Acute Care Bed - The setting in which care is received by a Covered Person who has been admitted to a hospital where complex medical, diagnostic and therapeutic services are provided.

Calendar Year - The period of 12 consecutive months starting January 1, and continuing through December 31, each year.

Casual Employee - An hourly employee who either works on call (occasional and irregular hours), or is a student assistant working up to 20 hours per week during school sessions and up to full-time during school breaks.

Chemical Dependency Services - Services and supplies covered under the Plan for the diagnosis and treatment of alcoholism and chemical or drug dependency as classified in the International Classification of Diseases of the U.S. Department of Health and Human Services.

COBRA - The Consolidated Omnibus Budget Reconciliation Act of 1985. Federally enacted legislation allowing employees and their dependents to continue group health insurance should the group health insurance be lost due to certain events (such as termination of employment). COBRA was enacted to protect these individuals by allowing them to continue their group health insurance under the employer's or the former employer's plan at affordable group rates for specified periods of time.

Common Law Spouse - An individual is considered a common-law spouse if recognized by the state in which the couple resides. Generally, there must be present mutual consent or agreement to be husband and wife followed by mutual and open assumption of marriage.

Contributory - The Participant pays a part of the cost of the Coverage.

Copayment Charge or Copayment - The charge, in addition to the premium contribution, which the Covered Person is required to pay for certain Health Services provided under the HMO. The Covered Person is responsible for the payment of any Copayment Charges directly to the provider of the Health Services at the time of service.

Cosmetic Services - Services for which plastic surgery or other services are indicated primarily to improve the Member's appearance, and will not result in significant improvement in physical function.

Coverage - The entitlement of a Covered Person to Health Services provided under the Plan. All Health Services must be provided only while the recipient is a Covered Person and meets all eligibility requirements as described in SECTION 1 - ELIGIBILITY REQUIREMENTS.

Covered Dependent - An eligible Dependent who is enrolled for Coverage under the Plan.

Covered Person - Either a Participant or any Covered Dependents.

Dependent -

1.

A Participant's spouse (if not legally separated from the Participant) or common law spouse, provided the Common Law Certification has been signed, or

2.

A Participant's unmarried child including stepchild or legally adopted child; or a child for whom the Participant has permanent legal guardianship from live birth until the end of the month in which the child attains age 24. Except that, the term Dependent includes a Participant's unmarried child who has attained age 24 while:

a.

The child is:

1.

Mentally or physically unable to earn his or her own living and proof of incapacity is furnished to Kaiser Permanente within 31 days of the date his or her Coverage would have ended due to age; and

2.

Actually dependent on the Participant for a majority of his or her support; and

3.

Covered under this Plan on the date just prior to the day his or her Coverage would have ended due to age.

b.

The child:

1.

Has not attained age 24; and

2.

Is primarily dependent upon the Participant for support and maintenance.

Coverage ends for children at the end of the month in which their 24th birthday occurs or at the end of the month in which they are married.

A covered Dependent who temporarily resides outside the Kaiser Permanente Service Area will be eligible for Health Services performed by a Kaiser Permanente Medical Office. In the event of an Emergency, Health Services obtained outside the Services Area are covered. However, follow up care after an emergency and routine care obtained at a non-Kaiser Permanente facility outside the Service Area are not covered.

A husband and wife who are both UCAR Employees can be covered either as an Employee or a Dependent.

If a husband and wife are both covered under the Plan as Employees, their Dependent children may be Covered Dependents of either the husband or the wife.

Note: An "adopted child" who is awaiting final order of adoption is an Eligible Dependent from the date the child is placed in the Participant's home.

Doctor - A person licensed to treat illness or injury by the state in which the treatment is performed. For purposes of this member handbook, Doctors and Physicians are any doctors of medicine associated with the Colorado Permanente Medical Group (CPMG) under an arrangement between Kaiser Foundation Health Plan of Colorado and CPMG.

Domestic Partner - To be eligible to be covered under the Plan as a Domestic Partner, the partner and the Employee must be of the same sex, and must:

1.

Complete an affidavit of Domestic Partnership

2.

Be eighteen years of age or older;

3.

Share a close personal relationship and be responsible for each other's common welfare;

4.

Have lived together continuously for at least six months;

5.

Be each other's sole Domestic Partner;

6.

Be unmarried or have not had another Domestic Partner within the prior 12 months;

7.

Be unrelated by blood closer than would bar marriage in the State of Colorado;

8.

Share the same regular and permanent residence, with the current intent to continue doing so indefinitely;

9.

Be jointly financially responsible for basic living expenses. "Basic living expenses" are defined as the cost of basic food, shelter and any other expenses of a Domestic Partner that are paid at least in part by a program or benefit for which the partner qualified because of the domestic partnership. (Note: Domestic Partners need not contribute equally or jointly to the cost of these expenses as long as they agree that both are responsible for the cost);

10.

Have the power of attorney applicable to medical emergencies; and

11.

Have been mentally competent to consent to contract when the domestic partnership began.

Note: For all Colorado Kaiser Permanente members covered under the Plan as a Domestic Partner, they must be of the same sex. Opposite sex partners can be covered under a plan as Common Law Marriage.

Durable Medical Equipment - Medical equipment which can withstand repeated use and is not disposable, is used to serve a medical purpose, is generally not useful to a person in the absence of an illness or injury, and is appropriate for use in the home.

Effective Date - The commencement date of Coverage under this Plan.

Eligible Expenses (Coordination of Benefits) - A necessary, reasonable and customary item of expense for health care, when the item of expense is covered at least in part by one or more plans covering the individual for whom claim is made. If a plan provides benefits in the form of services, the reasonable cash value of each service will be considered as both an Eligible Expense and benefit paid.

The difference between the cost of a private Hospital room and the cost of a semi-private Hospital room is not considered an Eligible Expense under the above definition unless the private room is Medically Necessary.

Eligible Person - Any person eligible to participate according to SECTION 1 - ELIGIBILITY REQUIREMENTS except Dependents, and who resides within the Service Area at the time of enrollment. Covered Persons who temporarily reside outside of the Service Area shall be eligible only for Health Services performed by a Kaiser Permanente Medical Office, except in the event of an Emergency. Follow-up care after an emergency and routine care must be obtained at a Kaiser Permanente Medical Office in order to be covered.

Emergency - A serious medical condition resulting from injury, illness, or mental illness which arises suddenly and requires immediate care and treatment to avoid jeopardy to the life or health of a Covered Person.

Emergency Care Center - The Emergency Department at Saint Joseph Hospital Emergency Room (Denver, CO) that is open 24 hours a day, seven days a week to respond to emergencies.

Emergency Services - Medically necessary health services that are immediately required because of unforeseen illness or injury.

Employee - As defined in SECTION 1 - ELIGIBILITY REQUIREMENTS in this handbook.

Experimental or Investigational Services - Medical, surgical or psychiatric procedures, treatments, devices and pharmacological regimes (including investigational drugs and drug therapies) which are not recognized in accord with generally accepted medical standards as safe and effective for treating the condition in question as determined by the medical community at large, including but not limited to the Food and Drug Administration, whether or not the Service is authorized by law for use in testing or other studies on human patients. Contact Kaiser Permanente to determine if a particular procedure, treatment, device, or pharmacological regime is considered to be Experimental or Unproven.

Health Services - The health care services and supplies covered under the Plan, except to the extent that such health care services and supplies are limited or excluded under the Plan.

Health Services Fees - The monthly premium required for each Participant and each Covered Dependent in accordance with the terms of the Plan.

Hemodialysis - A process used to cleanse the blood of patients in whom one or both kidneys are defective or absent, and to remove excess accumulation of drugs or toxic chemicals in the blood.

Home Health Services - Medically necessary health services that 1) can be safely and effectively provided in a Covered Person's home by health care personnel and 2) are prescribed or directed by a Kaiser Permanente Physician. Services will be delivered only to persons who are homebound.

Hospital - An institution operated pursuant to law which is primarily engaged in providing Health Services on an inpatient basis for the care and treatment of ill or injured individuals through medical, diagnostic and surgical procedures, which:

1.

Is licensed (if required) as a Hospital;

2.

Is open at all times;

3.

Is operated mainly to diagnose and treat illnesses on an inpatient basis;

4.

Has a staff of one or more doctors on call at all times;

5.

Has 24-hour nursing services by registered nurses;

6.

Is not a Skilled Nursing Facility, clinic, nursing home, rest home, convalescent home or like place; and

7.

For the purpose of treatment of mental illness, alcoholism or Chemical Dependency, the term "Hospital" also means any other public or private facility or portion thereof licensed, certified or approved by the state in which it is located to provide treatment or rehabilitation services for mental illness, alcoholism or Chemical Dependency.

Identification Card - The card issued to each Covered Person which shows the name of the Participant, their Plan ID Number and other pertinent information relating to the Plan.

Initial Eligibility Period - The period of time determined by UCAR during which Eligible Persons may enroll themselves and Dependents under the Plan.

Kaiser Permanente - A prepaid, group practice medical care program, and a federally qualified Health Maintenance Organization (HMO), which arranges medical and hospital care for Participants and their families.

Medical Necessity or Medically Necessary - Those Health Services which are determined by Kaiser Permanente to be necessary to meet the basic health needs of an individual. Determination of what is Medically Necessary is done on a case-by-case basis. The fact that a Physician has performed or prescribed a procedure or treatment does not mean that it is Medically Necessary. Also, such service must be:

1.

Consistent with the diagnosis of, and prescribed course of treatment for the patient's condition;

2.

Required for reasons other than the convenience of the patient or his or her Physician, or not be required solely for custodial, comfort or maintenance reasons; and

3.

Performed in the most cost-efficient type of setting appropriate for the condition.

4.

A service of item is medically necessary if its provision constitutes a medically appropriate course of treatment for the member.

The care or treatment, services or supplies must not be:

1.

For the scholastic education or vocational training of the patient; or

2.

Experimental in nature.

Medicare - Part A and Part B of the insurance program established by Title XVIII of the Federal Social Security Act and all amendments thereto.

Member Services Guide and Telephone Directory - A booklet containing pertinent Kaiser Permanente information and phone numbers which you will receive upon enrolling in the Plan.

Mental Health Provider - A person who has met the academic and professional requirements for licensure to deliver mental health services in the state in which services are being provided and who is employed by or associated with Kaiser Permanente.

Mental Health Services - Those services and supplies covered under the Plan for the diagnosis and treatment of mental illness which are classified in the International Classification of Diseases of the U.S. Department of Health and Human Services.

Participant - Any person eligible to participate according to SECTION 1 - ELIGIBILITY REQUIREMENTS except Dependents, and who has elected to be covered under this Plan.

Personal Primary Care Physician - Any doctor of medicine associated with or engaged by Kaiser Permanente who is primarily responsible for the care of a Covered Person with respect to any particular injury or illness.

Physician - See Doctor.

Plan - The medical coverage sponsored by UCAR and described in this handbook.

Plan Year - One-year period commencing on the Effective Date of the Plan or any anniversary date thereof, during which the Plan is in effect.

Prescription Drug - A drug which has been approved for use by the medical community at large, including but not limited to the Food and Drug Administration, which can, under federal or state law, be dispensed only pursuant to a Prescription Order.

Prescription Order or Refill - The authorization for a Prescription Drug issued by a Kaiser Permanente Physician who is duly licensed to make such an authorization in the ordinary care of his or her professional practice.

Primary Plan - The plan which pays benefits or provides Services first under the order of benefit determination rules for Coordination of Benefits. The Primary Plan does not reduce its benefits because of duplicate coverage.

Provider - A Physician or any other Health Services provider who has entered into an arrangement with Kaiser Permanente to provide Health Services to Covered Persons.

Schedule of Benefits - The part of SECTION 4 - MEDICAL BENEFITS of this Plan, outlining the benefits.

Secondary Plan - Any plan which provides Coverage for the person for whom the claim is made and which is not a Primary Plan. The Secondary Plan is responsible for paying the balance not covered by the Primary Plan, but no more than it would be obligated to pay under the terms of its own contract.

In most instances, the Secondary Plan's costs are less than they would have been if it had to pay for the services without regard to COB and as a result it experiences a savings. COB rules provide that the Secondary Plan keep track of any savings and credit it into a Benefit Reserve Account in the member's name.

The credit in the Benefit Reserve Account is available to pay for expenses covered in part by either plan regardless of when the expenses were incurred or the Benefit Reserve established, provided the expenses and the Benefit Reserve arose in the same calendar year. This process will continue until the Benefit Reserve Account runs out or the calendar year ends. All balances remaining in the Benefit Reserve Account at the end of the calendar year will return to zero and will be used to reduce the impact of future increases in overall dues rates.

Service Area - The geographic area serviced by Kaiser Permanente, as approved by regulatory agencies. Contact Kaiser Permanente to determine the precise geographic areas it serves.

Skilled Nursing Facility - An institution (or a distinct part of an institution) which:

1.

provides 24-hour-a-day licensed nursing care;

2.

has in effect a transfer agreement with one or more hospitals;

3.

is primarily engaged in providing skilled nursing care as part of an ongoing therapeutic regimen;

4.

is licensed under applicable state law; and

5.

has been approved in writing by Kaiser Permanente.

Supplemental Charge - See Copayment.

January 2004