The Local 802 Musicians Health Fund was formally officially established on July 1, 2007 through the merger of the Local 802 Health Benefits Fund and the Theatre Sick Pay and Hospitalization Fund. The Fund is administered by a joint board of employer and union trustees and a plan administrator. The union trustees are Local 802's President, Recording Vice-President, Financial Vice-President and two rank-and-file members of the union. The Fund was established to receive contributions on behalf of musicians from employers only. This means that the plan cannot be purchased by musicians individually, except as provided by law (COBRA).

The Fund's menu of benefits include Plan A+ with Hospitalization, Plan A+ (major medical only) and Plans A and B, which are also major medical plans only and do not include hospitalization coverage. All of the plans offer the option of buying into the Empire Blue Cross / Blue Shield Direct HMO, through a self-pay component. There are some collective bargaining agreements negotiated by Local 802 wherein employers have agreed to supplement the Local 802 plan with a separate hospitalization plan or with a cash payment if the musician/employee is privately purchasing hospitalization coverage. At the present time those agreements that include a hospitalization component include: Broadway Theatres, AFM Pamphlet B Touring, steady engagements in New York City hotels, the NYC Opera and Ballet, the Orchestra of St. Luke's, Brooklyn Philharmonic, American Composers Orchestra and Orpheus. Since each agreement is negotiated separately, be sure to become familiar with the terms and conditions of the agreements under which you work.

ELIGIBILITY

In order for a musician to be eligible to have contributions made to the Fund on his/her behalf, the musician must work under a Local 802 collective bargaining agreement, which establishes the contribution amount for the work performed. Since most musicians work for multiple employers during the course of a year, Local 802 agreements provide for a contribution on the musician's behalf from each employer. When a minimum threshold of contributions during a six-month contribution period (work period) is reached from one or more employers, the musician and his/her dependents are eligible to receive benefits under the plans.

Effective October 1, 2007 the Fund will provide four levels of coverage to eligible participants and their dependents:

• Plan A+: $250,000 All Cause Maximum/Person/Year with hospitalization
• Plan A+: $250,000 All Cause Maximum/Person/Year without hospitalization
• Plan A: $50,000 All Cause Maximum/Person/Year (medical only)
• Plan B: $5,000 All Cause Maximum/Person/Year (medical only)

Effective October 1, 2007 Plan A+ participants who have enrolled dependents will have to remit a quarterly premium of $600.00. There is no participant premium for individual enrollment.

Effective October 1, 2007 Plan A+ participants who have enrolled dependents but choose to choose to enroll for the major medial portion only and not the hospitalization portion of the benefit will have to remit $300.00 quarterly.

Effective October 1, 2007 Plan A+ participants who have enrolled dependents will have to remit a quarterly premium of $600.00. There is no participant premium for individual enrollment.

Effective October 1, 2007 Plan A participants will have to remit a quarterly premium payment or $75.00 Individual & $405.00 Family (2 or more individuals)

The Fund will invoice its participants quarterly. Participants will have a 30-day grace period beginning with the first day of the quarter (e.g. Jan.1, April 1, July 1, Oct. 1)

Plan A participants who choose not to pay the participant premium before the first day of the quarter will default to Plan B and will remain there until remittance has been received and processed. Any participant premium remittance received after the 30-day grace period has expired will be returned to the participant.

Empire Blue Cross Blue Shield Direct HMO participants will incur the monthly participant premium in addition to the current HMO monthly premium.

Plan B participants do not incur either individual or family participant premiums.

Effective January 1, 2007, the administrator for all medical claim adjudication is MagnaCare. All claims must be submitted to Musicians Local 802 HBF, c/o MagnaCare, P.O. Box 1001, Garden City, N.Y. 11530.

Providers can submit claims forms electronically via WebMD (payor# 11303)

You are not required to use MagnaCare network providers. Out-of-Network providers are covered in accordance with participant eligibility level.

If you reside in New York or New Jersey, MagnaCare is your preferred provider network.

If you reside outside of New York or New Jersey, a network that is a subsidiary of MagnaCare in your area will be available to you. Please consult your MagnaCare health insurance card for appropriate network access.

Empire Blue Cross - Hospitalization Claims (applicable to A+$4300.00 level only)

Providers should submit all claims to their local Blue Cross and/or Blue Shield Plan; or if Medicare is primary submit Medicare claims to Medicare, In California, send claims to Blue Cross of California, P.O. Box 60007, Los Angeles, CA 90060-0007.

$500.00 annual deductible for all out-of-network services. $1500.00 annual out-of-pocket maximum.

The deductible applies when you choose the services are rendered by of a physician or other provider who is not a participant in the MagnaCare network. However, if you choose to utilize the services of a physician from the MagnaCare network of doctors, there is no deductible and the only cost would be a $20.00 co-payment per office visit. All claims (MagnaCare and out-of-network) are submitted to MagnaCare.

After a $1,500.00 out-of-pocket maximum has been reached, coverage will be at 100% of the reasonable and customary allowance (100% of the 75^th percentile). Please remember that for out-of-network services, the annual deductible must be met before claims can be paid at 100%.

$250,000.00 all cause annual maximum (medical coverage only).

$1000.00 annual deductible for all out-of-network services. $1500.00 annual per person out-of-pocket maximum.

Please note that in order for the $1,000.00 family maximum to be considered met, a minimum of two people in the family must each meet their individual $500.00 deductible.

$250,000.00 per family member all cause annual maximum (medical coverage only).

After the deductible has been met, out-of-network services charges are paid at 70% of the reasonable and customary allowance charges (70% of the 75^th percentile).

After a $1500.00 individual or out-of-pocket maximum has been met, coverage will be at 100% of the reasonable and customary allowance (100% of the 75^th percentile).

The deductible applies when services are rendered by a physician or other provider who is not a participant in the MagnaCare network. However, if you choose to utilize the services of a physician from the MagnaCare network of doctors, there is no deductible and the only cost would be a $20.00 co-payment per office visit. All claims (MagnaCare and out-of-network) are submitted to MagnaCare.

After a $5,000.00 out-of-pocket maximum has been met, coverage will be at 100% of the reasonable and customary allowance (100% of the 75^th percentile). Please remember that for out-of-network services, the annual deductible must be met before claims can be paid at 100%.

$50,000.00 all cause annual maximum (medical coverage only).

$2000.00 annual deductible for all out-of-network services. $5000.00 annual per person out-of-pocket maximum.

Please note that in order for the $2,000.00 family maximum to be considered met, a minimum of two people in the family must each meet their individual $1,000.00 deductible.

$50,000.00 all cause per person annual maximum (medical coverage only).

After the deductible has been met, out-of-network charges are paid at 50% of the reasonable and customary allowance charges (50% of the 75^th percentile).

After a $5000.00 individual or out-of-pocket maximum has been met, coverage will be at 100% of the reasonable and customary allowance (100% of the 75^th percentile).

Deductible – applicable out-of-network services only
$1000.00 annual deductible for all out-of-network services.

The deductible applies when services are rendered by a physician or other provider who is not a participant in the MagnaCare network. However, if you utilize the services of a physician from the MagnaCare network of doctors, there is no deductible and the only cost would be a $20.00 co-payment per office visit. All claims (MagnaCare and out-of-network) are submitted to MagnaCare.

$5,000.00 all cause annual maximum (medical coverage only).

$2000.00 annual deductible for all out-of-network services.

$5000.00 all cause per person annual maximum (medical coverage only).

After the deductible has been met, out-of-network services charges are paid at 50% of the reasonable and customary allowance charges (50% of the 75^th percentile).

Plan B does not provide prescription benefits.

If you utilize providers outside the MagnaCare PPO network, the Fund covers physicians' fees, diagnostic and other major medical in accordance with the eligibility level rate of reimbursement.

Routine checkups that are unrelated to a medical diagnosis are not covered for adults under the Local 802 Musicians Health Fund (even if you use a MagnaCare provider). There are exceptions made in the case of a routine mammogram, annual gynecological visit and pap smear. There is also coverage for well-child care.

If you utilize in-network physicians, there is no deductible, but you will incur a $20.00 co-payment for office visits.

For radiology and lab tests that are performed in conjunction with a covered benefit that is considered "medically necessary" (see Musicians’ Local 802 Health Fund summary plan description booklet for definition of "medically necessary") the Fund offers 100% coverage of in-network service providers. (Please contact MagnaCare directly to confirm that a provider is participating.)

To find a participating MagnaCare PPO doctor or lab, call 1-800-352-6465 or check out their web site at www.magnacare.com

Only Plan A+ & Plan A participants and their dependents have prescription coverage through the Medco Health prescription drug plan. (There is no prescription plan under Plan B) There is a maximum cap of $5,000 in prescription benefits annually. You may use the mail order service for chronic prescriptions (30 days or longer up to a 90 day supply) and you may use your prescription drug card to get prescriptions filled at a local participating pharmacy (30 days supply or less).

The prescription benefit is a three-tier program, and co-payments are indicated as follows:

• First Level - Generic Drugs ($0)
• Second Level - Preferred brand drugs ($15)
• Third Level - Non-preferred brand drugs (20% with a $30 minimum/$60 maximum of total cost)

• First Level - Generic Drugs ($5)
• Second Level - Preferred brand drugs ($30)
• Third Level - Non-preferred brand drugs ($60)

• First Level - Generic Drugs (The greater of $10 or 25% of total cost)
• Second Level - Preferred brand drugs (The greater of $20 or 25% of total cost)
• Third Level - Non-preferred brand drugs (The greater of $40 or 25% of total cost)

• First Level - Generic Drugs (The greater of $20 or 25% of total cost)
• Second Level - Preferred brand drugs (The greater of $40 or 25% of total cost)
• Third Level - Non-preferred brand drugs (The greater of $80 or 25% of total cost)

You will pay an amount in addition to the co-payment listed above when you purchase a brand-name medication that has a generic equivalent available. This additional amount, called the differential, is equal to the difference between the approved cost of the brand-name and the generic medications. The differential will be charged even if your doctor indicates "dispense as written" or "no substitution".

You may want to discuss with your doctor whether the generic equivalent of any brand-name medication that you take is acceptable to use. If your doctor agrees, ask for a new prescription for the generic medication to take to your local retail pharmacy or send to Medco by Mail. Here are some facts on generic medications:

• Generics contain the same active ingredients and meet the same strict U.S. Food and Drug Administration standards as their equivalent brand-name drugs. Even though generics may differ in color, size, or shape, they must contain the same active ingredients as the brand version. They must also be equivalent in strength and dosage and be expected to produce the same effect in the body as the original brand-name drug
• Generics usually cost 30 to 60 percent less
• Using generics may help you and your Fund save money
• Half of all prescription drugs are now available as generics
• Some of the best-selling prescription medications in history have recently come off patent, so any drug manufacturer can now produce them

• Proton Pump Inhibitors (PPIs) and Non/Low Sedating Antihistamines (NSAs) are excluded beginning January 1, 2007. Here are names of some of these medications:
• PPIs Aciphex, Prevacid, Protonix, Omeprazole, and Nexium
• NSAs Allegra, Zyrtec, and Clarinex

Some PPIs and NSAs are now available as an over-the-counter drug. Prilosec OTC is an OTC PPI. OTC NSAs include Loratadine, Claritin 24-Hour Allergy, Claritin Reditabs, Claritin Hives Relief, Tavist ND, Clear-Atadine, Non-drowsy Allergy Relief, Triaminic Allerchews, Alavert, Dimetapp Children’s ND Non-Drowsy Allergy, and syrups such as Children’s Loratadine, Claritin, Dimetapp Children’s ND Non-Drowsy Allergy, Alavert Children’s and Non-Drowsy Allergy Relief for Kids. This information is provided for educational purposes only and you should always talk to your doctor before beginning or discontinuing any medication therapy.

If you need any assistance or have questions on using Medco By Mail, please call the Member Services phone number shown on the back of your prescription drug ID card: 1-800-818-6602. Representatives are available to help you 24 hours a day, 7 days, except for Thanksgiving and Christmas. The website and Member Services will be able to price medications with the new co-payments and determine which medications are newly excluded beginning on January 1, 2007.

VISION SERVICES

The Fund will pay a benefit once per calendar year for a routine eye examination, and one pair of eyeglass lenses and frames as shown below:

For participants who use the Fund’s cooperating vision providers, the full cost of an annual routine eye exam and one pair of glasses are covered (with a limited selection of frames). For a list of vision providers, call or e-mail the Local 802 HBP.

For participants on Plan A+ or Plan A, the Fund pays $75.00 per week, up to a maximum of 13 weeks, to members who are unable to work due to illness or injury that is not work related. Plan B provides no loss-of-time benefits.

The Fund covers for chiropractic care in accordance with the participant’s eligibility level. For in-network chiropractic care, the co-payment is $20.00 per visit. Please consult your MagnaCare health insurance card for appropriate network access.

The Fund does not cover the cost of routine psychotherapy. There is coverage of treatment for psychological disorders experienced during hospitalization at a general hospital (not a psychiatric facility). Outpatient services provided by a psychiatrist only for medication management are covered (not psychotherapy). Also, as mandated by New York State law, the Fund covers substance abuse counseling by state-certified providers for a maximum of 60 sessions per year.

As required by law, the Fund covers all expenses for well-child care, with no deductible or co-payment applied. Well-child care includes the full series of immunizations and tests, from infancy through adolescence, recommended by the American Academy of Pediatrics.

The Fund covers earplugs for the insured member only (benefit is not available to family members). The Local 802 Musicians Health Fund has entered into an arrangement with several providers of earplugs, on a preferred basis. If you use a preferred provider the complete cost of a set of earplugs is covered. $105.00 is reimbursable to members who choose to use other providers. This benefit is available only once every two years.

If you are eligible for Plan A+, A or Plan B, you have the option of enrolling in the Empire Blue Cross / Blue Shield HMO (which includes hospitalization) at an additional premium. If you enroll in the HMO, you are no longer covered by Plan A+, A or Plan B and you would no longer be using the MagnaCare network of providers. Please contact the Local 802 Musicians Health Fund for details.

If a musician and his/her spouse or domestic partner (see below) are both working under Local 802 agreements, their benefit contributions can be combined so that they can more easily reach the minimum threshold for coverage, thus maximizing the level of coverage they receive.

The Musicians Local 802 Health Benefits Fund (the "Fund") defines Domestic Partners as follows: Two unmarried adults (both of whom are 18 years or older), neither of whom is married or legally separated, who:

• have resided with each other for at least twelve months prior to the application for benefits and who intend to live continuously with each other indefinitely;
• are not related by blood closer than the law would permit by marriage;
• are financially dependent on each other;
• have an exclusive close and committed relationship with each other;
• have not terminated the domestic partnership;
• have registered as domestic partners in the municipality in which they reside (if applicable);
• and neither partner is married or legally separated.

A Fund Participant who seeks coverage for a Domestic Partner must submit to the Fund Office an Affidavit attesting to the domestic partnership and a Declaration of financial Interdependence (if each is dependent on the other partner) or Affidavit of "Dependency" for Tax Purposes (if the Domestic Partner being added to the policy is financially dependent on the Participant) along with two items of proof of cohabitation and joint responsibility for common welfare, if applicable. In addition, individuals who live in municipalities offering a domestic partner registry (such as New York and San Francisco) are required to show proof that they have registered as Domestic Partners.

Persons who fraudulently, wrongfully or negligently obtain coverage for persons who are not entitled to such coverage, or who fail to notify the Fund Office of the termination of a domestic partnership within 30 days, may be subject to disciplinary and/or civil action.

Domestic Partners of Fund Participants are eligible for coverage on the same basis as dependent coverage is provided under the Fund.

The Board of Trustees reserves the right, in its sole and absolute discretion, to amend or modify the eligibility requirements for domestic partner coverage and to amend, modify or terminate domestic partner coverage, in whole or in part, at any time and for any reason. The Board of Trustees also reserves the right to interpret all Fund documents (with regard to domestic partner coverage and all other matters) and to interpret the requirements for, and extent of, coverage for domestic partners under the Fund.

The Health Fund staff and Fund administrator are your liaisons with the insurance company and other providers. Call them at (212) 245-4802 if you have any questions concerning your level of coverage and benefits.

It is a good idea to call the Health Fund office at (212) 245-4802 or a union representative assigned to your area of work every six months to check the level of your coverage. If you believe that you should be covered by the Fund but learn that contributions have not been made on your behalf, then contact the union representative responsible for that area of work, so that he/she may file a claim with the employer for the benefits. All calls will be kept confidential.