Governing Plan Document Your option is subject to all the provisions of the Plan, the provisions of which are hereby made a part of your option, and is further subject to all interpretations, amendments, rules and regulations, which may from time to time be promulgated and adopted pursuant to the Plan. In the event of any conflict between the provisions of your option and those of the Plan, the provisions of the Plan shall control.
Attachment B, Payment Provisions The payment provisions are amended as follows:
Summary of Benefits Medicare Part A helps pay for health care in hospitals, skilled nursing facilities, hospice care, and some home health care services. The table below shows how much Medicare, this plan, and you pay for specific services. Please note, you pay for any services not covered by Medicare A & B or Plan 65 Medicare Supplement Plan Select G. Hospitalization (*) Semi-private room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,556 $1,556 (Part A deductible) $0 Days 61 thru 90 All but $389 per day $389 per day $0 Days 91 and after while using 60 lifetime reserve days All but $778 per day $778 per day $0 Once lifetime reserve days are used, an additional 365 days $0 100% of Medicare eligible expenses (**) $0(**) Beyond the additional 365 days $0 $0 100% Skilled Nursing Facility (SNF) Care (*) You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 Days 21 thru 100 All but $194.50 per day Up to $194.50 per day $0 Days 101 and after $0 $0 100% Blood (inpatient) First 3 pints $0 100% $0 Additional amounts 100% $0 $0 Hospice Care You must meet Medicare’s requirements, including a doctor’s certification of terminal illness. All but very limited copayment or coinsurance for outpatient drugs and inpatient respite care Medicare copayment or coinsurance for outpatient drugs and inpatient respite care $0 (*) A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. (**) When your Medicare Part A hospital benefits are exhausted, BCBSRI stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. Medicare Part B helps pay for doctors’ services, outpatient hospital care, certain medically necessary home health care services and other medical services that Part A does not cover, such as physical and speech therapy. The table below shows how much Medicare, your plan, and you pay for specific services. Please note, you pay for any services not covered by Medicare A & B or Plan 65 Medicare Supplement Plan G. Medical Expenses Includes treatment in or out of the hospital and outpatient hospital treatment, such as: doctor’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment First $233 of Medicare-approved amounts(^) $0 $0 $233 (Part B deductible) Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Part B Excess Charges (Above Medicare-approved amounts) $0 100% $0 Blood First 3 pints $0 100% $0 Next $233 of Medicare-approved amounts(^) $0 $0 $233 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 Clinical Laboratory Services Tests for diagnostic services 100% $0 $0 Home Health Care Medicare-approved services Medically necessary skilled care services and medical supplies 100% $0 $0 Durable Medical Equipment Medicare-approved services First $233 of Medicare-approved amounts(^) $0 $0 $233 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 ^ Once you have been billed $233 of Medicare-approved amounts for covered services (which are noted with a carrot), your Part B deductible will have been met for the calendar year. Foreign Travel- Not Covered by Medicare Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum Note: The Summary of Benefits contains only a brief summary of Medicare benefits. Please contact your local Social Security Office or consult the “Medicare & You” handbook for details about Medicare.
Description of Benefits The benefits available under this Plan will be as defined in Item F(5) of the Adoption Agreement.
Adoption Agreement The document executed by the Employer through which it adopts the Plan and agrees to be bound by all terms and conditions of the Plan.
Appendix The following definitions shall be in effect under the Agreement:
ADDENDUM Effective as of May 11, 1999 (the “Effective Date”), Healthtrust, Inc. — The Hospital Company (“Healthtrust”) assigned, transferred and conveyed its 100% limited liability company interest in Xxxxxxxx Hospital, LLC, a Delaware limited liability company (“LLC”), to LifePoint Hospitals, Inc. (“LifePoint Inc.”), whereupon LifePoint Inc. became the sole member of LLC. Attached hereto is a copy of the Limited Liability Company Agreement of LLC (the “Agreement”). The undersigned hereby agrees to be bound by all of the terms and provisions of the Agreement, and further agrees that, from and after the Effective Date, all references in the Agreement to Healthtrust as the sole member (the “Member”) shall be deemed to be references to LifePoint Inc. as the Member.
Incorporation of Plan Terms This award is subject to the terms and conditions of the Plan. Such terms and conditions of the Plan are incorporated into and made a part of this Agreement by reference. In the event of any conflicts between the provisions of this Agreement and the terms of the Plan, the terms of the Plan will control. Capitalized terms used but not defined in this Agreement shall have the meanings set forth in the Plan unless the context clearly requires an alternative meaning.
Limitation of Benefits under Certain Circumstances If the payments and benefits pursuant to Section 12 of this Agreement, either alone or together with other payments and benefits which Executive has the right to receive from the Company and the Bank, would constitute a “parachute payment” under Section 280G of the Code, the payments and benefits pursuant to Section 12 shall be reduced or revised, in the manner determined by Executive, by the amount, if any, which is the minimum necessary to result in no portion of the payments and benefits under Section 12 being non-deductible to the Company and the Bank pursuant to Section 280G of the Code and subject to the excise tax imposed under Section 4999 of the Code. The determination of any reduction in the payments and benefits to be made pursuant to Section 12 shall be based upon the opinion of the Company and the Bank’s independent public accountants and paid for by the Company and the Bank. In the event that the Company, the Bank and/or Executive do not agree with the opinion of such counsel, (i) the Company and the Bank shall pay to Executive the maximum amount of payments and benefits pursuant to Section 12, as selected by Executive, which such opinion indicates there is a high probability do not result in any of such payments and benefits being non-deductible to the Company and the Bank and subject to the imposition of the excise tax imposed under Section 4999 of the Code and (ii) the Company and the Bank may request, and Executive shall have the right to demand that they request, a ruling from the IRS as to whether the disputed payments and benefits pursuant to Section 12 have such consequences. Any such request for a ruling from the IRS shall be promptly prepared and filed by the Company and the Bank, but in no event later than thirty (30) days from the date of the opinion of counsel referred to above, and shall be subject to Executive’s approval prior to filing, which shall not be unreasonably withheld. The Company, the Bank and Executive agree to be bound by any ruling received from the IRS and to make appropriate payments to each other to reflect any such rulings, together with interest at the applicable federal rate provided for in Section 7872(f)(2) of the Code. Nothing contained herein shall result in a reduction of any payments or benefits to which Executive may be entitled upon termination of employment other than pursuant to Section 12 hereof, or a reduction in the payments and benefits specified in Section 12 below zero.
DESCRIPTION OF CONTRACT MODIFICATION This contract modification is made in accordance with Exhibit E-Revised-1, Contractual Terms and Conditions, Section 22. CHANGES, to be made part hereof for all pertinent purposes. The changes are as follows: