Retiree Medical Insurance Plan Summary of Benefits Underwritten by: United American Insurance Company Services Medicare Pays Plan Pays You Pay OUT-PATIENT MEDICAL EXPENSES - - In or Out of the Hospital and Out-Patient Hospital Treatment, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: Medicare Part B Deductible: First $0 $0 Part B Deductible Medicare-approved amounts** 20% until Calendar Next Medicare-approved amounts Generally 80% $0 year deductible is met ($400) 4% until Out Of Next Medicare-approved amounts Generally 80% 16% Pocket Maximum is met ($1,250) Remainder of Medicare-approved Generally 80% Generally 20% 0% amounts Part B Excess Charges (Above Medicare Approve $0 100% 0% Amounts) BLOOD First 3 pints $0 All costs $0 Next Medicare Approved $0 $0 Part B Deductible Amounts** 20% until Calendar Next Medicare-approved amounts Generally 80% $0 year deductible is met ($400) 4% until Out Of Next Medicare-approved amounts Generally 80% 16% Pocket Maximum is met ($1,250) Remainder of Medicare Approved 80% 20% $0 Amounts CLINICAL LABORATORY SERVICES Blood tests for Diagnostic Services 100% $0 $0