO, inform the Alternate Recipient that a representative

(custodial parent or guardian) may be designated to receive any required notices. Also the Order would

specify to whom the Plan would make any payments or reimbursements.

4. Provide the Alternate Recipient or representative a copy of this summary plan description. Also, a

supply of claim forms will be provided.

If you are required to provide health coverage as the result of a Qualified Medical Child Support Order

issued on or after the date your coverage becomes effective, any Plan provisions which require evidence of

good health, limits due to a pre-existing condition, or coverage delays due to a confinement will not apply

to the initial health coverage for this child.

If you are the non-custodial parent, proof of claim for such child may be given by the custodial parent.

Benefits for such claims will be paid to the custodial parent.

Enrollment and Date of Coverage

You are eligible to participate in the Plan on the first day of the month following your date of hire.

During the first month of your employment, you will receive a Flexible Benefits enrollment form to

complete to designate your medical plan election. Coverage begins on your eligibility date if you have

enrolled. If you do not return an enrollment form, you will automatically default to waive medical

coverage.

Qualified Status Changes

You must notify the Human Resources Service Center and complete the necessary form within 31

calendar days of any change in family status – such as marriage, birth of a child, divorce, or a child who is

no longer an eligible dependent. Participants that have a status change that does not require a change of

election have a 90 day window to cover an additional dependent. Contingent upon the requisite

notification, changes in coverage are effective on the first day of the month following the date the

Company receives the required notification, except that newborn children are covered from the date of

birth and coverage for an adopted child under age 18 will begin on the date the child is placed with you

for adoption. For any change in family status, failure to notify the Human Resources Service Center and

complete the necessary form within 31 calendar days of the status change may eliminate the availability

of benefits that result from such changes. Participants that miss the 31 day window but require a status

change must pay the difference between the cost of the original election and the new level of coverage on

an after tax basis for the remainder of the plan year.


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Annual Enrollment

Open enrollment is announced and conducted in the fall each year as part of the Flexible Benefits

enrollment period. It is your annual opportunity to change your election for coverage. Changes in

coverage made during the annual enrollment period are effective the following January 1. Information

about your medical and prescription drug plan options is available from the Human Resources Service

Center or your local Human Resources Office.

Special Enrollment Rights under the Children’s Health Insurance Program Reauthorization Act of

2009 (CHIP)

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIP) requires employer-

sponsored group health plans to permit an employee who is eligible, but not enrolled, for coverage under

the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled for coverage) to

enroll if either of the following conditions is met:

• The employee or dependent covered under Medicaid or CHIP has coverage terminated as a

result of loss of eligibility, or

• The employee or dependent becomes eligible for a premium assistance subsidy under

Medicaid or CHIP.

If either of the above conditions is met, you must notify the Human Resources Service Center and

complete the necessary forms within 60 days of the date coverage terminates under Medicaid or CHIP, or

within 60 days of the determination of eligibility for a premium assistance subsidy.

Employee Medical Contributions

The cost of medical coverage and employee contributions are determined by the Company and

communicated during the annual Flexible Benefits enrollment period. The Company contributes 45% of

the cost of Plan coverage for part-time employees who are regularly scheduled to work 20 or more hours

per week. Part-time employees who are scheduled to work less than 20 hours per week may still

participate in the Plan but must pay the full cost of elected coverage. Employee contributions will be

deducted from your paycheck on a before-tax basis.

The level of benefits and employee contributions required for medical coverage are subject to change at

the discretion of the Company and in accordance with the current agreements reached between the

Company and the participating unions.

Company Retiree Medical Contributions and Coverage after December 31, 2014

The Company announced in March 2011 that subsidized monthly payments toward retiree health coverage,

which includes prescription coverage, would end as of December 31, 2014. This change affects eligible

current employees as well as eligible current retirees. Eligible retirees who are younger than age 65 will

have access to the government planned health care exchanges (as a result of the federal health care

legislation) or a Private Exchange through Towers Watson’s OneExchange; or may choose to maintain

coverage under the FirstEnergy Access Plan, which includes Rx Base prescription drug coverage as part of

the Base PPO medical coverage, by paying the full premium. Health and prescription drug coverage can’t

be unbundled. This premium is based on retiree claims experience and is not rated with the active employee

plan. Retirement health care benefits are not vested and the Company retains the discretion to amend

or terminate the FirstEnergy Access Plan.

The termination of the subsidized monthly payments toward retiree health coverage may not apply to all

retirees, such as those with individualized contracts or those who are covered under the terms of a collective

bargaining agreement which specifically provides for a continuation of a subsidy. For those employees


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continuing eligibility for a subsidy, the Company’s contribution toward the cost of medical coverage will

reflect your age and years of service at retirement, as shown below. The contribution required for a

surviving spouse of an active employee is based on the employee’s age and service at the time of the

employee’s death.

Your Age + Service Company's Contribution

85+ Cost of elected coverage less employee contribution

75-84 75% of cost of elected coverage less employee contribution

65-74 50% of cost of elected coverage less employee contribution

Pursuant to the terms of their collective bargaining agreement, IBEW Local1289 retirees receive a different

subsidy and participate in a different plan design than other retirees who remain eligible for a subsidy.

For persons who retire as the result of a disability and are eligible to continue coverage at retirement, age

and service will be determined based on the effective date of their disability retirement. As long as the

employee had 10 years of service, a minimum of 65 will be used to determine the monthly contribution.

Retirees enrolled in the FirstEnergy Access Plan will be billed by Conexis for the full premium. Premiums

will not be deducted from your monthly retirement check.

Spousal Premium

Applies to full-time bargaining and nonbargaining regular employees, except employees represented by

Local 1289, Local 29, Local 102, Local 272, and Local 777.

If your spouse is working full-time (at least 32 hours per week) and is eligible for employer-subsidized

medical and prescription drug coverage, employees who elect coverage for their spouses will be charged

an additional spousal premium of $200 per month. A change in qualified status throughout the year that

results in your spouse not having employer-subsidized coverage permits you to add your spouse to coverage

without a charge for the premium.

HEALTH CARE PLAN OPTIONS

The FirstEnergy Health Care Plan offers you substantial protection for a wide range of medical expenses

and the flexibility to choose the right medical option for you and your family. The Plan offers most

employees the choice of one of three options – Consumer HDHP, Enhanced HDHP or Base PPO. Local

1289 members are also offered the PPO 500-90/10 Plan.. Many retirees are offered the Base PPO and

the Consumer HDHP. Medicare-eligible retirees in the GPU Pre-1996 Local 180 and 459 retiree group

are eligible for the PPO 500-70/30. In addition to the PPO plans, most Medicare eligible retirees are

offered the Medicare Preferred (LPPO) Base plan. An explanation of each of the options follows.


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PPO 500-90/10 (Local 1289)

The PPO 500-90/10 is administered by Anthem Blue Cross and Blue Shield.

Like the other PPO options, PPO 500-90/10 requires that all care be received from network providers in

order to receive a higher level of benefits. Coverage at a reduced level is available from the PPO 500-

90/10 if care is received out of network.

In-network care is reimbursed at 90% after a $500 annual deductible per covered individual with a

maximum family deductible of $1,000. After the annual out-of-pocket maximum of $3,500 per person or

$6,500 per family for in-network care is reached, the plan will reimburse 100% of eligible expenses.

In-network wellness care is covered at 100% with no annual deductible. This benefit coverage is aimed at

monitoring your medical status before problems arise. A chart of preventive services is located on

Anthem’s website at www.anthem.com. A link to the document is available on the Health and Wellness

tab of www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon.

Care provided outside of the network is reimbursed at 60% of the maximum allowed amount after a

$1,500 annual deductible per covered individual, with a maximum annual family deductible of $3,000.

After the annual out-of-pocket maximum of $6,500 per person or $12,500 per family for out-of-network

care is reached, the plan will reimburse 100% of eligible expenses. Benefits for all out-of-network care

are subject to Maximum Allowed Amount set by the administrator.

Prescription drug deductibles, co-pays and coinsurance do not apply to PPO 500-90/10 deductibles and

out-of-pocket maximums.

In-network expenses cannot be used to satisfy the out-of-network deductible or out-of-pocket maximum.

Likewise, out-of-network expenses cannot be used to satisfy the in-network deductible or applied to the

out-of-pocket maximum for in-network care.

If you seek out-of-network care, you will be responsible for filing claim forms and for obtaining advance

approvals (pre-certification) from the administrator for any inpatient hospital care and outpatient

procedures, services, and tests. In addition, when you receive covered services from an out of network

provider, you may be responsible for paying any difference between the maximum allowed amount and

the provider’s actual charges. You should call a member services representative at the toll-free number

shown on your ID card to initiate the pre-certification process. The administrator will gather information

from your doctor about your condition and the recommended treatment to determine the level of coverage

for the proposed care.

PPO 500-90/10 does not contain a preexisting condition limitation.

Summary of PPO 500-90/10 Benefits

The following chart provides a summary of the benefits available through PPO 500-90/10. All covered

expenses must be for medically necessary services. All out-of-network care is subject to Maximum

Allowed Amount.

PPO 500 90/10 SUMMARY OF BENEFITS

Plan Features In-Network Benefits Out-of-Network Benefits¹

Deductible Per calendar year

$500 per person

$1,000 family maximum

$1,500 per person


http://www.anthem.com/

http://www.myfirstrewards.com/


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Health Reimbursement

Account Not applicable

Out-of-Pocket Maximum Per calendar year, including

deductible

$3,500 individual


Excludes prescription drug

deductibles and co-pays

$6,500 individual




Coordination of Benefits Maintenance of Benefits Maintenance of Benefits

Inpatient Care

Hospital Room & Board 90% after deductible 60% after deductible

Other Hospital Services and

Supplies 90% after deductible 60% after deductible

Physician Hospital Services 90% after deductible 60% after deductible

Surgeon and Assistant

Surgeon 90% after deductible 60% after deductible

Emergency Care² 90% after deductible 60% after deductible³

Convalescent Care 60 day maximum, up to 50% of

cost of semi-private hospital

room

90% after deductible 60% after deductible

Outpatient Services

Outpatient Surgery 90% after deductible 60% after deductible

Physician Office Visits Unless part of wellness care


Outpatient Physical,

Radiological and Speech

Therapy


Durable Medical Equipment 90% after deductible 60% after deductible

Other Covered Services

Home Health Care 100 visits per calendar year up

to 50% of cost of semi-private

hospital room


Private Duty Nursing When medically necessary, 15

days per calendar year


Hospice - Inpatient 30 day maximum up to 50% of


room


Hospice - Outpatient 90% after deductible 60% after deductible


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Wellness Benefits⁴

Well baby care Primary care physician (PCP)

can include doctor practicing

family medicine or pediatrician

100%

No deductible or coinsurance Not covered

Physical Assessment

Per schedule and by PCP only;

PCP can include doctor

practicing internal or family

medicine, or pediatrician

100%


Routine GYN Exam Performed by PCP only;


practicing family medicine or

gynecology

100%


Mammogram When recommended by PCP or

gynecologist; one per year

100%


¹ All out-of-network care subject to Maximum Allowed Amount.

² You will be responsible for additional $250 co-pay by the carrier if your visit is determined to be

non-emergency.

³ Emergency care, as defined on page 39, received at an out-of-network facility will be paid at the

higher network level benefit.

⁴ A chart of preventive services is located on Anthem’s website at www.anthem.com. A link to the

document is available on the Health and Wellness tab of www.myfirstrewards.com. Click on the

Preventive Health Guidelines link under the Medical icon.

PPO 500-70/30

This plan is offered to Medicare-eligible retirees in the former GPU Pre-1996 Local 180 and 459

group.

The PPO 500-70/30 is administered by Anthem Blue Cross and Blue Shield.

Like the other PPO options, PPO 500-70/30 requires that all care be received from network providers in

order to receive a higher level of benefits. Coverage at a reduced level is available from PPO 500-70/30 if

care is received out of network.







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tab of www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon.

Care provided outside of the network is reimbursed at 60% of the maximum allowable amount after a

$1,500 annual deductible per covered individual, with a maximum annual family deductible of $3,000.

After the annual out-of-pocket maximum of $6,500 per person or $12,500 per family for out-of-network

care is reached, the plan will reimburse 100% of eligible expenses. Benefits for all out-of-network care are

subject to Maximum Allowed Amount set by the administrator.

Prescription drug deductibles, co-pays and coinsurance do not apply to PPO 500-70/30 deductibles and out-

of-pocket maximums.







provider, you may be responsible for paying any difference between the maximum allowed amount and the

provider’s actual charges. You should call a member services representative at the toll-free number shown

on your ID card to initiate the pre-certification process. The administrator will gather information from

your doctor about your condition and the recommended treatment to determine the level of coverage for

the proposed care.

PPO 500-70/30 does not contain a preexisting condition limitation.

Summary of PPO 500-70/30 Benefits

The following chart provides a summary of the benefits available through PPO 500-70/30. All covered

expenses must be for medically necessary services. All out-of-network care is subject toMaximum

Allowed Amount.

PPO 500 70/30 SUMMARY OF BENEFITS



$500 per person


$1,500 per person





deductible

$3,500 individual




$6,500 individual





Inpatient Care




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room


Outpatient Services






Therapy






hospital room







room







100%



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Physical Assessment





100%





gynecology

100%




100%


¹ All out-of-network care subject to Maximum Allowed Amount


non-emergency.






Consumer High Deductible Health Plan (HDHP)

The Consumer HDHP is combination of a high deductible health plan and a tax-advantaged savings

account that can be used to pay for medical and prescription drug expenses. It is administered by Anthem

Blue Cross and Blue Shield.

Like the other PPO options, the Consumer HDHP requires that all care be received from network

providers in order to receive a higher level of benefits. Coverage at a reduced level is available from the

Consumer HDHP if care is received out of network.

A health savings account is a tax advantaged savings account that can be used to pay current medical and

prescription drug expenses as well as to save for future expenses - including retirement. Contributions,

earnings and distributions are exempt from federal income and Social Security taxes when used to pay for

qualified medical expenses. You own and manage your HSA. Money left in your account at the end of the

year rolls over into the next year.

In-network care is reimbursed at 80% after applicable co-payments and/or a $2,600 annual deductible per

covered individual with a maximum family deductible of $5,200. The family deductible and out-of-

pocket maximum amount can be satisfied by any combination of family members but an individual would

never need to satisfy more than their own individual deductible and out-of-pocket maximum amount.

This is an embedded deductible. After the annual out-of-pocket maximum of $5,500 per person or





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In-network wellness care is covered at 100%. A chart of preventive services is located on Anthem’s website

at www.anthem.com. A link to the document is available on the Health and Wellness tab of

www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon.

Care provided outside of the network is reimbursed at 60% of the maximum allowed amount after a $5,000

annual deductible per covered individual and a $10,000 annual family deductible. After the annual out-of-

pocket maximum of $10,000 per person or $20,000 per family for out-of-network care is reached, the plan

will reimburse 100% of eligible expenses. Benefits for all out-of-network care are subject to a Maximum

Allowed Amount set by the administrator.

Prescription drug costs apply to the Consumer HDHP deductibles and out-of-pocket maximums. See the

Prescription Drug Summary Plan Description for details.











the proposed care.

Participants in the Consumer HDHP plan are encouraged to review IRS Publication 969 regarding HSA

requirements.

The Consumer HDHP does not contain a preexisting condition limitation.

Summary of the Consumer HDHP Benefits

The following chart provides a summary of the benefits available through the Consumer HDHP. All

covered expenses must be for medically necessary services. All out-of-network care is subject to a

Maximum Allowed Amount.

CONSUMER HDHP SUMMARY OF BENEFITS



$2,600 per person


$5,000 per person





deductible

$5,500 individual


Includes prescription drug


$10,000 individual








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Inpatient Care










room


Outpatient Services






Therapy






hospital room







room







100%



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Physical Assessment





100%





gynecology

100%




100%


¹ All out-of-network care subject to Maximum Allowed Amount


non-emergency.






Enhanced High Deductible Health Plan (HDHP)

The Enhanced HDHP is combination of a high deductible health plan and a tax-advantaged savings

account that can be used to pay for medical and prescription drug expenses. It is administered by Anthem

Blue Cross and Blue Shield.

Like the other PPO options, the Enhanced HDHP requires that all care be received from network providers

in order to receive a higher level of benefits. Coverage at a reduced level is available from the Enhanced

HDHP if care is received out of network.

A health savings account is a tax advantaged savings account that can be used to pay current medical and

prescription drug expenses as well as to save for future expenses - including retirement. Contributions,

earnings and distributions are exempt from federal income and Social Security taxes when used to pay for

qualified medical expenses. You own and manage your HSA. Money left in your account at the end of the

year rolls over into the next year.

In-network care is reimbursed at 80% after applicable co-payments and/or a $1,300 annual deductible per

covered individual with a maximum family deductible of $2,600. If you elect family coverage (or any

coverage level other than single), claims for the entire family will not pay at 80-percent coinsurance until

the entire family deductible of $2,600 has been met. This is called a true deductible. After the annual out-

of-pocket maximum of $4,500 per person or $9,000 per family for in-network care is reached, the plan

will reimburse 100% of eligible expenses.




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In-network wellness care is covered at 100%. A chart of preventive services is located on Anthem’s website

at www.anthem.com. A link to the document is available on the Health and Wellness tab of

www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon.


annual deductible per covered individual and a $5,000 annual family deductible. After the annual out-of-

pocket maximum of $8,500 per person or $17,000 per family for out-of-network care is reached, the plan

will reimburse 100% of eligible expenses. Benefits for all out-of-network care are subject to a Maximum

Allowed Amount set by the administrator.

Prescription drug costs apply to the Enhanced HDHP deductibles and out-of-pocket maximums. See the

Prescription Drug Summary Plan Description for details.











the proposed care.

Participants in the Enhanced HDHP plan are encouraged to review IRS Publication 969 regarding HSA

requirements.

The Enhanced HDHP does not contain a preexisting condition limitation.

Summary of the Enhanced HDHP Benefits

The following chart provides a summary of the benefits available through the Enhanced HDHP. All

covered expenses must be for medically necessary services. All out-of-network care is subject to a

Maximum Allowed Amount.

ENHANCED HDHP SUMMARY OF BENEFITS



$1,300 per person


$2,500 per person





deductible

$4,500 individual




$8,500 individual








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Inpatient Care










room


Outpatient Services






Therapy






hospital room







room







100%



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Physical Assessment





100%





gynecology

100%




100%


¹ All out-of-network care subject to a Maximum Allowed Amount


non-emergency.

³ Emergency care, as defined on page 39 received at an out-of-network facility will be paid at the





Base PPO

The Base PPO is administered by Anthem Blue Cross and Blue Shield.

Like the other PPO options, the Base PPO requires that all care be received from network providers in order

to receive a higher level of benefits. Coverage at a reduced level is available from the Base PPO if care is

received out of network.







tab of www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon


annual deductible per covered individual, with a maximum annual family deductible of $3,000. After the

annual out-of-pocket maximum of $6,500 per person or $12,500 per family for out-of-network care is

reached, the plan will reimburse 100% of eligible expenses. Benefits for all out-of-network care are subject

to a Maximum Allowed Amount set by the administrator.






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Prescription drug deductibles, co-pays and coinsurance do not apply to the Base PPO deductibles and out-

of-pocket maximums.











the proposed care.

The Base PPO does not contain a preexisting condition limitation.

Summary of the Base PPO Benefits

The following chart provides a summary of the benefits available through the Base PPO. All covered

expenses must be for medically necessary services. All out-of-network care is subject to a Maximum

Allowed Amount.

BASE PPO SUMMARY OF BENEFITS



$750 per person


$1,500 per person





deductible

$3,500 individual




$6,500 individual





Inpatient Care









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room


Outpatient Services






Therapy






hospital room







room







100%


Physical Assessment





100%



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gynecology

100%




100%


¹ All out-of-network care subject to a Maximum Allowed Amount


non-emergency.



⁴ Since Wellness Benefits are covered at 100% with no deductible or coinsurance, expenses

incurred for wellness care are not deducted from the HRA




Medicare Preferred (LPPO) Base Plan

The LPPO Base Plan is a retiree plan that is administered by Anthem Blue Cross and Blue Shield. The

LPPO Base Plan is a Medicare Preferred Plan that is offered by Anthem as a replacement to the

traditional Medicare program. Participants must be enrolled in both Medicare Part A & Part B to be

eligible to enroll into a LPPO plan.

Participants in the plan can visit any hospital or physician that accepts Medicare Assignment and the terms

of the Medicare Preferred LPPO plan. Participants present their Anthem Blue Cross and Blue Shield

Medicare Preferred LPPO card when receiving services. Anthem Blue Cross and Blue Shield will pay the

physician/hospital for the eligible charges. Eligible charges and co-pays are listed in the table below.

Participants can decrease co-payment amounts by calling Anthem Blue Cross and Blue Shield to pre-notify

them when inpatient hospital services, durable medical equipment or home health care services have been

scheduled.

The LPPO Base plan has a $200 annual deductible. The annual out-of-pocket maximum is $5,000 per

individual for in-network care. After the annual out-of-pocket maximum is reached, the plan will reimburse

100% of eligible expenses. LPPO plans do not have a maximum lifetime benefit for medical coverage.

Refer to your LPPO Evidence of Coverage (EOC) booklet provided by Anthem for detailed benefit

information. Should there be any discrepancy between benefits outlined in this document and benefits

outlined in the LPPO EOC, the LPPO EOC shall govern.

ANTHEM BLUE CROSS and BLUE SHIELD LPPO BASE PLAN

Plan Feature LPPO Base




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Annual Medical Deductible $200

Annual Out-of-Pocket Maximum $5,000 per individual

Lifetime Maximum No Limit

Inpatient Hospital Care

$750 co-pay per admission

$2,250 In and Out of Network combined

Maximum out of pocket

combined with IP Mental Health

Emergency Room $60 co-pay; No co-pay if admitted within 72

hours

Mental Health/Substance Abuse Services

$750 co-pay per admission

$2,250 In and Out of Network combined

Maximum out of pocket

combined with IP Hospital Care

Skilled Nursing Facility $200 per admission

Hospice Must use Medicare certified hospice

Paid by original Medicare

Outpatient Surgery $200 co-pay, after deductible

Urgent Care Visit $35 co-pay

Emergency - Ambulance $100 co-pay

Physical Therapy Visit $35 co-pay, after deductible

Chiropractic Visit $20 co-pay, after deductible

Durable Medical Equipment (DME) Responsible for 10% coinsurance on all

Medicare-approved DME

Occupational Therapy $35 co-pay, after deductible

Home Health Care No co-pay

Allergy Testing and Treatment

Subject to either the doctor visit co-pay ($20) or

outpatient co-pay ($200), depending on place of

service

Allergy Injections

Subject to either the doctor visit co-pay ($20) or

outpatient co-pay ($200), depending on place of

service

Primary Care Office Visit $20 co-pay, after deductible

Specialist Office Visit $35 co-pay

X-Ray and Laboratory

$35 co-pay, after deductible

No co-pay for Lab tests

Complex Diagnostic Tests and Radiology $100

co-pay after deductible

Mental Health/Substance Abuse Outpatient

Visit

$25 co-pay for mental health

$25 co-pay for substance abuse

Substance Abuse Lifetime Maximum No limit

Routine Physical Exam 1 exam every 12 months

No co-pay

Routine Gynecological Exam No co-pay


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Routine Mammography 1 mammogram every 12 months

No co-pay

Routine Colonoscopy Screening No co-pay

Well Baby/Child Care Visit Not covered

Immunizations No co-pay

Routine Prostate Screening No co-pay

Routine Eye Exam No co-pay

Abnormal Aortic Aneurysm Screening No co-pay

Smoking Cessation Counseling 8 visits; no co-pay

Your Member ID Card

Once you’ve enrolled in one of the medical plans, you will receive an ID card for yourself and enrolled

family members. Carry your ID card with you and have it available whenever you make an appointment

or receive medical services. The card also gives you and your medical provider, your group number,

payment information, and the toll-free number for member services.

You should make a note of the member services number on your ID card. If your card is lost or stolen,

you will need to call member services to request a replacement card.

You can also request a member ID card by logging into to Anthem’s website at www.Anthem.com.

Member Services

When you have questions about your coverage, claim status, or an explanation of benefit form, a member

services representative is available to help you. Call the toll-free number shown on your ID card or log-in

at www.Anthem.com

Mental Health and Chemical Dependency Care

Each of the plans provides coverage for inpatient and outpatient treatment of mental health and chemical

dependency conditions.

Life Resources (Employee Assistance Program)

Active employees should first contact the Life Resources Program (EAP) before seeking mental health or

chemical dependency care through the medical plan. Life Resources (EAP) provides up to five outpatient

visits for treatment of a mental health or chemical dependency conditions at no charge to you. If further

care is required after the five outpatient visits have been used, you may seek care through the Plan.

The Life Resources Program (EAP) provides assistance for many other circumstances that may affect you

and your household members. For more information, refer to the Work/Life Employee Assistance Plan

section of the Compensation and Benefits Handbook, or contact Life Resources at 1-888-745-0714 or

www.firstenergycorp.com/liferesources

PROGRAMS OFFERED BY THE HEALTH CARE PLAN

The following programs are administered by Anthem Blue Cross Blue Shield to assist you with your

health care decisions.




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Quick Care Options

Quick Care Options helps to raise your awareness about appropriate alternatives to hospital emergency

oms (ERs). When you need care right away, retail health clinics and urgent care centers can offer

appropriate care for less cost—and leave the ER available for actual emergencies. Quick Care Options

educates you on the availability of ER alternatives for non-urgent diagnoses and provides provider finder

website to support searches for ER alternatives.

AIM Imaging Cost & Quality Program

This Imaging Cost & Quality Program is administered by AIM Specialty Health. This Program provides

you with access to important information about imaging services you might need.

If you need an MRI or a CT scan, it’s important to know that costs can vary quite a bit depending on where

you go to receive the service. Sometimes the differences are significant – anywhere from $300 to $3000 –

but a higher price doesn’t guarantee higher quality. When you are required to pay a portion of this cost

(like a deductible or coinsurance) where you go can make a very big difference to your wallet.

That’s where the AIM Imaging Cost & Quality Program comes in – AIM does the research for you and

makes it available to help you find the right location for your MRI or CT scan. Here’s how the Program

works:

• Your doctor refers you to a radiology provider for an MRI or CT scan

• AIM works with your doctor to help make sure that you are receiving the right test – using evidence-

based guidelines

• AIM also reviews the referral to see if there are other providers in your area that are high quality but

have a lower price than the one you were referred to

• If AIM finds another provider that meets the quality and price criteria,, AIM will give you a call to let

you know

• You have the choice – you can see the radiology provider your doctor suggested OR you can choose to

see a provider that AIM tells you about. AIM will even help you schedule an appointment with the new

provider

The AIM Imaging Cost & Quality Program gives you the opportunity to reduce your health care expenses

by selecting high quality, lower cost providers or locations. We are bringing this Program to you to give

you information that helps you to make informed choices about where to go when you need care.

24/7 NurseLine

You may have emergencies or questions for nurses around-the-clock. 24/7 NurseLine provides you with

accurate health information any time of the day or night. Through one-on-one counseling with

experienced nurses available 24 hours a day via a convenient toll-free number, You can make more

informed decisions about the most appropriate and cost-effective use of health care services. A staff of

experienced nurses is trained to address common health care concerns such as medical triage, education,

access to health care, diet, social/family dynamics and mental health issues. Specifically, the 24/7

NurseLine features:

• A skilled clinical team – RN license (BSN preferred) that helps you assess systems, understand medical

conditions, ensure you receive the right care in the right setting and refer you to programs and tools

appropriate to your condition.

• Bilingual RNs, language line and hearing impaired services.

• Access to the AudioHealth Library, containing hundreds of audiotapes on a wide variety of health topics.


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MP 01 2017 of 55

• Proactive callbacks within 24 to 48 hours in the event you are referred to 911 emergency services, poison

control and pediatric patients with needs identified as either emergent or urgent.

• Referrals to relevant community resources.

Future Moms

The Future Moms program offers a guided course of care and treatment, leading to overall healthier

outcomes for mothers and their newborns. Future Moms helps routine to high-risk expectant mothers

focus on early prenatal interventions, risk assessments and education. The program includes special

management emphasis for expectant mothers at highest risk for premature birth or other serious maternal

issues. The program consists of nurse coaches, supported by pharmacists, registered dietitians, social

workers and medical directors. You’ll get:

• 24/7 phone access to a nurse coach who can talk with you about your pregnancy and answer

your questions.

• Your Pregnancy Week by Week, a book to show you what changes you can expect for you

and your baby over the next nine months.

• Useful tools to help you, your doctor and your Future Moms nurse coach track your

pregnancy and spot possible risks.

• The Future Moms program is not offered to retirees.

LiveHealth Online

When available in your area, your coverage will include online visits from a LiveHealth Online

Provider. Covered services include a medical consultation using the internet via a webcam, chat or

voice. Online visit charge will be billed to Anthem and Deductible and Coinsurance will be applied to the

claim, Online visits are not covered from Providers other than those contracted with LiveHealth Online.

Non Covered Services include, but are not limited to communications used for:

• Reporting normal lab or other test results

• Office appointment requests

• Billing, insurance coverage or payment questions

• Requests for referrals to doctors outside the online care panel

• Benefit precertification

• Physician to Physician consultations

Health Care Management

Health Care Management includes the processes of Precertification, Predetermination and Post Service

Clinical Claims Review. Its purpose is to promote the delivery of cost-effective medical care by

reviewing the use of appropriate procedures, setting (place of service), and resources and optimizing your

health. These processes are described in the following section.

Network Providers know that in many cases you are required to obtain prior authorization in order for you

to receive benefits for certain services. However, it is ultimately your responsibility to work with your

provider to take the necessary steps.

If you have any questions regarding the types of service that require precertification or any information

contained in this section you should call the Anthem Customer Service telephone number on your

Identification Card.


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MP 01 2017 of 55

Types of Requests

Precertification – A required review of a service, treatment or admission for a benefit coverage

determination which must be obtained prior to the service, treatment or admission start date. For

emergency admissions, you, your authorized representative or physician must notify the Claims

Administrator within 2 business days after the admission or as soon as possible within a reasonable period

of time. For childbirth admissions, Precertification is not required unless there is a complication and/or

the mother and baby are not discharged at the same time.

Predetermination – An optional, voluntary Prospective or Concurrent request for a benefit coverage

determination for a service or treatment. The Claims Administrator will review to determine if there is an

exclusion for the service or treatment. If there is a related clinical coverage guideline, the benefit

coverage review will include a review to determine whether the service meets the definition of Medical

Necessity under this Plan or is Experimental/Investigative as that term is defined in this Plan.

Post Service Clinical Claims Review A retrospective review for a benefit coverage determination to

determine the medical necessity or experimental/investigative nature of a service, treatment or admission

that did not require Precertification and did not have a Predetermination review performed. Medical

Reviews occur for a service, treatment or admission in which the Claims Administrator has a related

clinical coverage guideline and are typically initiated by the Claims Administrator.

SERVICES COVERED BY THE HEALTH CARE PLAN

The types of services covered by the Plan are described here.

Hospital Benefits

Hospital room and board and other services are paid by the plans when a covered person is admitted for

an illness or injury that is not work related.

Room and Board

Room and board expenses are based upon the hospital’s usual daily rate for semi-private room

accommodations. Unless medically necessary, payment for private room and board charges will be

limited to the hospital’s usual daily rate for semi-private room accommodations. If a hospital does not

have semi-private rooms, the daily limit will be an amount equal to the average daily charge for its least

expensive private room.

Other Hospital Services and Supplies

During the period room and board expenses are covered, or during an outpatient visit for surgery, charges

for necessary hospital services and supplies will be covered. Some examples are:

• General nursing care, excluding private or special nurses;

• Use of operating, cast and cystoscopic room and equipment;

• Use of recovery room, treatment room and equipment;

• Use of intensive care room, treatment and equipment;

• Use of anesthesia supplies and equipment, and administration of anesthesia by a hospital

employee;

• Laboratory examinations and pathological tissue examinations;

• X-ray examinations and therapy;


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• All drugs and medicines for use in the hospital that are commercially available for purchase

and readily obtainable by the hospital;

• Use of blood transfusion equipment (not including blood or blood plasma); administration of

blood;

• Use of oxygen and equipment for its administration;

• Dressings and plaster casts;

• Use of therapeutic equipment;

• Ambulance provided by the hospital or any local ambulance service required for initial

transfer to the closest hospital capable of providing the required care.

All other regular and necessary daily supplies and services, other than professional services.

Doctor’s Hospital Visits

The plans cover doctor’s visits during a hospital stay that results in a room and board charge. The

hospital stay must be due to an illness or injury that is not work related.

Newborn Care

The plans cover hospital room and board, doctor’s visits and other hospital services and supplies

furnished for the care of a newborn child immediately following birth. Newborn charges for the child of

a dependent child are not covered under the Plan.

Hospital benefits resulting from pregnancy are determined in the same manner as any other condition.

Group health plans and health insurance providers generally may not, under Federal law, restrict benefits

for any hospital length of stay in connection with child birth for the mother or newborn child to less than

48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However,

Federal law generally does not prohibit the mother’s attending provider, after consulting with the mother,

from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any

case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the

Plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Emergency Admissions

Admission to the hospital because of an emergency is covered the same as any other illness or injury.

Hospital Expenses Not Covered

Except for outpatient confinements for preadmission testing, benefits are not provided for confinements

solely for radiographic, laboratory or basal metabolism examinations, electroencephalograms,

electrocardiograms, physical therapy, radio-therapy or any combination of such services.

Covered Surgical Benefits

Benefits will be provided for:

• Surgical services performed by a doctor as the result of an illness or injury that is not work

related;


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• Coverage for a mastectomy, which includes reconstruction of the breast on which the

mastectomy was performed – including surgery and reconstruction of the other breast to

present a symmetrical appearance – and prostheses and coverage for physical complications

throughout the mastectomy procedure, including lymphedemas;

• Obstetrical services resulting from pregnancy are covered in the same manner as any other

condition. Charges related to the newborn child of a dependent child are not covered under

the Plan ;

• Surgical services for artificial insemination;

• Surgical services for up to 3 attempts of invitro fertilization, only after all other methods of

fertilization have been exhausted;

• The administration of anesthetics, except local infiltration anesthetic, provided that the

anesthesia is administered and billed by a doctor other than the operating surgeon or surgical

assistant;

• Services of a doctor who actively assists the operating surgeon if the condition of the patient

requires such assistance, and the hospital does not have surgical assistance available;

• The immediate preoperative examination by the doctor performing the procedure and the

postoperative care required by the procedure.

Outpatient Surgery

Many kinds of surgery are performed without a hospital stay. You may be instructed by your physician to

go to the outpatient department of a hospital or surgical center on the day surgery is to be performed.

If you have any surgical procedure performed on an outpatient basis, the plans will cover the surgery,

including fees for the surgeon, assistant surgeon (if medically necessary) and anesthesiologist, in addition

to laboratory, x-rays, supplies and facility charges.

OTHER BENEFITS

Preadmission Testing

The plans covers preadmission laboratory tests and x-rays performed on an outpatient basis before a

scheduled hospital admission or outpatient surgery.

The following conditions must be met:

• The hospital admission or outpatient surgery must be ordered and certified before the tests are

performed;

• The tests should not be diagnostic in nature or used to determine the patient’s condition or the

necessity for surgery;

• Hospital admission or outpatient surgery must follow your tests within 7 days;

• Tests may not be duplicated upon admission unless medically necessary.

Emergency Care

Emergency care is defined as care given in a hospital's emergency room to evaluate and treat medical

conditions of a recent onset and severity, including, but not limited to, severe pain, which would lead a

prudent layperson possessing an average knowledge of medicine and health, to believe that his or her

condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in:

• placing the person's health in serious jeopardy; or

• serious impairment to bodily functions; or


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• serious dysfunction of a body part or organ; or

• in the case of a pregnant woman, serious jeopardy to the health of the fetus.

Examples include unconsciousness, severe difficulty breathing, poisoning, heart attack and serious

bleeding.

If you have a true emergency, as defined above, seek medical attention immediately. If emergency services

are received at an out-of-network facility, charges related to this visit will be covered at the higher network

level of benefit, provided that the emergency criteria outlined above is met. However, when you receive

covered services from an out of network provider, you may be responsible for paying any difference

between the maximum allowed amount and the provider’s actual charges.

If you go to the emergency room for a non-emergency situation, the services may not be covered because

the level of care may not be medically necessary. You will be responsible for an additional $250 copay by

the carrier if your visit is determined to be a non-emergency (not applicable to Medicare Preferred Base

LPPO Plan).

Obstetrical Care

Obstetrical care resulting from pregnancy is covered in the same manner as any other condition. Charges

related to the newborn child of a dependent child are not covered under the Plan

Out-Of-Area Care

If you are away from home and require medical care, contact member services to determine if there are

network providers in the area.

Coverage extends to eligible dependent children who are away at school. If your child has a medical

emergency while away at school, he or she should seek appropriate care at the nearest hospital or source

of medical care. Any routine, non-emergency, or follow-up care should be provided within the network

whenever possible. Contact member services to determine if there are network providers in the area.

Doctor’s Office and Home Visits

The plans cover visits made by you or your dependents to a doctor’s office or visits made by a doctor to

your home for treatment of an illness or injury which is not work related.

Wellness Benefits

The plans cover benefits for routine care provided by an in-network physician to monitor your medical

status in order to identify problems before they arise. Wellness care is covered at 100% with no annual

deductible when received from a network medical provider. A chart of preventive services is located on


tab of www.myfirstrewards.com. Click on the Preventive Health Guidelines link under the Medical icon

Further care required as the result of the wellness exam, lab work or testing is subject to the deductible

and percentage reimbursement (coinsurance) based on the plan you have selected. Treatment must be

received in-network in order to receive the higher level of benefits from any of the PPO plans.

Wellness care received outside the PPO network is not covered by the Plans.




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Routine Gynecological Exams and Mammograms

Female employees and the female dependents of employees, including dependent children, may receive

one routine gynecological exam each calendar year from any participating network provider as part of

wellness care. The plan covers the exam, pap smear and any related lab fees.

Your gynecologist or physician may also recommend a mammogram if appropriate. Mammograms must

be received from a participating network provider to be covered by the plans.

Routine gynecological care and mammograms will not be covered if received outside the PPO network.

Further care required as the result of gynecological exam, or mammogram is subject to the deductible and

percentage reimbursement (coinsurance) based on the plan you have selected. Treatment must be received

in-network in order to receive the higher level of benefits from any of the plans.

Outpatient Short-Term Rehabilitation including Physical Therapy, Radiotherapy and Speech Therapy

The plans cover eligible expenses for outpatient physiotherapy, radiotherapy and speech therapy for

treatment of an illness or injury which is not work related when ordered by a physician or a licensed

certified physical, occupational or speech therapist.

Short-term rehabilitation is therapy which is expected to result in the improvement of a body function

(including the restoration of the level of an existing speech function), which has been lost or impaired due

to an injury, disease or congenital defect.

Short-term rehabilitation services consist of physical therapy, occupational therapy, radiotherapy or

speech therapy furnished to a person who is not confined as an inpatient in a hospital or other facility for

medical care. This therapy shall be expected to result in significant improvement of the person's

condition.

Short-Term Rehabilitation Services Not Covered Include:

• Special education, including lessons in sign language, to instruct a person whose ability to

speak has been lost or impaired to function without that ability;

• Speech therapy unless necessary to restore speech which was lost due to disease, injury, or as

the result of a congenital defect.

Outpatient Diagnostic X-rays and Lab Exams

The plans cover diagnostic x-ray and laboratory examinations necessary because of a diagnosed illness or

injury which is not work related. Diagnostic x-rays and lab exams received as part of care for a diagnosed

illness or injury are not wellness care and are subject to the deductible and percentage reimbursement

(coinsurance) based on the plan you have elected.

Treatment of Mouth Conditions

The plans cover doctor’s services for treatment of a tumor involving the teeth, surrounding tissue or

structure; or for the treatment of injuries to natural teeth the calendar year of the injury or the next one,

including the replacement of the teeth within that period.

Miscellaneous Services and Supplies

The plans provide benefits for other miscellaneous services and supplies for treatment of an illness or

injury which is not work related. The following are examples of other eligible expenses covered by the

plans:

Blood and blood plasma;


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Prosthetic devices such as artificial limbs, larynx and eyes;

Durable medical equipment including surgical dressings, casts, splints, trusses, braces, crutches, rental of wheelchair or hospital bed, oxygen and rental of equipment for its administration (subject to pre-certification through member services);

X-ray and radioactive treatments and treatments with other radioactive substances;

Private duty nursing by a registered graduate nurse (maximum 15 days per calendar year, subject to pre-certification through member services).

Mental Health and Chemical Dependency Benefits

The plans provide benefits for inpatient treatment of psychiatric, mental and nervous disorders. Inpatient

treatment for drug or alcohol dependency or abuse is also covered. These benefits are provided the same

as any other hospital stay.

The plans cover counseling and other medically necessary services and supplies. Coverage is also

available for outpatient psychiatric care and chemical dependency treatment. Referral services are

available through member services to provide access to a network of providers.

There is no lifetime maximum for any medical care, including mental health benefits. This applies to

both inpatient and outpatient care combined. There is also no lifetime maximum for chemical

dependency benefits, applicable to both inpatient and outpatient care combined.

EXTENDED CARE SERVICES

Home Health Care

In cases where intermediate care and monitoring is medically necessary, the plans cover home health care

as an alternative to extended hospitalization or confinement in a convalescent care facility. The plans

cover a maximum of 100 visits per calendar year up to 50% of the cost of a semi-private room. Each visit

of up to 4 hours by a home health aide is one visit, and each visit by a nurse or therapist is considered one

visit. The provider of the home health care services must be a licensed agency or organization and meet

all of the following requirements:

Have a full-time administrator;

Maintain written records of services provided to the patient;

Include on its staff one registered nurse (R.N.).

The home health care program for care and treatment in your home of an illness or injury must be prescribed

in writing by your doctor and is subject to pre-certification by member services.

The following, when performed by someone other than a family member, are considered eligible services:

Home nursing care rendered or supervised by a registered nurse (R.N.);

Home health aide services;

Physical, occupational, speech or respiratory therapy by a qualified therapist;

Nutrition counseling provided or supervised by a registered dietitian;

Medical supplies, laboratory services, drugs and medications prescribed by a physician are also covered when provided in your home.

Convalescent Care

Following a hospital stay, you or your covered dependents may need more closely monitored care than

home health care services can provide. A convalescent care facility provides round-the-clock


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professional care without the expense of a full-service hospital. Subject to pre-certification, the plans

cover convalescent care facilities for you and your eligible dependents if the confinement is

recommended by your physician and begins within 14 days after discharge from a hospital confinement

that lasted at least three days. A maximum of 60 days is covered and begins with the first day the person

is confined in a convalescent facility and ends when the person has not been confined in a hospital,

convalescent facility, or other place giving nursing care for 90 consecutive days.

The plans do not cover room and board charges or other services and supplies provided solely for

custodial care in a rest home, nursing facility or a facility for the aged.

Hospice Care

The plans cover the following benefits for hospice care for a terminally ill person:

Inpatient care for room and board and other services and supplies furnished to a patient for pain control

and other acute and chronic symptom management. The plans cover a maximum of 30 days of inpatient

care up to 50% of the cost of a semi-private room.

Outpatient charges for part-time or intermittent nursing care by an R.N. or L.P.N. for up to 8 hours in

any one day;

Medical social services under the direction of a physician. These include assessment of the person’s

social, emotional and medical needs, and the home and family situation; identification of the

community resources which are available to the person; and assisting the person to obtain those

resources needed to meet the person’s assessed needs.

Psychological and dietary counseling;

Consultation or case management services by a physician;

Physical and occupational therapy;

Part-time and intermittent home health aide services for up to 8 hours in any one day.

The following charges are not covered under hospice care:

Bereavement counseling or pastoral counseling;

Funeral arrangements;

Financial or legal counseling, including estate planning or drafting a will;

Homemaker or caretaker services;

Respite care.

Vision Care

All participants in the FirstEnergy Health Care Plan receive basic vision care through the FirstEnergy

Vision Plan which is a separate plan whose terms can be found in the FirstEnergy Vision Plan SPD.

Under the basic vision coverage, available at no cost as part, you may receive discounts on your

examination, lenses and frames at participating providers. For a listing of current providers contact the

contracted administrator - Vision Service Plan at (800) 877-7195 or go to the VSP Web Site at

www.vsp.com.

What the Health Care Plan Does Not Cover

Anything that is determined not to be necessary for the treatment of disease or injury;

Anything not ordered by a doctor or not necessary for medical care;

http://www.vsp.com/


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Expenses used to satisfy the deductible (Except HRA and HSA reimbursements applied to the

deductible);

Any hospital stay or other services and supplies furnished before a person is covered under the Plan;

The portion of out-of-network charges in excess of the Maximum Allowed Amount;

Expenses due to cosmetic surgery, except when due to an accident occurring while covered under the

Plan;

Experimental procedures that generally are not accepted by the medical profession;

Care received that is educational in nature or for research purposes;

Periodic physical checkups and routine examinations unless performed by your physician;

Tests for non-diagnostic purposes;

Expenses due to an accident related to employment or sickness covered under Workers’ Compensation

or similar law;

Services or supplies furnished by or for the U.S. Government or any other government, unless payment

is legally required; or to the extent provided under any governmental plan or law under which the

individual is, or could be, covered;

Services or supplies received as a result of an act of war occurring while covered;

Doctors’ services or x-rays in connection with the treatment of periodontal or periapical disease or any

condition, other than a tumor, involving teeth, surrounding tissue or structure;

Speech therapy unless necessary to restore speech which was lost due to disease, injury, or as the

result of a congenital defect;

Prescription medication unless provided as part of inpatient hospital care or outpatient surgery covered

by the plan;

Vision examinations, glasses, frames, lenses, contacts, or surgical procedures to correct vision;

Hearing aids;

Routine foot care, Shoe inserts, orthotics (except when prescribed by a physician for diseases of the

foot or systemic diseases that affect the foot such as diabetes when deemed medically necessary), and

orthopedic shoes (except when an orthopedic shoe is joined to a brace).

Dental care and treatment and oral surgery (by Physicians or dentists) including dental surgery; surgical

removal of impacted teeth; dental appliances; dental prostheses such as crowns, bridges, or dentures;

implants; orthodontic care; operative restoration of teeth (fillings); dental extractions; endodontic care;

apicoectomies; excision of radicular cysts or granuloma; treatment of dental caries, gingivitis, or

periodontal disease by gingivectomies or other periodontal surgery; vestibuloplasties; alveoplasties;

dental procedures involving teeth and their bone or tissue supporting structures; frenulectomy. Any

treatment of teeth, gums or tooth related service. (Related outpatient facility services are covered when

necessary to ensure the safety of the patient, Inpatient would be subject to precertification.)

Nursing, speech therapy, physical therapy or psychotherapy you provide or provided by your spouse,

dependent or relative;

Hospital charges to the extent they are allocable to scholastic education or vocational training:

Charges for services provided to the newborn child of a dependent child are not covered under the Plan.

If you have questions about your coverage, contact Anthem Blue Cross and Blue Shield member services.

The number is located on the back of your medical card.


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Definition of Terms

Definition of terms in the Plan terms are used which have special meanings.

A hospital is a legally operated institution which provides complete inpatient services and surgical facilities

for a fee under the supervision of a staff and physicians, and nursing service by registered graduate nurses.

The term does not include an institution, or part of one, which is used principally as a rest or nursing facility,

or facility for the aged.

A doctor is a licensed practitioner of the healing arts acting within the scope of his/her practice. The term

includes a Doctor of Medicine (M.D.), a Doctor of Osteopathy (D.O.), a Chiropractor (D.C.), a Podiatrist

(D.P.M.), a Doctor of Dental Surgery (D.D.S.) and licensed Psychologists.

A convalescent care facility is a place that is licensed, organized and operated to provide convalescent and

rehabilitative treatment and which:

Provides skilled nursing care for patients who require medical or nursing care or provides

rehabilitation of injured or sick persons;

Has policies to guide its operations;

Has a medical staff;

Has a requirement that the care of every patient must be under the supervision of a doctor, and that a

physician be available to furnish necessary medical care in case of an emergency;

Meets nursing needs on a 24-hour basis, and has at least one registered professional nurse employed

full time;

Maintains medical records on all patients;

Provides methods and procedures for giving out drugs to its patients;

Has a program whereby admissions, length of stay and services are reviewed for their necessity and

efficiency;

Is licensed under state or local law or is approved by the appropriate state or local agency.

The term convalescent care facility does not include a rest home, nursing home, place for custodial care or

facility for the aged.

The Plan only covers necessary services and supplies and well-patient care provided by your physician.

Services and supplies are necessary if they are needed for the diagnosis, care, or treatment of a physical

condition. In addition, based upon recognized standards of the specialty involved, the service or supply

must be widely accepted as effective, appropriate, and essential.

Services and supplies will not be considered necessary if they are rendered by a professional but do not

require the technical skills of the provider. Also, services and supplies will not be considered necessary if

they are provided mainly as a convenience, or if they are provided on an inpatient basis to an individual

who’s physical and mental condition does not require confinement.

The maximum allowable amount is the maximum amount of reimbursement Anthem will allow for

services and supplies:

• That meet the definition of covered service and not excluded;

• That are medically necessary; and


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• That are provided in accordance with all applicable preauthorization, utilization management or

other requirements set forth in the Plan.

You will be required to pay a portion of the maximum allowed amount to the extent you have not met your

deductible or coinsurance. In addition, when you receive covered services from an out of network provider,

you may be responsible for paying any difference between the maximum allowed amount and the provider’s

actual charges.

When you receive Covered Services from a Provider, the Claims Administrator will, to the extent

applicable, apply claim processing rules to the claim submitted for those Covered Services. These rules

evaluate the claim information and, among other things, determine the accuracy and appropriateness of

the procedure and diagnosis codes included in the claim. Applying these rules may affect Claims

Administrator’s determination of the Maximum Allowed Amount. The Claims Administrator’s

application of these rules does not mean that the Covered Services you received were not Medically

Necessary. It means Claims Administrator has determined that the claim was submitted inconsistent with

procedure coding rules and/or reimbursement policies. For example, your Provider may have submitted

the claim using several procedure codes when there is a single procedure code that includes all of the

procedures that were performed. When this occurs, the Maximum Allowed Amount will be based on the

single procedure code rather than a separate Maximum Allowed Amount for each billed code.

Likewise, when multiple procedures are performed on the same day by the same physician or other

healthcare professional, the Plan may reduce the Maximum Allowed Amounts for those secondary and

subsequent procedures because reimbursement at 100% of the Maximum Allowed Amount for those

procedures would represent duplicative payment for components of the primary procedure that may be

considered incidental or inclusive.

The Maximum Allowed Amount may vary depending upon whether the Provider is a Network Provider

or an Out-of-Network Provider.

A Network Provider is a Provider who is in the managed network for this specific product or in a special

Center of Excellence/or other closely managed specialty network, or who has a participation contract with

the Claims Administrator. For Covered Services performed by a Network Provider, the Maximum

Allowed Amount for this Plan is the rate the Provider has agreed with the Claims Administrator to accept

as reimbursement for the Covered Services. Because Network Providers have agreed to accept the

Maximum Allowed Amount as payment in full for those Covered Services, they should not send you a

bill or collect for amounts above the Maximum Allowed Amount. However, you may receive a bill or be

asked to pay all or a portion of the Maximum Allowed Amount to the extent you have not met your

Deductible or have a Copayment or Coinsurance. Please call Customer Service for help in finding a

Network Provider or visit www.anthem.com.

Providers who have not signed any contract with the Claims Administrator and are not in any of the

Claims Administrator’s networks are Out-of-Network Providers, subject to Blue Cross Blue Shield

Association rules governing claims filed by certain ancillary providers.

For Covered Services You receive from an Out-of-Network Provider, the Maximum Allowed Amount for

this Plan will be one of the following as determined by the Claims Administrator:

1. An amount based on the Claims Administrator’s Out-of-Network Provider fee schedule/rate,

which the Claims Administrator has established in its’ discretion, and which the Claims


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Administrator reserves the right to modify from time to time, after considering one or more of the

following: reimbursement amounts accepted by like/similar providers contracted with the Claims

Administrator, reimbursement amounts paid by the Centers for Medicare and Medicaid Services

for the same services or supplies, and other industry cost, reimbursement and utilization data; or

2. An amount based on reimbursement or cost information from the Centers for Medicare and

Medicaid Services (“CMS”). When basing the Maximum Allowed amount upon the level or

method of reimbursement used by CMS, Anthem will update such information, which is

unadjusted for geographic locality, no less than annually; or

3. An amount based on information provided by a third party vendor, which may reflect one or more

of the following factors: (1) the complexity or severity of treatment; (2) level of skill and

experience required for the treatment; or (3) comparable providers’ fees and costs to deliver care;

or

4. An amount negotiated by the Claims Administrator or a third party vendor which has been agreed

to by the Provider. This may include rates for services coordinated through case management; or

5. An amount based on or derived from the total charges billed by the Out-of-Network Provider.

Providers who are not contracted for this product, but contracted for other products with the Claims

Administrator are also considered Out-of-Network. For this Plan, the Maximum Allowed Amount for

services from these Providers will be one of the five methods shown above unless the contract between

the Claims Administrator and that Provider specifies a different amount.

Unlike Network Providers, Out-of-Network Providers may send you a bill and collect for the amount of

the Provider’s charge that exceeds the Plan’s Maximum Allowed Amount. You are responsible for

paying the difference between the Maximum Allowed Amount and the amount the Provider charges. This

amount can be significant. Choosing a Network Provider will likely result in lower Out of Pocket costs to

you. Please call Customer Service for help in finding a Network Provider or visit the Claims

Administrator’s website at www.anthem.com.

Customer Service is also available to assist you in determining this Plan’s Maximum Allowed Amount

for a particular service from an Out-of-Network Provider. In order for the Claims Administrator to assist

You, You will need to obtain from your Provider the specific procedure code(s) and diagnosis code(s) for

the services the Provider will render. You will also need to know the Provider’s charges to calculate your

Out of Pocket responsibility. Although Customer Service can assist you with this pre-service

information, the final Maximum Allowed Amount for your claim will be based on the actual claim

submitted by the Provider.

HOW TO SUBMIT A CLAIM

When services are provided by a network hospital, physician or other medical provider, the claim will be

filed by the provider. However, you may need to submit a Group Health Claim Form if services are

received out-of-network. In this case, a form must be completed each time bills are submitted in order to

receive payment of benefits.


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Claims must be filed by the end of the calendar year following the calendar year in which the services

were received to be eligible for payment.

If You Are Hospitalized

If you or a dependent goes to a hospital, present your medical plan ID card upon arrival if possible. Many

hospitals may want you to complete their claim form. By signing the hospital’s form, you may be

assigning benefits so that payment of benefits will be made directly to the hospital.

Doctor’s Services

If you obtain services outside of the PPO network, a Group Health Claim Form must be submitted for

expenses associated with a doctor’s hospital visits; surgery, including obstetrical care; administration of

anesthesia; radiotherapy services performed by a doctor; visiting nurse services; and a doctor’s home or

office visits.

Your doctor may complete the section provided on the back of the form, or you can itemize expenses in the

appropriate section and attach the bills.

A Group Health Claim Form may be obtained from your Human Resources office or the Human Resources

Service Center. Claim forms may also be obtained by selecting Forms under the Benefits section on the

Services and Support page of the FirstEnergy Today portal. Make sure that all applicable sections have

been completed. In addition you may be required to submit a claim form annually to update coordination

of benefits information.

It is fraudulent to file a claim for someone who is not eligible, submit information that you know to be false,

or to omit important facts. Dismissal from employment, criminal and/or civil penalties can result from such

acts.

As a general rule, the bills will be satisfactory evidence of a claim if they show the name of the hospital,

doctor or other medical provider; the diagnosis or nature of the illness or injury; itemized charges; an

explanation of each charge and the amount of the charge.

For out-of-network care, attach all bills and receipts for eligible expenses for you or your dependents to the

completed Group Health Claim Form. If the information on a bill is incomplete, it will be returned to you

for the missing information. For diagnostic x-ray and laboratory services, nursing and physiotherapy

services and medical services and supplies, you must obtain an explanation from the doctor stating the

diagnostic purpose of the service.

Coordination of Benefits

Some persons have other medical coverage in addition to coverage under the Plan. When this is the case,

the benefits from other plans will be taken into account, and coordinated with the benefits paid by the

Plan. This may mean a reduction in benefits under this plan. The combined benefits will not be more

than what the FirstEnergy Plan would have paid if there was no other insurance coverage. This approach

is called “maintenance of benefits.” The Plan will pay:

Its regular benefits in full or a reduced amount equal to:

a. The benefit payable under the Plan minus;

b. The benefits payable by the “other plans.”


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This coordination of benefits will be based on the following rules:

1. A plan with no rules for coordination of benefits will be deemed to pay its benefits before a plan that

contains such rules.

2. A plan that covers a person as an employee will be deemed to pay its benefits before a plan that covers

the person as a dependent.

3. The plan that covers the person as a dependent of a person whose birthday comes first in a calendar

year will be primary or pay first. The plan that covers the person as a dependent of a person whose

birthday comes later in that calendar year will be secondary, and pay benefits after the primary plan has

paid. If the other plan does not have this provision regarding birthdays, then the rule set forth in the

other plan will determine the order of benefits.

4. In the case of a dependent child whose parents are divorced or separated: If there is a court decree which establishes financial responsibility for the medical, dental or other health care expenses with respect to the child; the benefits of a plan covering the child as a dependent of the parent with such financial responsibility shall be determined before the benefits of any other plan which covers the child as a dependent.

If there is no court decree and if the parent with custody of the child has not remarried, the benefits of a plan which covers the child as a dependent of the parent with custody will be determined before the benefits of a plan which covers the child as a dependent of the parent without custody.

If the parent with custody of the child has remarried, the benefits of a plan which covers the child as a dependent of the parent with custody shall be determined before the benefits of a plan which covers that child as a dependent of the step-parent. The benefits of a plan which covers that child as a dependent of the step-parent will be determined before the benefits of a plan which covers that child as a dependent of the parent without custody.

5. If the above scenarios do not establish an order of payment, the plan under which the person has been covered for the longest will be deemed to pay its benefits first.

In order to administer this provision, the Plan can release or obtain data and can also make or recover

payments. In the case of an accident, different rules may apply. See the section below on Third Party

Liability and Subrogation for additional information on the rules that apply in the case of an accident.

COORDINATION WITH MEDICARE

When the FirstEnergy Health Care Plan is Primary

If you are an active employee and you or your spouse has reached at least age 65, or if you or your spouse

are disabled (for other than End Stage Renal Disease(ESRD)) and eligible for Medicare benefits and you

are still on the Company’s payroll, your primary coverage will continue to be the Company’s plan.

However, when you retire you must enroll in Medicare when you become eligible. Medicare then

becomes your primary coverage and the Company’s plan is secondary. You must notify the Company if

you or any covered dependent becomes eligible for Medicare.

If you are an active employee and you or your spouse become Medicare eligible due to End State Renal

Disease (ESRD), Medicare will be secondary payer for the ESRD coordination period. At the end of the

coordination period, Medicare becomes primary payer even if you remain active and on the Company’s

payroll.

This Plan coordinates benefits with Medicare under the “maintenance of benefits” approach. This means

that benefits paid by Medicare will be taken into account and coordinated with the benefits paid under the


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Plan. The combined benefits paid will not be more than what the Plan would have paid if there were no

other insurance coverage.

If you are retired and you or any covered dependent becomes eligible for Medicare at age 65 or you or an

eligible dependent become eligible for Medicare due to disability, you must enroll in Medicare Part-B.

The Plan will coordinate benefits as if you have Medicare Part-B regardless of whether or not you select

it. All health claims for out-of-network care must first be submitted to Medicare for payment. You will

then receive an “Explanation of Medicare Benefits” worksheet detailing what payments, if any, have been

made. After receiving the Medicare worksheet, you should then complete a Group Health Claim Form for

submission to the insurance company. Attach the Medicare worksheet along with a copy of the bill for

services when filing for benefits eligible under the Plan. In most cases, if you are receiving care in-

network, the hospital, doctor or other medical provider will file these claims for you.

Claims submitted without Medicare worksheets will be returned to you requesting that you submit this

information to the insurance company so that the expenses can be considered.

Third Party Liability and Subrogation

In some cases, you or a covered dependent may incur medical expenses as the result of an injury or illness

for which a third party may be liable. For example, you may incur medical expenses as the result of an

injury received in an automobile accident. In these cases, the Plan has the right to recover any benefits it

has paid for these medical expenses from any settlement you may receive from the third party. The Plan

also has the right to act on your behalf (subrogate) in filing suit against the third party to recover the

benefits it has paid for medical expenses related to the illness or injury for which the third party may be

liable.

If you file a claim for payment of medical expenses for which a third party may be liable, you may be

asked to provide information concerning the injury or illness and who is responsible. In some cases, you

may be asked to sign a release that would allow the Plan to recover any benefits it has paid from any

settlement you may receive. The Plan reserves the right to withhold payment of benefits until the

necessary information has been provided, or the release has been signed.

Assignment and Responsibility for Payment

The Plan reimburses expenses for covered medical services and supplies according to the terms of the

PPO plan you have selected and administrator contracts. In many cases, benefits are assigned directly to

the hospital, doctor or other medical provider. Charges that are not reimbursed by the plans are the

patient’s responsibility. Generally, these would include deductibles, coinsurance, and charges for services

that are not covered or greater than the Maximum Allowed Amount.

Many hospitals, doctors and other medical providers ask you to sign a form accepting responsibility for

all charges whether they are covered by insurance or not. To limit your liability, you may wish to

indicate on the form that you will accept responsibility only for medically necessary services and

supplies, up to the Maximum Allowed Amount.

Notification of Payment

Generally after a claim is processed, you will receive an Explanation of Benefits (EOB) form from the

insurance company. However, in instances where benefits are assigned or a member’s liability is zero, an

EOB may not be provided.


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The total amount of the benefit from the plan will be shown as well as the percent paid. The explanation

will also show any ineligible charges and the reason they were not allowed.

If you have any questions concerning the benefits paid, contact the administrator by calling the toll-free

member services number listed on your identification card.

BENEFIT CLAIMS AND APPEALS PROCEDURES

The following is an outline of the procedures for the processing of a claim and summarizes the appeal of

any claims determination made by the Plan Administrator or its Designee relative to the entitlement of a

participant, beneficiary or other claimant to benefits offered under the Plan. The procedures defined in

this document are intended to comply with the Employee Retirement Security Act of 1974 (“ERISA”)

and the regulations issued by the Department of Labor related to ERISA as amended effective January 1,

2002.

The Plan Administrator is FirstEnergy Service Company. The Plan includes any medical benefit plan

offered to employees, retirees or their surviving spouses of FirstEnergy Corp, its subsidiaries or affiliated

Companies identified as a Participating Employer below. It is not intended that the Plan Administrator

will assume the responsibility for the initial claims determination or for the appeals process for any carrier

or other benefit service provider to whom that responsibility has been given under agreement with

FirstEnergy Service Company and/or its subsidiaries or affiliates. Any carrier or benefit service provider

who has agreed to act as a fiduciary for the purpose of initial claims determination or for the appeals

process shall be hereinafter referred to as “Designee”. For the 2016 “plan year”, the carrier or benefit

service provider that you elected during open enrollment has agreed to be the fiduciary, or “Designee” for

claims and appeals processing.

Claims Process

A Claim as referred to in this document is a request for a Plan benefit. Claims for benefits must be in

writing, signed by the participant, beneficiary, other claimant or their authorized representative, and

submitted on the appropriate form and in a manner acceptable to the Plan Administrator or its Designee.

A claim for a benefit includes any urgent, pre-service or post-service claim.

In the case of a claim involving urgent care, the Designee shall notify the Claimant of the Plan’s benefit

determination as soon as possible, taking into account the medical exigencies, but not later than 72 hours

after the receipt of the claim by the Plan, unless the claimant fails to provide sufficient information to

determine whether, or to what extent, benefits are covered or payable under the Plan. In such case the

Designee shall notify the Claimant as soon as possible, but not later than 24 hours after receipt of the claim

by the Plan, of the specific information necessary to complete the claim. The Claimant shall have not less

than 48 hours to provide the specified information. The Designee shall then notify the Claimant of the

Plan’s benefit determination as soon as possible, but in no case less than 48 hours after the Plan’s receipt

of the specified information or the end of the period afforded the claimant to provide the specified additional

information.

If the Plan has approved an ongoing course of treatment, any reduction or termination of such course of

treatment before its scheduled end shall constitute an adverse benefit determination and the Designee must

notify the Claimant of this determination. This notification must be sufficiently in advance of the reduction

or termination so as to allow the Claimant to appeal and obtain a determination on review of that adverse

benefit determination before the benefit is reduced or terminated. Any request by a claimant to extend the

course of treatment that involves urgent care shall be decided as soon as possible, and the claimant shall be

notified of the determination within 24 hours after the receipt of the claim.


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In the case of a pre-service claim the Designee shall notify the claimant of the benefit determination no

later than 15 days after the receipt of the claim. This period may be extended one time by up to 15 days

provided the extension is necessary due to matters beyond the control of the Plan and the claimant is notified

prior to the expiration of the initial 15 day period, of the circumstances requiring the extension and the date

the Plan expects to render a determination.

In the case of a post-service claim, the Designee will notify the claimant of the Plan’s adverse determination

of entitlement to benefits not later than 30 days after the receipt of the claim. This period may be extended

one time by up to 15 days provided the extension is necessary due to matters beyond the control of the Plan

and the claimant is notified prior to the expiration of the initial 30 day period, of the circumstances requiring

the extension and the date the Plan expects to render a determination.

If the Designee denies any part, or all, of the initial claim for benefits, the claimant will be notified in

writing, stating the reason for the denial and the Plan provisions on which the denial is based. The claimant

shall be entitled to receive, upon written request, reasonable access to and copies of all documents, records

and other information relevant to the claim for benefits. The denial will provide a description of any

additional information or material necessary for the claimant to perfect the claim and an explanation as to

why the additional information or material is required. The denial will further provide an explanation of

the claims appeal procedure and the time limits for filing an appeal. Such notice of denial or any other

notice as referred to in this procedure shall be deemed duly given when addressed to the claimant and

mailed by first class mail to the address last appearing in the records of the Plan Administrator or Designee.

The claimant shall have 180 days from the date of the initial benefit determination to file an appeal. The

appeal must be in writing, unless the claim involves urgent care or the Designee otherwise permits verbal

appeals. The claimant will have the opportunity to submit written comments, documents or other

information in support of the claim as part of the appeal. The appeal must be submitted to the Designee

that made the initial claims determination, at the address, fax or phone number provided on the initial claim

denial. If the Designee permits a verbal appeal, or the appeal involves urgent care, all necessary information

shall be transmitted to the Designee by telephone, facsimile, or other available similarly expeditious

method.

Appeals Process

The Designee will review and make its decision on the appeal. The claimant shall be provided two levels

of appeal. The claimant shall have 60 days to file a second appeal once they have been notified of the

decision on the first level of appeal. This second level of appeal shall be sent to the same address as the

first appeal. The claimant can bypass this voluntary second level appeal and request an External review at

this time.

For urgent care claims, the Designee shall notify the claimant of the Plan’s determination on review as soon

as possible, taking into account the medical exigencies, but not later than 72 hours after receipt of the

claimant’s request for review. A second level review is available at this time, however, the claimant may

bypass the voluntary second level review and request an External review at this time. For pre-service

claims, the Designee shall provide the claimant notice of the Plan’s determination on review, not later than

30 days after receipt by the Plan of the claimant’s request for review of the adverse determination or the

Plan’s first determination on review. A second level review is available, however, the claimant may bypass

the voluntary second level appeal and request an External review. The Designee shall provide the claimant

notice of the Plan’s determination on the voluntary second level review not later than 30 days. For post

service claims, the Designee shall provide the claimant notice of the Plan’s determination on review, not


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later than 60 days after receipt by the Plan of the claimant’s request for review of the adverse determination.

A second level review is available, however, the claimant may bypass the voluntary second level appeal

and request an External review. The Designee shall provide the claimant notice of the Plan’s determination

on the voluntary second level review not later than 60 days.

The Independent Review Organization (IRO) will provide claimant notice of determination on the External

review, conducted by the IRO for an urgent request or after completion of the mandatory first level review

not later than 45 days from receipt of request by the IRO.

In making its decision, the Designee will have full power and authority to interpret the Plan, to resolve

ambiguities, inconsistencies and omissions, to determine any question of fact, to determine the right to

benefits of, and the amount of benefits, if any, payable to the claimant in accordance with the provisions of

the Plan. The Designee will not defer to the original determination but will independently review the initial

claim for benefits and consider all comments, documents and other information submitted as part of the

appeal in making its decision. In addition, neither the person who made the adverse determination nor that

person’s subordinate will participate in the decision on the appeal.

If an appeal is based on medical judgment, the Designee shall consult with a health care professional with

the appropriate training and experience in making its decision. The health care professional consulted by

the Designee will not be the same person consulted in the adverse determination or that person’s

subordinate.

If the Designee’s decision is to uphold the denial of benefits, the notification will include the reason for the

denial and the Plan provisions on which the denial is based. The claimant shall be entitled to receive, upon

written request, reasonable access to and copies of all documents, records and other information on which

the decision was based. The decision will further provide a notice of the participant’s right to appeal the

decision of the Designee or IRO in accordance with ERISA and the time limits for filing an appeal.

The claimant must exhaust the above appeals process prior to any action at law, in equity, pursuant to

arbitration or otherwise. The participant shall have 180 days from the date of the decision of the Designee

or IRO to file an appeal action under ERISA. No legal action may be commenced against the Plan, the

Plan Administrator, the Designee or IRO more than 180 days after the decision has been made with respect

to all or any portion of the claim for benefits.

The address for the claim to file an appeal is:

Anthem Blue Cross Blue Shield

Clinical Appeals: P.O. Box 105568

Atlanta, GA 30348

Legal Claims

Any civil suit brought against the Plan, its Administrator, Sponsor or any other Plan fiduciary may only

be submitted and filed in the United States District Court for the Northern District of Ohio.

CLAIMS AND APPEALS OTHER THAN FOR BENEFITS

A separate claims procedure shall apply to claims regarding eligibility or participation by any eligible

employee or eligible retired employee, eligibility for a dependent to be entitled to coverage or benefits,

and to claims other than claims for group health benefits. To the extent that an applicable collective

bargaining agreement provides for different claims procedures than the claims procedures set forth herein,


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then such other claims procedures shall apply to claims made by individuals who are subject to such

collective bargaining agreement.

Any participant who wishes to file a claim for any benefit relating to the terms of eligibility or

participation under the Plan, including but not limited to eligibility to participate in any benefit program

or coverage option, the dependent status of an individual, eligibility to make a mid-year change in a

coverage election, eligibility to pay premiums on a pre-tax or after-tax basis, the amount of any premium,

or for benefits other than group health benefits, shall file such claim with the Administrator.

The address for filing a claim with the Administrator is:

FirstEnergy Health Care Plan

Attention: Plan Administrator

76 South Main Street, 7th floor

Akron, Ohio 44308

Initial Claim Decision for Claims Relating to Eligibility and Participation

The Administrator shall process each properly filed claim within a reasonable time but not later than 90

days after its receipt of an application for benefits. This period may be extended by an additional 90 days

if the Administrator provides the claimant with written notice of the extension within the initial 90 day

period. The extension notice shall explain the reason for the extension and the date by which the

Administrator expects a decision will be made. If the extension is necessary because additional

information is needed to decide the claim, the extension notice shall describe the required information.

The claimant should provide the required information as soon as possible.

The Administrator shall notify the claimant in writing, delivered in person or mailed by first-class mail to

his last known address, if any part of a claim has been denied. The notice of a denial of any claim shall

include: (i) the specific reasons for the denial; (ii) a reference to specific provisions of the plan document

upon which the denial is based; (iii) a description of any internal rule, guidelines, protocol or similar

criterion relied on in making the denial (or a statement that such internal criterion will be provided free of

charge upon request); (iv) a description of any additional material or information deemed necessary by

the Administrator for the claimant to perfect his claim and an explanation of why such material or

information is necessary; and (v) an explanation of the claims review procedure under the plan.

If the notice described above is not furnished and if the claim has not been granted within the time

specified above, the claim shall be deemed denied and shall be subject to review as set forth below.

Appeals of Denied Claims Relating to Eligibility and Participation

If a claim is denied, in whole or in part, the claimant may request that the Appeals Committee review his

or her claim. A claimant shall have 60 days in which to request a review. Such request shall be in writing

and delivered to the Appeals Committee. The address for the Appeals Committee is:

FirstEnergy Corp. Employee Benefit Claims and Appeals Committee


Akron, Ohio 44308

If no such review is requested, the decision of the Administrator shall be considered final and binding.

A request for review must specify the claimant’s reason(s) for requesting that the denial be reversed. The

claimant may submit additional written comments, documents, records, and other information relating to

and in support of his claim; all information submitted shall be reviewed whether or not it was available for

the initial review. A claimant may request reasonable access to, and copies of, all documents, records, and

other information relevant to his claim for benefits. If a review is requested, a full and fair review of the


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decision will be made by a person different than, and who is not a subordinate of, the original decision

maker.

The Appeals Committee shall render its final decision within a reasonable period of time but not later than

60 days from its receipt of a request for review. This period may be extended up to an additional 60 days,

if the Appeals Committee determines that special circumstances exist (such as the need for a hearing) which

require an extension of time for processing the review. The Appeals Committee shall provide the claimant

with written notice of the extension within the initial 60 day period. The extension notice will explain the

reason for the extension and the date by which the Appeals Committee expects a decision will be made. If

the extension is necessary because additional information is needed, the extension notice will describe the

required information. The claimant should provide the required information as soon as possible.

If after review the claim continues to be denied, the Appeals Committee shall provide the claimant with a

notice of the denial of his appeal which shall contain the following information: (i) the specific reasons for

the denial of the appeal; (ii) a reference to the specific provisions of the plan document on which the denial

was based; (iii) a statement that the claimant is entitled to receive, upon request and free of charge,

reasonable access to, and copies of, all documents, records, and other information relevant to his claim for

benefits; (iv) a statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in

making the denial (or a statement that such information would be provided free of charge upon request);

and (v) a statement describing his right to bring a civil suit under Federal law no later than 180 days after

receipt of the denial and a statement concerning any other voluntary alternative dispute resolution options

that may be available.

Legal Claims

Any civil suit brought against the Plan, its Administrator, Sponsor or any other Plan fiduciary may only

be submitted and filed in the United States District Court for the Northern District of Ohio.

BENEFITS UPON TERMINATION

Termination of Coverage

Termination of coverage for you and your eligible dependents will, in most cases, terminate at the end of

the month in which you leave the Company; if you cease to be an eligible employee; or if the Plan is

discontinued.

Coverage will also terminate immediately if the required employee contribution, if applicable, has not

been made. A dependent’s coverage will terminate at the end of the month in which he or she is no longer

an eligible dependent.

Your Rights to Continued Health Care Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 is an act of Congress that

protects you and your dependents from loss of group health care coverage if certain events occur that

would otherwise result in your loss of coverage.

When your coverage as an active employee ends you can elect continued coverage — at your own expense

and without evidence of good health — which is identical to the coverage provided for all other employees.

Coverage may be continued for a period of 18, 29, or 36 months for the following COBRA qualified

reasons:


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Loss of coverage due to termination of employment. If your employment is terminated due to any

reason other than gross misconduct, you and your covered dependents may continue health care

coverage for up to 18 months.

Eligibility for continued coverage because of disability. If you or your dependent are Social Security

disabled at the time you qualify for COBRA, coverage may be extended from 18 months to 29 months.

You must be eligible for Social Security disability benefits and notify the Company of your eligibility

for Social Security disability benefits before your first 18 months of COBRA expire.

Termination of coverage due to a divorce or death. If you should die, or become divorced, your covered

dependents may continue group health care coverage for up to 36 months. If you are already covered

by COBRA under the 18-month provision, and any of the preceding events occur, your dependents can

extend coverage to a maximum of 36 months from the first date of eligibility for COBRA coverage. If

a former Allegheny Energy employee hired after January 1, 1993 dies prior to retirement and his/her

spouse is covered at the time, they may continue to be covered by this Plan by paying the appropriate

premium until they become covered under the group medical plan through another employer, reach age

65 or commence survivor pension benefits. Dependent children may continue to be covered by this

Plan until they reach the normal dependent age.

Termination of coverage due to a loss of eligibility. You or your covered dependents may continue

group health care coverage for up to 36 months after you are no longer eligible or your dependents no

longer qualify as covered dependents. Note: If you are already covered by the 18-month provision,

your dependents can extend coverage to a maximum of 36 months from the first date of eligibility for

COBRA coverage.

How to Continue Coverage

If your employment ends for any reason other than gross misconduct, you will receive notification from

FirstEnergy’s COBRA administrator with a detailed explanation of your COBRA rights and all necessary

application forms.

Under the COBRA law, the employee or family member has the responsibility to inform the local Human

Resources representative or the Human Resources Service Center of a divorce, legal separation, or change

in eligibility for a dependent child covered under the Plan. Notice must be received in writing within 60

days of the later of (i) date the qualifying event occurs, or (ii) the date the qualified beneficiary loses

coverage as a result of the event. The participant will have 60 days from the date of the qualifying event

to elect continuation of coverage. If notice is not received within 60 days of the qualifying event, the

right to continue coverage will be lost. When notice is received, you and your dependents will be notified

about your rights to continue coverage under COBRA. If you or a covered dependent decides to continue

coverage, the election must be completed within 60 days of the date notification was received.

The Cost of Continued Coverage

You are responsible for paying the cost or premium for continued group health care coverage. The

monthly premium for continued coverage will be included in the notice sent to you or your dependents.

Once you have elected to continue group health care coverage, the first premium must be received by

FirstEnergy’s COBRA administrator within 45 days after continued coverage is elected. Premiums for

continued coverage are due on the first day of each month. If the required premium is not paid within 30


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days from the first of the month, coverage will be terminated.

When Continued Coverage Ends

Your group health care coverage will continue until the earliest of the following:

The required monthly premiums are not paid;

The person becomes covered by another group health plan (unless a pre-existing condition clause used

in the other plan prevents coverage);

The person becomes eligible for Medicare;

The date the Company terminates all of its group health care plans;

After a period of 18, 29, or 36 months of continued coverage depending upon the circumstances of the

termination of coverage.

When continued coverage is no longer available, you or your dependents may convert coverage to an

individual health insurance policy.

Conversion to an Individual Health Insurance Policy

If coverage for you or your dependents ends for any reason under the Plan, you may convert your

coverage to an individual health insurance policy, if offered by the administrator, on a direct payment

basis. Application for this conversion policy must be made within 31 days of the date coverage

terminates.

The conversion option is also available at the end of the continuation period as described in the section

entitled “Your Rights to Continued Health Care Coverage.” Application for an individual health insurance

policy may be made within 180 days before the end of the continuation period.

Instructions on how to apply for conversion may be obtained from the Human Resources Office at your

location or the Human Resources Service Center.

HIPAA PRIVACY NOTICE The Plan will only disclose Protected Health Information (PHI) to the Employer in accordance with the

Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Plan agrees not to use or

further disclose PHI other than as permitted in its privacy notice or as required by law.

The Plan will train any employees who have access to PHI regarding the requirements of HIPAA. The Plan

ensures that any of its business agents that receive PHI from the Plan agree to the same restrictions and

conditions. PHI will not be used or disclosed for employment-related actions or in connection with any

other benefit or employee benefit plan.

Access to and use of PHI by Human Resources personnel shall be restricted to plan administration functions

performed for the Plan. Such access or use shall be permitted only to the extent necessary to perform the

duties of the Plan.

Seeking assistance from Human Resources

The Plan will attempt to limit PHI received from participants or beneficiaries by encouraging participants

and beneficiaries to directly contact the provider who administers benefits payable by the applicable

health and welfare plan. However, in the event that the Company receives PHI, the following procedures

will be in effect to protect the privacy of that information.


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The Company will designate specific Human Resources representatives to have access to PHI at each

Company location. To the extent possible, only the designated Human Resources representative and

members of the Benefits section of the Human Resources Department will have access to PHI. Under

HIPAA regulations, designated Human Resources representatives or members of the Benefits section of

Human Resources will not be permitted to disclose PHI to a health care provider unless authorized in

writing by the participant/beneficiary or their authorized personal representative.

LEGISLATIVE CHANGES

The FirstEnergy Health Care Plan and the FirstEnergy Prescription Drug Plan are complaint with the

Patient Protection and Affordable Care Act (the “Affordable Care Act”). Questions regarding which

changes apply to these plans should be directed to the plan administrator: FirstEnergy Health Care &

Prescription Drug Plans, 76 South Main Street, Akron, OH 44308, Attn: Plan Administrator.

You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-

866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which

protections do and do not apply to grandfathered health plans.

Mental Health Parity and Addiction Equity Act

The Federal Mental Health Parity and Addiction Equity Act (MHPA) signed into law and effective

January 1, 2010 amends the previous Mental Health Parity Act. The MHPA requires “parity” between the

financial requirements and treatment limitations applied to medical and/or surgical benefits and mental

health and substance abuse disorder benefits.

The Plan will comply with MHPA. The medical plan comparison chart in this guide reflects the elimination

of the 30-day inpatient treatment days and 30-visit outpatient limitations. Out-of-network mental health or

substance abuse treatment charges will no longer be excluded from the out-of-pocket maximum limit.

Additionally, there will no longer be a separate maximum lifetime benefit for chemical dependency

treatment.

OTHER FACTS AND INFORMATION

Certificate of Credible Coverage

Plan members may request a certificate of credible coverage under HIPAA by calling the FirstEnergy

Human Resources Service Center at 1-800-543-4654 during regular business hours.

Benefit Rights

This summary describes the current level of benefits and contributions required for active employees,

retirees, and eligible dependents. The decision to offer medical benefits and the levels of coverage are

based on management decision or with respect to bargaining unit employees, upon the agreements

reached between the Company and the unions. Retirement health care benefits are not vested. Medical

benefits and the contributions required for coverage including retiree health care benefits and

contributions may be amended or terminated at any time by the Chief Executive Officer of FirstEnergy

Corp. or his appointed designee.


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Source of Benefits

Medical benefits are provided under an arrangement described in the Group Health Care Policies whereby

the benefits are to be afforded directly by the Company.

The complete terms of the Plan are set forth in this summary plan description and as administered under

the terms of the Administrative Services Agreement by a third party Administrator. The extent of the

coverage for each individual is governed at all times by the terms of the Group Policy. The administrator

determines the benefits for which an individual qualifies under the Plan, whether provided directly by the

Company or by the insurance company. All payments are based upon that determination.

VEBA

The Company has established trusts to pre-fund a portion of its post-retirement medical liability for

current and some future retirees. These trusts are called a Voluntary Employee Benefit Associations

(VEBA’s) and will be operated to receive favorable tax treatment under IRS Section 501(C)(9). The

VEBA’s are as follows:

• Ohio Edison Company Postretirement Health Benefits Trust for Management and Non-

represented Employees.

• Ohio Edison Company Postretirement Health Benefits Trust for Represented Employees.

• Trust Agreement for GPU Companies Health Care Plan for Non-bargaining Retirees.

• Trust Agreement for GPU Companies Health Care Plan for Employees Represented by IBEW

System U-3.


Local 777.


Local 459 and UWUA Local 180.

• Trust Agreement for GPU Companies Health Care Plan for Non-bargaining Employees.

• Trust Agreement for Allegheny Power System Benefit Fund– Medical (APEF1707502,

APEF1707432, APEF1707422, and APEF1710422) for all non-bargaining and pre-1/1/1993

retirees except for Local 102.

• Trust Agreement for Monongahela Power Company – Medical (APRF1745692) for all pre-

1/1/1993 retirees for Local 2357 and 162.

• Trust Agreement for Potomac Edison Company – Medical (APRF1745702) for pre-1/1/1993

retirees of Local 307, 771 and 331.

• Trust Agreement for West Penn Power Company – Medical (APRF1745742) for all pre-1/1/1993

retirees of Local 102.

Trust assets are used to pay health benefits for active and retired employees, and the administrative costs

of the trust and Plan. The amount of funding, timing of contributions, administration, and funding policy

will be determined by the Plan Sponsor.

The creation, administration, and funding of these trusts does not preclude the Plan Sponsor from amending,

modifying, or terminating the health care benefits at any time. Post-retirement medical benefits are not

vested.

Participant’s Rights

As a participant in the Plan you are entitled to:


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Examine, without charge, at the Plan Administrator’s office and plant or regional human resources

offices, a copy of the Plan, the latest annual report and the Plan description;

Obtain copies of Plan documents and other Plan information upon written request to the Plan

Administrator. The Administrator may make a reasonable charge for the copies;

Receive a summary of the Plan’s annual financial report; and

Expect that the people who operate your Plan, called “fiduciaries” of the Plan, will do so prudently and

in the interest of you and other Plan participants and beneficiaries.

No one — your employer, your union, or any other person — may fire you or otherwise discriminate against

you in any way to prevent you from obtaining a Plan benefit or exercising your rights under the Employee

Retirement Income Security Act of 1974 (ERISA). Under ERISA, there are steps you can take to enforce

your rights. For instance, if you request materials and do not receive them for 30 days, you may file suit in

federal court (Northern District of Ohio). If you have a claim for benefits which is denied or ignored, in

whole or in part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse

the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance

from the U.S. Department of Labor, or you may file suit in a federal court.

If you are successful, the court may order the person you have sued to pay court costs and legal fees; if you

lose, the court may order you to pay these costs and fees.

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any

questions about this statement or about your rights under ERISA, you should contact the nearest area

office of the Employee Benefits Administration listed in your telephone directory, or the Division of

Technical Assistance and Inquiries, Employee Benefits Security Administration; U.S. Department of

Labor, 200 Constitution Avenue NW, Washington, D.C. 20210.

Plan is Not an Employment Contract

The Plan shall not be deemed to constitute a contract between the participating employer and any

employee nor shall anything herein contained be deemed to give any employee any right to be retained in

the employ of the participating employer or to interfere with the right of the participating employer to

discharge any employee at any time and to treat the employee without regard to the effect which such

treatment might have upon the employee as a participant in the Plan.

Right to Amend Plan

The Plan may be amended or terminated by the Chief Executive Officer of FirstEnergy Corp. or his

appointed designee at any time or for employees represented by a labor union in accordance with the

applicable collective bargaining agreements.

Administration

The Plan Administrator has the authority to control and manage the operation and administration of the

Plan with benefits provided in accordance with the provisions of the group policy issued by the insurance

company. Inquiries should be made to the Plan Administrator:

FirstEnergy Service Company


Akron, OH 44308

1-800-543-4654


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Plan Sponsor

FirstEnergy Corp. is the Plan Sponsor for the Plan

General inquiries about the Plan may also be directed to the administrators that have contracted with

FirstEnergy Service Company to process claims. Any questions about benefit coverage for a medical

service or supply, or the processing of a claim should be directed to Member Services for the administrator

you have elected for coverage at the address or telephone number below.

Anthem Blue Cross/Blue Shield

220 Virginia Avenue

Indianapolis, IN 46204-3632

1-866-236-4365

www.anthem.com

Type of Plan

The Plan is a welfare benefit plan.

Plan Number

501

Agent for Service of Legal Process

CT Corporation System

1300 East 9th Street

Suite 1010

Cleveland, OH 43114

Fiscal Year

The last day of the Plan’s fiscal year is December 31.

PARTICIPATING EMPLOYERS AND IDENTIFICATION NUMBERS

FirstEnergy Service Company Ohio Edison Company

EIN 34-1968288 EIN 34-0437786

Pennsylvania Power Company The Cleveland Electric Illuminating Company

EIN 25-0718810 EIN 34-0150020

The Toledo Edison Company Jersey Central Power & Light Company

EIN 34-4375005 EIN 21-0485010

Metropolitan Edison Company Pennsylvania Electric Company

EIN 23-0870160 EIN 25-0718085



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FirstEnergy Nuclear Operating Company FirstEnergy Solutions Corp.

EIN 34-1881483 EIN 31-1560186

American Transmission Systems, Incorporated FirstEnergy Generation, LLC

EIN 34-1882848 EIN 34-1940561

Potomac Edison Company West Penn Power Company

EIN 13-5323955 EIN 13-5480882

Monongahela Power Company

EIN 13--5229392

Additions or deletions to the list of Participating Employers may be made at any time at the sole

discretion of the Program Sponsor. An up-to-date listing of Participating Employers may be obtained

from the Plan Administrator.

PARTICIPATING UNIONS

Additions or deletions to the list of Participating Unions may be made at any time at the sole discretion of

the Program Administrator. An up-to-date listing of Participating Unions may be obtained from the Plan

Administrator.

Participating Unions in accordance with the labor agreement between The Toledo

Edison Company, FirstEnergy Nuclear Operating Company and FirstEnergy

Generation, LLC and:

International Brotherhood of Electrical Workers, A.F.L. -C.I.O.

Local Union No. 245

Participating Unions in accordance with the labor agreement between FirstEnergy

Generation, LLC and:

International Brotherhood of Electrical Workers A.F.L. -C.I.O

Local Union No. 272*

Utility Workers Union of America, A.F.L.-C.I.O.

Local Union Nos. 350/351



Participating Unions in accordance with the labor agreement between Metropolitan

Edison Company and:



International Brotherhood of Electrical Workers A.F.L.-C.I.O

Local Union No. 777S – Reading Call Center


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Participating Unions in accordance with the labor agreement between Ohio Edison

Company and:


Local Union No. 1194


Local Union Nos. 118/126


Edison Company and FirstEnergy Nuclear Operating Company and:



Participating Unions in accordance with the labor agreement between Jersey

Central Power and Light Company and:


System Council Local 1289


Edison Company, FirstEnergy Service Company, FirstEnergy Nuclear Operating

Company, FirstEnergy Generation, LLC and:

Office & Professional Employees International Union, A.F.L.-C.I.O.

Local Union No. 19

Participating Unions in accordance with the labor agreement between Pennsylvania

Power Company and:


Local Union No. 140

Participating Unions in accordance with the labor agreement between Pennsylvania

Electric Company and:



International Brotherhood of Electrical Workers, A.F.L.-C.I.O.

Local Union No. 459

Participating Unions in accordance with the labor agreement between The

Cleveland Electric Il luminating Company, FirstEnergy Nuclear Operating

Company and FirstEnergy Generation, LLC and:


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Local Union No. 270 *

Participating Unions in accordance with the labor agreements between The FirstEnergy Nuclear

Operating Company and:


Local Union No. 29*


Local Union No. 29MP*


Local Union No. 270 (Perry Techs)

Participating Unions in accordance with the labor agreements between West Penn Power, Potomac Edison,

FirstEnergy Generation, LLC and FirstEnergy Service Company, and:



Participating Unions in accordance with the labor agreement between Monongahela Power

Company and:


Local Union No. 2357

Participating Unions in accordance with the labor agreement between Allegheny Energy Service

Corporation on behalf of Allegheny Energy Supply, LLC and the Potomac Edison Company and

West Penn Power Company doing business as Allegheny Energy:


Local Union No. 50

Participating Unions in accordance with the labor agreements between

Monongahela Power Company and FirstEnergy Generation, LLC and:

Utility Workers Union of America, A.F.L.-C.I.O

Local Union No. 304

* Member of these unions are eligible for the Consumer HDHP only.

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