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MEDICAL DENTAL PLAN UMENT

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					                            MEDICAL and Dental PLAN DOCUMENT



      The San Benito Consolidated Independent School District Employee Medical Benefit Plan provides for
      employees during continuance of this Plan, the benefits hereinafter described, in the event they and/or their
      dependent(s) incur medical expenses covered by this Plan.

      The Plan is subject to all the terms, provisions, and conditions recited on the following pages hereof.

      San Benito Consolidated Independent School District has the authority to control and manage
      operation and administration of the Plan as described in the General Provisions section of the
      Medical Plan Document.

      This Plan is to take effect as of 12:01 a.m., standard time, on October 1, 2002, at San Benito, Texas.

      Amended June 18., 2003.




As a non-federal governmental plan, San Benito Consolidated I.S.D. is exercising its privilege to
opt-out of the Health Insurance Portability and Accountability Act (HIPAA) as it relates to
recognizing creditable coverage under a previous medical plan to meet this Plan’s pre-existing
condition requirements.




                                                      H.A.S.
                               HEALTH ADMINISTRATION SERVICES, INC.
                                          P.O. Box 672448
                                     Houston, Texas 77267-2488




                                               1-866-697-5580
                                              Customer Service
                   SAN BENITO CISD – PLAN A SCHEDULE OF MEDICAL BENEFITS
     PLAN PAYS – Eligible Charges are payable by the Plan as follows:                PPO              Non-PPO
                                                                                   Providers          Providers
Physician Office Visits
(Co-Payment applies to all services rendered and billed                            100% after         60% after
by the physicians office. Co-Payment does not apply                                $25 copay          $25 copay
to office/outpatient surgery, prenatal care or physical therapy.)

*Inpatient Hospital Services                                                        80% after      60% after
(Requires Utilization Review - Non-Compliance Penalty is $250)                     $200 copay     $200 copay

All Services Received at Dolly Vinsant Hospital                                      100%

*Outpatient Surgery                                                                 80% after      60% after
                                                                                   $100 copay     $100 copay

 Second Surgical Opinions                                                            100%              100%

 Ambulance                                                                          80% after      60% after
                                                                                   $100 copay     $100 copay

MRI’s and CT Scans                                                                  80% after      60% after
                                                                                   $100 copay     $100 copay

Emergency Room Services/ Urgent Care Facilities                                       80%               60%

Allergy Tests & Treatment (including injections)                                      80%               60%

Pregnancy/PreNatal Care
    First Visit to Diagnose Pregnancy                                              $30 copay            60%
    Subsequent Visits                                                                 $0
Mandatory Participation in Healthy ArrivalS Program- Non compliance PENALTY $500

Birthing Centers                                                                     100%               60%

Maternity Care                                                                        80%               60%

Newborn Well Baby Care (Included with mother’s charges at the time of delivery.)      80%               60%

Inpatient Psychiatric (See Plan Maximums)                                             80%               60%

Inpatient Substance Abuse (See Plan Maximums)                                         80%               50%

Outpatient Psychiatric (See Plan Maximums)                                            80%               50%

Outpatient Substance Abuse (See Plan Maximums)                                        80%               50%

Chiropractic Care (See Plan Maximums)                                                 80%               80%

Home Health Care                                                                      80%               60%


              SAN BENITO CISD – PLAN A SCHEDULE OF MEDICAL BENEFITS
     San Benito CISD                                                1                  October 2002
Skilled Nursing Care (See Plan Maximums) First 10 Days                                                                     100%                   100%
                                         Next 170 Days                                                                      80%                    80%
TMJ Surgery (See Plan Maximums)                                                                                             50%                    50%

Orthognathic Surgery (See Plan Maximums)                                                                                    50%                    50%

Morbid Obesity Surgery (See Plan Maximums)                                                                                  50%                    50%

Routine/Preventive Care Included:(For all covered Persons)                                                             80% to $300            80% to $150
Pap Smears, Mammograms, Routine Physical Exams, Well Baby Care and Immunization,                                      per family per         per family per
Blood Profiles, Cholesterol, Urinalysis, PSA and CSA Test & Sponsored Fair Testing                                    Calendar Year          Calendar Year
Charges.

Specialty Care (Care that can only be provided by a Non-PPO)                                                                None                   80%

All Other Covered Medical Expenses                                                                                          80%                    60%

* Benefits for Eligible Expenses for services rendered in a PPO facility by a "Hospital Based" anesthesiologist,
  assistant surgeon, radiologist or pathologist will be paid at the PPO benefit level.

OUTPATIENT PRESCRIPTION DRUGS (ClaimsPro RX Program)- Covered Person pays the following co-payments:
                  Retail (30 day supply)
                           Generic:                                            $5
                           Preferred Brand                                     $15
                           Non-Preferred Brand                                 $25

                                  Mail Order (90 day supply)
                                         Generic:                                                                            $5
                                         Preferred Brand:                                                                    $10
                                         Non-Preferred Brand:                                                                $25

Prescription medications are filled in accordance with manufacturers recommended dosages.
Outpatient prescriptions filled outside of the RX program are not covered.
PLAN MAXIMUMS – (Per Covered Person)
All Causes Combined ........................................................................................................... $1,000,000
Hospital Room and Board .................................................................................................... Semi-Private Room Rate
Chiropractic Care .................................................................................................................. $450 Per Calendar Year
Preventive Care..................................................................................................................... $300 (In Network ONLY)
TMJ Surgery ......................................................................................................................... $2,000 Lifetime Maximum
Sleep Disorder ...................................................................................................................... $5,000 Lifetime Maximum
Orthognathic Surgery ............................................................................................................ $2,000 Lifetime Maximum
Morbid Obesity Surgery ....................................................................................................... $2,000 Lifetime Maximum
Skilled Nursing Care............................................................................................................. 180 Days Max.Per Calendar Year
Inpatient Mental & Nervous/ Chemical Dependency ........................................................... 20 Days Per Calendar Year
Outpatient Mental & Nervous/ Chemical Dependency ......................................................... 40 Visits Per Calendar Year
Transplants ........................................................................................................................... $200,000
 Charges related to, but which are not a direct procedure of the transplant will be covered under those benefits available
     elsewhere in the Plan.




     San Benito CISD                                                                 2                                        October 2002
           SAN BENITO CISD – PLAN A SCHEDULE OF MEDICAL BENEFITS
                                                                                                 PPO         Non-PPO
OUT-OF-POCKET MAXIMUM                                                                        Providers       Providers
Per Covered Person/Calendar Year                                                                $2,000         $2,400
         Family Maximum/Calendar Year                                                           $4,000         $4,800
Once the out-of-pocket Maximum has been satisfied, eligible expenses are payable at 100% for the remainder of that
Calendar Year. The amount applied towards the out-of-pocket Maximum is a Covered Person's personal payment for
eligible expenses, excluding all of the following:
                                      - Co-Payments;
                                      - Charges beyond usual and customary;
                                      - Expenses for Psychiatric/Chemical Dependency treatment;
                                      - Benefits paid at 100%;
                                      - Ineligible expenses under the Plan;
                                      - Penalty Amounts.
                          Benefits are subject to "Usual, Customary and Reasonable" guidelines.
This is a summary of your medical benefits. All benefit payments are governed by the Master Plan Document.

                                      * * * * CLAIMS FILING DEADLINE * * * *
All claims for eligible expenses must be filed with the Contract Administrator within 12 months following the date
expenses are incurred.


   NOTES:
   Out of Area/Emergency Care – For Covered Persons residing outside the PPO service area or for
   Covered Persons who require emergency care from Non-PPO Provider, benefits will be payable as if the
   Covered Person received treatment in the PPO network.

   All services received from Non-PPO Providers are subject to reasonable and customary limitations.

    Charges received in from non-network ancillary providers (radiologists, pathologists, etc.) received in a
                              PPO hospital will be paid at in-network benefits




   San Benito CISD                                               3                                October 2002
             SAN BENITO CISD – PLAN B SCHEDULE OF MEDICAL BENEFITS
    PLAN PAYS - Eligible Charges are payable by the Plan as follows:                             PPO              Non-PPO
                                                                                               Providers          Providers
Physician Office Visits
(Co-Payment applies to all services rendered and billed by the physicians office. Co-Payment   100% after         60% after
 does not apply to office/outpatient surgery, prenatal care or physical therapy.)              $25 copay          $25 copay

*Inpatient Hospital Services                                                                    80% after    60% after $300
(Requires Utilization Review - Non-Compliance Penalty is $250)                                 $300 copay       copay

All Services Received at Dolly Vinsant Hospital                                                  100%

*Outpatient Surgery                                                                             80% after    60% after $100
                                                                                               $100 copay       copay

Second Surgical Opinions                                                                         100%              100%

Ambulance                                                                                       80% after    60% after $100
                                                                                               $100 copay       copay

MRI’s and CT Scans                                                                              80% after    60% after $100
                                                                                               $100 copay       copay

Emergency Room Services/ Urgent Care Facilities                                                   80%               60%

Allergy Tests & Treatment (including injections)                                                  80%               60%

Pregnancy/Pre Natal Care
    First Visit to Diagnose Pregnancy                                                             $30               60%
    Subsequent Visits                                                                             $0
Mandatory Participation in Healthy ArrivalS Program- Non compliance PENALTY $500

Birthing Centers                                                                                 100%               60%

Maternity Care                                                                                    80%               60%

Newborn Well Baby Care (Included with mother’s charges at the time of delivery.)                  80%               60%

Inpatient Psychiatric (See Plan Maximums)                                                         80%               50%

Inpatient Substance Abuse (See Plan Maximums)                                                     80%               50%

Outpatient Psychiatric (See Plan Maximums)                                                        80%               50%

Outpatient Substance Abuse (See Plan Maximums)                                                    80%               50%

Chiropractic Care (See Plan Maximums)                                                             80%               80%

Home Health Care                                                                                  80%               80%
Hospice Care                                                                                     100%              100%
             SAN BENITO CISD – PLAN B SCHEDULE OF MEDICAL BENEFITS

    San Benito CISD                                                     4                          October 2002
Skilled Nursing Care (See Plan Maximums) First 10 Days                                                                        100%                   100%
                                       Next 170 Days                                                                           80%                    80%

TMJ Surgery (See Plan Maximums)                                                                                                50%                    50%

Orthognathic Surgery (See Plan Maximums)                                                                                       50%                    50%

Morbid Obesity Surgery                                                                                                         50%                    50%

Routine/Preventive Care Included:(For all covered Persons)                                                               80% to $300            80% to $150
Pap Smears, Mammograms, Routine Physical Exams, Well Baby Care and Immunization,                                        per family per          per family per
Blood Profiles, Cholesterol, Urinalysis, PSA and CSA Test & Sponsored Fair Testing                                      Calendar Year           Calendar Year
Charges.

Specialty Care (Care that can only be provided by a Non-PPO)                                                                  None                    80%

All Other Covered Medical Expenses                                                                                             80%                    60%

* Benefits for Eligible Expenses for services rendered in a PPO facility by a "Hospital Based" anesthesiologist,
  assistant surgeon, radiologist or pathologist will be paid at the PPO benefit level.

OUTPATIENT PRESCRIPTION DRUGS (ClaimsPro RX Program)- Covered Person pays the following co-payments:
                  Retail (30 day supply)
                           Generic:                                            $5
                           Preferred Brand                                     $15
                           Non-Preferred Brand                                 $25

                                   Mail Order (90 day supply)
                                          Generic:                                                                              $5
                                          Preferred Brand:                                                                      $10
                                          Non-Preferred Brand:                                                                  $25

Prescription medications are filled in accordance with manufacturers recommended dosages.
Outpatient prescriptions filled outside of the RX program are not covered.
PLAN MAXIMUMS – (Per Covered Person)
All Causes Combined ........................................................................................................... $1,000,000
Hospital Room and Board .................................................................................................... Semi-Private Room Rate
Chiropractic Care .................................................................................................................. $450 Per Calendar Year
Preventive Care..................................................................................................................... $300 (In Network ONLY)
TMJ Surgery ......................................................................................................................... $2,000 Lifetime Maximum
Sleep Disorder ...................................................................................................................... $5,000 Lifetime Maximum
Orthognathic Surgery ............................................................................................................ $2,000 Lifetime Maximum
Morbid Obesity Surgery ....................................................................................................... $2,000 Lifetime Maximum
Skilled Nursing Care ............................................................................................................. 180 Days Max.Per Calendar Year
Inpatient Mental & Nervous/ Chemical Dependency ........................................................... 20 Days Per Calendar Year
Outpatient Mental & Nervous/ Chemical Dependency ......................................................... 40 Visits Per Calendar Year
Transplants ........................................................................................................................... $200,000
 Charges related to, but which are not a direct procedure of the transplant will be covered under those benefits available
     elsewhere in the Plan.




     San Benito CISD                                                                  5                                          October 2002
            SAN BENITO CISD – PLAN B SCHEDULE OF MEDICAL BENEFITS
                                                                                         PPO          Non-PPO Providers
OUT-OF-POCKET MAXIMUM                                                                  Providers
Per Covered Person/Calendar Year                                                        $3,000               $3,400
         Family Maximum/Calendar Year                                                   $6,000               $6,800
Once the out-of-pocket Maximum has been satisfied, eligible expenses are payable at 100% for the remainder of that Calendar
Year. The amount applied towards the out-of-pocket Maximum is a Covered Person's personal payment for eligible expenses,
excluding all of the following:
                                     - Co-Payments;
                                     - Charges beyond usual and customary;
                                     - Expenses for Psychiatric/Chemical Dependency treatment;
                                     - Benefits paid at 100%;
                                     - Ineligible expenses under the Plan;
                                     - Penalty Amounts.
                            Benefits are subject to "Usual, Customary and Reasonable" guidelines.
This is a summary of your medical benefits. All benefit payments are governed by the Master Plan Document.

                                        * * * * CLAIMS FILING DEADLINE * * * *
All claims for eligible expenses must be filed with the Contract Administrator within 12 months following the date expenses
are incurred.

    NOTES:
    Out of Area/Emergency Care – For Covered Persons residing outside the PPO service area or for
    Covered Persons who require emergency care from Non-PPO Provider, benefits will be payable as if the
    Covered Person received treatment in the PPO network.

    All services received from Non-PPO Providers are subject to reasonable and customary limitations.

    Charges received in from non-network ancillary providers (radiologists, pathologists, etc.) received in a
    PPO hospital will be paid at in-network benefits




    San Benito CISD                                               6                                October 2002
                   SAN BENITO CISD PLAN C SCHEDULE OF MEDICAL BENEFITS
    PLAN PAYS - Eligible Charges are payable by the Plan as follows:                             PPO              Non-PPO
                                                                                               Providers          Providers
Physician Office Visits
(Co-Payment applies to all services rendered and billed by the physicians office. Co-Payment   100% after         60% after
 does not apply to office/outpatient surgery, prenatal care or physical therapy.)              $25 copay          $25 copay

*Inpatient Hospital Services                                                                    80% after      60% after
(Requires Utilization Review - Non-Compliance Penalty is $250)                                 $500 copay     $500 copay

All Services Received at Dolly Vinsant Hospital                                                  100%

*Outpatient Surgery                                                                             80% after      60% after
                                                                                               $100 copay     $100 copay

Second Surgical Opinions                                                                         100%              100%

Ambulance                                                                                       80% after      60% after
                                                                                               $100 copay     $100 copay

MRI’s and CT Scans                                                                              80% after      60% after
                                                                                               $100 copay     $100 copay

Emergency Room Services/ Urgent Care Facilities                                                   80%               60%

Allergy Tests & Treatment (including injections)                                                  80%               80%

Pregnancy/Pre Natal Care
    First Visit to Diagnose Pregnancy                                                             $30               60%
    Subsequent Visits                                                                             $0
Mandatory Participation in Healthy ArrivalS Program – Non compliance PENALTY $500

Birthing Centers                                                                                 100%               60%

Maternity Care                                                                                    80%               60%

Newborn Well Baby Care (Included with mother’s charges at the time of delivery.)                  80%               60%

Inpatient Psychiatric (See Plan Maximums)                                                         80%               50%

Inpatient Substance Abuse (See Plan Maximums)                                                     80%               50%

Outpatient Psychiatric (See Plan Maximums)                                                        80%               50%

Outpatient Substance Abuse (See Plan Maximums)                                                    80%               50%

Chiropractic Care (See Plan Maximums)                                                             80%               80%

Home Health Care                                                                                  80%               60%
Hospice Care                                                                                     100%              100%


             SAN BENITO CISD – PLAN C SCHEDULE OF MEDICAL BENEFITS
    San Benito CISD                                                     7                          October 2002
Skilled Nursing Care (See Plan Maximums) First 10 Days                                                                        100%                   100%
                                       Next 170 Days                                                                           80%                    80%

TMJ Surgery (See Plan Maximum)                                                                                                 50%                    50%

Orthognathic Surgery (See Plan Maximum)                                                                                        50%                    50%

Morbid Obesity Surgery                                                                                                         50%                    50%

Routine/Preventive Care Included:(For all covered Persons)                                                               80% to $150             80% to $150
Pap Smears, Mammograms, Routine Physical Exams, Well Baby Care and Immunization,                                        per family per          per family per
Blood Profiles, Cholesterol, Urinalysis, PSA and CSA Test & Sponsored Fair Testing                                      Calendar Year           Calendar Year
Charges.
Specialty Care (Care that can only be provided by a Non-PPO)                                                                  None                    80%

All Other Covered Medical Expenses                                                                                             80%                    60%

* Benefits for Eligible Expenses for services rendered in a PPO facility by a "Hospital Based" anesthesiologist,
  assistant surgeon, radiologist or pathologist will be paid at the PPO benefit level.

OUTPATIENT PRESCRIPTION DRUGS (ClaimsPro RX Program)- Covered Person pays the following co-payments:
                  Retail (30 day supply) After a $100 Deductible:
                           Generic:                                            20%
                           Preferred Brand                                     40%
                           Non-Preferred Brand                                 50%

                                   Mail Order (90 day supply)
                                          Generic:                                                                              $5
                                          Preferred Brand                                                                       $10
                                          Non-Preferred Brand                                                                   $25

Prescription medications are filled in accordance with manufacturers recommended dosages.
Outpatient prescriptions filled outside of the RX program are not covered.
PLAN MAXIMUMS – (Per Covered Person)
All Causes Combined ........................................................................................................... $1,000,000
Hospital Room and Board .................................................................................................... Semi-Private Room Rate
Chiropractic Care .................................................................................................................. $450 Per Calendar Year
Preventive Care..................................................................................................................... $300 (In Network ONLY)
TMJ Surgery ......................................................................................................................... $2,000 Lifetime Maximum
Sleep Disorder ...................................................................................................................... $5,000 Lifetime Maximum
Orthognathic Surgery ............................................................................................................ $2,000 Lifetime Maximum
Morbid Obesity Surgery ....................................................................................................... $2,000 Lifetime Maximum
Skilled Nursing Care ............................................................................................................. 180 Days Max.Per Calendar Year
Inpatient Mental & Nervous/ Chemical Dependency ........................................................... 20 Days Per Calendar Year
Outpatient Mental & Nervous/ Chemical Dependency ......................................................... 40 Visits Per Calendar Year
Transplants ........................................................................................................................... $200,000
 Charges related to, but which are not a direct procedure of the transplant will be covered under those benefits available
     elsewhere in the Plan.




     San Benito CISD                                                                  8                                          October 2002
             SAN BENITO CISD – PLAN C SCHEDULE OF MEDICAL BENEFITS
                                                                                                 PPO            Non-PPO
OUT-OF-POCKET MAXIMUM                                                                         Providers         Providers
Per Covered Person/Calendar Year                                                                $3,500             $3,900
         Family Maximum/Calendar Year                                                           $7,000             $7,800
Once the out-of-pocket Maximum has been satisfied, eligible expenses are payable at 100% for the remainder of that Calendar
Year. The amount applied towards the out-of-pocket Maximum is a Covered Person's personal payment for eligible expenses,
excluding all of the following:
                                    - Co-Payments;
                                    - Charges beyond usual and customary;
                                    - Expenses for Psychiatric/Chemical Dependency treatment;
                                    - Benefits paid at 100%;
                                    - Ineligible expenses under the Plan;
                                    - Penalty Amounts.
                             Benefits are subject to "Usual, Customary and Reasonable" guidelines.
This is a summary of your medical benefits. All benefit payments are governed by the Master Plan Document.

                                         * * * * CLAIMS FILING DEADLINE * * * *
All claims for eligible expenses must be filed with the Contract Administrator within 12 months following the date expenses are
incurred.

     NOTES:
     Out of Area/Emergency Care – For Covered Persons residing outside the PPO service area or for
     Covered Persons who require emergency care from Non-PPO Provider, benefits will be payable as if the
     Covered Person received treatment in the PPO network.

     All services received from Non-PPO Providers are subject to reasonable and customary limitations.

     Charges received in from non-network ancillary providers (radiologists, pathologists, etc.) received in a
     PPO hospital will be paid at in-network benefits




     San Benito CISD                                                9                               October 2002
                                 VOLUNTARY DENTAL PLAN
                                  SCHEDULE OF BENEFITS

AMOUNT (TYPE B & C EXPENSES)

     Individual Deductible Per Calendar Year                                           $ 50
     Family Deductible Per Calendar Year                                               $ 150

PERCENTAGE PAYABLE OF ELIGIBLE CHARGES

     Type A (Preventive) Expenses
           Preventive & Diagnostic Procedures                                          80%
         (includes Sealants for children under
           age 14)

     Type B (Basic) Expenses
          Restorative & Surgical Procedures                                            80%

     Type C (Major) Expenses
          Prosthodontic Procedures                                                     50%


MAXIMUM BENEFIT PAYABLE

     Individual Maximum Per Calendar Year                                             $750


PREDETERMINATION PROVISION

Predetermination of benefits should be made to prevent misunderstandings on amounts payable by the Plan
whenever the treatment plan involves Basic or Major services in excess of $300. Otherwise, a recommended plan of
treatment may not be fully payable.




San Benito CISD                                            10                              October 2002
                                           DEFINITIONS

Terms as used herein shall be deemed to define words that may be used in the wording of the Plan
Document. These definitions shall not be construed to provide coverage under any benefit unless
specifically provided.

A.    GENERAL DEFINITIONS

      1.    Administrator means the employer.

      2.    Ambulatory Surgical Center is an institution or facility, either free-standing or as a part of a
            hospital with permanent facilities, equipped and operated for the primary purpose of
            performing surgical procedures and to which a patient is admitted to and discharged from
            within a twenty-four (24) hour period.

      3.    Amendment is a formal document changing the provisions of the Plan and signed by the
            representative(s) of the Employer or Plan. Amendments apply to all covered persons,
            including those persons who are covered before the amendment becomes effective, unless
            otherwise specified.

      4.    Calendar Year is a period of one (1) year beginning January 1st.

      5.    Case Manager - The person responsible for identifying catastrophic or chronically ill or
            injured individuals, assessing needs and facilitating quality, cost-effective treatment options.

      6.    Co-insurance or co-payment is the percentage or certain dollar amount of eligible expenses
            not payable by the plan that is the responsibility of the employee (exclusive of any
            deductible).

      7.    Contract Administrator means the person or firm employed by the Employer or Plan, who is
            responsible for the processing of claims and payment of benefits, administration, accounting,
            reporting, and other services contracted for by the Plan.

      8.    Contribution means that amount payable by the Employer, the Employee, or the amount
            payable by the Employer and Employee jointly for participation in the benefits of the Plan.

      9.    Creditable Coverage means coverage of an individual that is not followed by a significant
            break in coverage, under any of the following:

            a.    a group health plan (as herein defined);

            b.    health insurance coverage as herein defined (without regard to whether the coverage is
                  offered in the group market, the individual market, or otherwise);

            c.    Part A or Part B of Medicare;

            d.    Medicaid, other than coverage consisting solely of benefits under the program for
                  distribution of pediatric vaccines;
San Benito CISD                                         11                             October 2002
            e.    medical and dental care for members and certain former members of the uniformed
                  services and for their dependents;

            f.    a medical care program of the Indian Health Service or of a tribal organization;


            g.    a State health benefits risk pool;

            h.    a health plan offered under the Federal Employees Health Benefits Program;

            i.    a public health plan, which means any plan established or maintained by a State,
                  County, or other political subdivision of a State that provides health insurance
                  coverage to individuals who are enrolled in the Plan;

            j.    a health benefit plan under the Peace Corps Act.

      10.   Custodial care includes care to meet personal needs and daily living activity needs of an
            individual that could be provided by persons without professional skills or training.

      11.   Deductible means the amount of covered expense that must be incurred by a covered person
            before benefits become payable by this Plan.

      12.   Dentist means a person who is a Doctor of Dental Surgery, (D.D.S.) or Doctor of Dental
            Medicine (D.M.D.) and who is a member of his state Dental Association or eligible for
            membership in such association and shall also include a person who is a Physician as defined
            above.

      13.   Durable Medical Equipment is rental equipment that is medically necessary and appropriate
            for the therapeutic treatment of a covered illness or a covered injury. Durable Medical
            Equipment is normally found in a hospital setting and cannot be considered as a household
            item for use by other family members or for the comfort and convenience of the patient or
            family.

      14.   Eligible Expenses means only the fees and prices regularly and customarily charged for
            medical services and supplies generally furnished for cases of comparable nature and
            severity in the particular geographical area concerned. Any agreement as to fees or charges
            made between the individual and the doctor shall not bind the Fund or Plan in determining its
            liability with respect to expenses incurred. Expense incurred is deemed to be incurred on the
            date on which the service or supply, which gives rise to the expense or charge, is rendered or
            obtained.

      15.   Emergency Surgery is surgery that may not be scheduled at the convenience of the physician
            and the patient without endangering the patient's life or bodily functions. Certification from
            the attending physician will be required to determine if the surgery was an emergency.

      16.   Employer refers to San Benito Consolidated Independent School District

      17.   Exclusions are those charges for which benefits are not provided. Such charges are:
San Benito CISD                                         12                            October 2002
            a.    Those which are listed in "General Exclusions or Limitations"; or

            b.    Those that are not listed as covered expenses.

      18.   Extended Care Facility (Skilled Nursing Facility) means an institution (or a distinct part of
            an institution) which:

            a.    Is primarily engaged in providing for inpatients skilled nursing care and related
                  services for patients who require medical or nursing care, or rehabilitation service for
                  the rehabilitation of injured or sick persons;

            b.    Has policies which are developed with the advice of (and with provision of review of
                  such policies from time to time by) a group of professional personnel, including one or
                  more physicians and one or more registered professional nurses, to govern the skilled
                  nursing care and related medical or other services it provides;

            c.    Has a physician, a registered professional nurse, or a medical staff responsible for the
                  execution of such policies;

            d.    Has a requirement that the health care of every patient must be under the supervision
                  of a physician, and provides for having a physician available to furnish necessary
                  medical care in case of emergency;

            e.    Maintains clinical records on all patients;

            f.    Provides 24-hour nursing service which is sufficient to meet nursing needs in
                  accordance with the policies developed as provided in sub-paragraph (b) above, and
                  has at least one registered professional nurse employed full-time, and one or more
                  Registered Nurses (R.N.), Licensed Vocational Nurses (L.V.N.), or Licensed Practical
                  Nurses (L.P.N.) on duty at all times;

            g.    Provides appropriate methods and procedures for the dispensing and administering of
                  drugs and biologicals;

            h.    Has, in effect, a utilization review plan which provides for the review of admissions to
                  the institution, the duration of stays therein, and the professional services furnished
                  with respect to medical necessity, and for the purpose of promoting the most efficient
                  use of available health facilities and services; and with such review to be made by
                  either a staff committee of the institution composed of two or more physicians or a
                  group similarly composed which is established by the local medical society and some
                  or all of the hospitals and convalescent nursing homes in the locality; and which
                  review provides for prompt notification to the nursing home, the individual, and his
                  attending physician of any finding by the committee or group that any further stay in
                  the nursing home is not medically necessary;

            i.    Is licensed pursuant to any applicable state or local law or is approved by the
                  appropriate state or local agency as meeting the standards established for such
                  licensing;
San Benito CISD                                          13                           October 2002
            j.    Except that such term shall not include any institution which is primarily for custodial
                  care.

      19    Family Status Change is a material change in family member(s) status under which one has no
            control that affects medical benefits for which a person is eligible. Under IRC 125, the federal
            government uses examples of marriage; divorce; birth or adoption of child or placement for
            adoption; death; termination or commencement of employment by the employee's spouse or
            dependent; change in the employee, employee’s spouse or dependents work schedule which
            includes switching from part-time to full-time employment, from full-time to part-time
            employment or strike or lockout; the employee or the employee's spouse taking an unpaid leave
            of absence; a dependent satisfies or ceases to satisfy the requirements for unmarried
            dependents; a change in the place of residence or worksite of the employee, spouse or
            dependent.

      20.   Free-Standing Surgical Facility means a public or private institution, other than private
            offices or clinics of Physicians, which meets the official free-standing surgical facility
            requirements of the State Department of Health or, which in the absence of such
            requirements:

            a.    Has established, equipped, and operated for the purpose of performing surgical
                  procedures by a Physician;

            b.    Have a permanent plant, equipment, and supplies not usually available in the
                  Physician's office for surgical procedures not requiring inpatient confinement;

            c.    Has at least two operating rooms and: 1) has at least one post-anesthesia recovery
                  room; 2) is equipped to perform diagnostic x-ray laboratory examinations required in
                  connection with any surgery performed; and 3) has a blood bank or other blood supply;

            d.    Have full-time services of Registered Nurses (R.N.) for patient care in the operating
                  and post-anesthesia recovery room;

            e.    Has a written agreement with one or more Hospitals in the area for immediate
                  acceptance of patients who develop complications or require post-operative
                  confinement;

            f.    Has an organized medical staff supervising its operation in accordance with established
                  policy, and maintains adequate medical records for each patient.

      21.   Health Care Financing Administration (HCFA) is the federal agency that administers the
            Medicare program.

      22.   Home Health Care Agency means a public or private agency or organization:

            a.    Licensed by the state in which it is located; or

            b.    Accredited by the Joint Commission on the Accreditation of Hospitals or the National
                  League for Nursing/American Public Health Association; or
San Benito CISD                                          14                            October 2002
            c.    Approved by Medicare.

      23.   Home Health Care Plan means a program for continued care and treatment of the Covered
            Person:

            a.    Established and approved in writing by the attending physician; and

            b.    Certified by the attending physician that the proper treatment of the disability would
                  require continued confinement as an inpatient in a hospital in the absence of the
                  services and supplies provided as part of the Home Health Care Plan.

      24.   Hormonal Disorder is the abnormal, inadequate or impaired function of the reproductive
            organs not including diagnoses of menopausal conditions.

      25.   Hospice Home Care Program means a coordinated, inter-disciplinary program approved by
            the terminally ill individual's attending physician and the medical director of a hospice, for
            meeting the special physical, psychological, spiritual, and social needs of:

            a.    An individual who has a life expectancy of less than six (6) months;

            b.    The immediate family of such individual; and

            by providing palliative and supportive medical, nursing, and other health care services for a
            period not to exceed six (6) months.

            A Hospice Home Care Program may be extended for an additional period of six (6) months if
            approved by:

            a.    The terminally ill individual's attending physician; and

            b.    The medical director of a hospice.

      26.   Hospice Home Care Services means:

            a.    Medical treatment given by a physician;

            b.    Intermittent nursing care by a registered professional;

            c.    Part-time or intermittent home health aide services for patient care;

            d.    Physical therapy;

            e.    Nutritional guidance given by a registered nutritionist;

            f.    Drugs and medicines lawfully obtainable only upon the written prescription of a
            physician;

            g.    Blood transfusions and blood which is not donated nor replaced;
San Benito CISD                                         15                                October 2002
            h.    Oxygen and other gases and their administration;

            i.    Dressings;

            j.    Rental of durable medical equipment;

            k.    Medical social services provided by a licensed social worker for the immediate family
                  prior to the death of the terminally ill individual for:

                  1)    Assessment of the social, psychological, and family problems related to or
                        arising out of the terminally ill individual's illness and treatment;

                  2)    Appropriate action and utilization of community resources to assist in resolving
                        such problems; and

                  3)    Participation in the development of treatment for the terminally ill individual.

      27.   Hospital means only an institution constituted and operated pursuant to law, engaged in
            providing on an inpatient basis at the patient's expense diagnostic and therapeutic facilities
            for the surgical and medical diagnosis, treatment, and care of injured and sick individuals by
            or under the super-vision of licensed physician and surgeon and continuously provides 24-
            hour a day services by registered nurses. A Birthing Center that has an Obstetrician
            Consultant and Certified Nurse-Midwives on its staff will be considered as a hospital. The
            term "Hospital" shall not include an institution or any part thereof, which is other than
            incidentally a place for rest, a place for the aged, or a nursing home or convalescent hospital
            or hotel. However, an institution specializing in the care and treatment of mentally ill and/or
            chemically dependent patients and licensed as an acute care facility or immediate care
            facility (residential treatment facility), or which would qualify under this definition as a
            hospital, except solely for the fact that it lacks organized facilities on its premises for major
            surgery and has limited need for round the clock services, shall nevertheless be deemed a
            hospital under the Plan.

      28.   Illness shall mean bodily sickness or disease, psychiatric disorders, and congenital
            abnormalities of the newborn child. Illness must be medically diagnosed and receive
            treatment by a physician.

      29.   Injury is a condition that results independently of sickness and all other causes, and is a
            result of an externally violent force.

      30.   Intensive Care Unit is a section, ward, or wing within a hospital which is operated
            exclusively for critically ill patients and provides special supplies, equipment, and constant
            observation and care by registered graduate nurses or other highly trained hospital personnel,
            excluding however, any hospital facility maintained for the purpose of providing normal
            postoperative recovery treatment or service.

      31.   Investigational or Experimental Treatment includes (but is not limited to) any developmental
            treatment, including drugs, related to any protocol or procedure which requires the patient to

San Benito CISD                                          16                             October 2002
            sign an informed consent which advises them of the research status or for which the protocol
            is titled "research".
      32.   Life Threatening Illness or Injury is an illness or injury requiring immediate attention, in
            order to stabilize an acute condition, to prevent loss of life or bodily function.

      33.   Maintenance Care - All services, equipment, and supplies which are provided solely to
            maintain a patient's condition at the level to which it is restored or stabilized and from which
            no practical improvement can be expected.

      34.   Med-Watch - H.A.S.'s utilization review program. Assists with management of all stages of
            inpatient and/or outpatient surgical and extended care cases.

      35.   Medical Case Management - is a program that reviews the specific needs of those patients
            whose conditions are indicative of long-term or high dollar medical care. The goal is to
            provide the necessary care in the most cost-effective manner possible. Each case requires a
            treatment plan specifically designed to meet the patient's individual needs and situation. It is
            the responsibility of the Case Manager to ascertain the specific needs of the cases, to assist
            the patient in obtaining quality services, and to ensure that these services are rendered in the
            most appropriate and cost effective setting for covered expenses.

      36.   Medical Child Support Order – means any judgement, decree, or court order (including
            approval of a settlement agreement) which (i) provides for child support with respect to a
            child of a Participant under the Plan or provides for health benefit coverage to such a child,
            is made pursuant to a state domestic relations law (including a community property law), and
            relates to benefits under this Plan, or (ii) enforces a state law relating to medical child
            support described in Section 1908 of the Social Security Act with respect to this Plan;
            provided, however, that such judgement, decree, or court order is issued by a court of
            competent jurisdiction or issued through a state administrative process and has the force and
            effect of state law.

      37.   Medical Necessity - Care which is: 1) the appropriate therapeutic procedure, service, or
            supply used in the medical treatment of disease or injury; 2) in accordance with generally
            accepted standards of medical practice; 3) not primarily for the convenience of the covered
            person, physician, or another provider; 4) the most appropriate supply or level which can be
            provided (for inpatient stays, this means acute care is necessary due to the kinds of services
            the covered person is receiving or the severity of the covered person's condition and that safe
            adequate care cannot be received on an outpatient basis).

      38.   Medicare means Title XVIII (Health Insurance for the Aged) of the United States Social
            Security Act as amended by Social Security Amendment of 1965 or as later amended.

      39.    The Name of the Plan is the San Benito Consolidated Independent School District Employee
             Medical Benefit Plan.

      40.   Nurse means a Registered Graduate Nurse (R.N.), a Licensed Vocational Nurse (L.V.N.), an
            Advanced Practice Nurse (A.P.N.), or a Licensed Practical Nurse (L.P.N.).




San Benito CISD                                         17                             October 2002
      41.   Nurse Midwife means a licensed Registered Nurse who is certified as a Nurse Midwife by
            the American College of Nurse-Midwives and is authorized to practice as a Nurse Midwife
            under state regulations.

      42.   Occupational Therapy is therapy provided by an occupational therapist directed at improving
            impaired concentration, attention span, thought organization, problem solving, visual-spatial
            relationships, eye-motor coordination and sensory integration or any combination of the
            above.

      43.   Out-of Area Care is defined as treatment, for conditions of a non-predetermined diagnosis,
            received in a Non-PPO hospital (as an inpatient or in the hospital emergency room) which is
            in a geographical area farther than 50 miles from the nearest PPO hospital. Treatment
            includes all ancillary services including radiology, pathology, and anesthesiology obtained
            on the same day as the hospital charges. (For example, applicable to dependent students and
            covered persons on vacation.)

            Furthermore, this Plan allows persons to enroll in the out-area plan (as shown on the
            schedule of benefits) if the employee resides in an area that is not within 50 miles of a PPO
            provider or hospital.

      44.   Out-of-Pocket Maximum - Once the employee accumulates personal payments on a covered
            person for eligible expenses in the amount stated in the Schedule of Benefits (excluding
            charges beyond usual and customary, deductibles, co-payments, expenses for
            psychiatric/chemical dependency, benefits paid at 100%, chiropractic charges and penalty
            amounts), the Plan will pay 100% of eligible expenses thereafter in the calendar year, unless
            otherwise stated.

      45.   Outpatient means a Covered Person who is treated at a hospital and confined less than
            twenty-four (24) consecutive hours.

      46.   Period of Disability as it applies to an individual means all periods of disability arising from
            the same causes, including any and all complications therefrom, except that if the individual
            completely recovers or returns to active full-time employment, any subsequent period of
            disability from the same cause shall be considered a new disability.

            For Covered Dependents, the term "Period of Disability" as it applies, means all periods of
            disability arising from the same cause including any and all complications therefrom, except
            that if the Dependent recovers for a period of six months and throughout such period is
            capable of resuming the normal activities of a person in good health and of the same age and
            sex, any subsequent period of disability from the same cause shall be considered a new
            period of disability.

      47.   Physical Therapy is therapy directed for treatment of disease or injury by physical agents and
            methods to assist in rehabilitation and restoration normal bodily functions, that have been
            significantly impaired due to an acute illness, injury or congenital defect for which surgery
            has been performed, subject to established administrative guidelines.

      48.   Physician means only a person acting within the scope of his license and holding the degree
            of Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Doctor of Dental Surgery
San Benito CISD                                         18                             October 2002
            (D.D.S.), Doctor of Podiatry (D.P.M.), Doctor of Optometry (O.D.), Doctor of Chiropractic
            (D.C.), Physician Assistant, (P.A.), Surgical Assistant, (S.A.), Psychologist (Ph.D.), and
            Master's Level Psychotherapists who hold the certification of LMSW (Licensed Masters in
            Social Work) or LPC (Licensed Professional Counselor) and are eligible for memberships in
            his/her respective society or association.

      49.   Plan is the provisions for coverage and payment of benefits as described herein.

      50.   Plan Sponsor (Plan Administrator) means San Benito Consolidated Independent School
            District

      51.   Pre-Authorization is the process of evaluating the medical necessity of potential cosmetic
            procedures and determining plan coverage.

      52.   Pre-Certification is the process of evaluating the plan and place of care before routinely
            scheduled or urgent services are provided.

      53.   Pre-Determination is the process of determining the allowable physician fees for surgical
            procedures covered by the benefit plan.

      54.   Pre-Existing Condition is a condition for which the individual received medical treatment,
            diagnosis, consultation, or prescription drugs within the six (6) month period immediately
            preceding the effective date of coverage under the Plan for that Covered Person.

      55.   Preferred Provider Organization (PPO) is a group of medical providers (doctors and/or
            hospitals) who, as a group or individually, agree to specified fee schedules and cost
            containment procedures in the delivery of health care and are named by the Administrator as
            participating in the Plan.

      56.   Pregnancy includes 1) all pregnancies except extra-uterine, which are considered to be
            genito-urinary conditions; 2) childbirth; 3) miscarriage; or 4) any complications arising
            wholly from these conditions; and 5) any pregnancy complications arising from any trauma.

      57.   Prior Medical Plan means the medical plan(s) offered by an employer that was terminated.

      58.   Psychiatric Conditions are those conditions or illnesses that are numerically listed from
            290.0 through 314.9 in either a DSM III-R (Diagnostic and Statistical Manual of mental
            Disorders, Third Edition Revised) diagnosis code or an ICD-9 CM (International
            Classification of Diseases 9th Revision Clinical Modification) codes for Mental Disorders.

      59.   Room and Board includes bed, linens, meals, special diets, standard nursing services, social
            services, dietary services, including dietary instructions, use of hospital equipment,
            transportation within the hospital, and any other services regularly furnished by the hospital
            as a condition of being hospitalized.

      60.   Semi-private is a hospital room containing two (2) beds, but does not include the charge
            made by the hospital for Intensive Care.



San Benito CISD                                        19                             October 2002
      61.   Significant Break in Coverage means a period of sixty-three (63) (or more) consecutive days
            without Creditable Coverage. Periods of no coverage during an HMO affiliation period or
            Waiting Period shall not be taken into account for purposes of determining whether a
            Significant Break in Coverage has occurred.

      62.   Special Enrollee means an Employee or Dependent who is entitled to and who requests
            Special Enrollment: a) within thirty (30) days of losing other health coverage; or b) for a
            newly acquired Dependent, within thirty (30) days of the marriage, birth, adoption, or
            placement for adoption.

      63.   Special Enrollment Date - If an eligible Employee or Dependent declined coverage hereunder
            at the time of initial eligibility (and stated in writing at that time that coverage was declined
            because of alternative health coverage) but subsequently loses coverage under the other
            health plan and makes application for coverage hereunder within thirty (30) days of the loss,
            such individual shall be a Special Enrollee provided such person: (a) was under a COBRA
            continuation provision and the coverage under such provision was exhausted; or (b) was not
            under such a provision and either the coverage was terminated as a result of loss of eligibility
            for the coverage (including as a result of legal separation, divorce, death, termination of
            employment, reduction in the number of hours of employment) or employer contributions
            toward such coverage were terminated. Individuals who lose other coverage due to
            nonpayment of premium or for cause (e.g., filing fraudulent claims) shall not be Special
            Enrollees hereunder. An eligible Employee or Dependent who seeks to enroll in the Plan as
            a result of the acquisition of a new Dependent through marriage, birth, adoption, or
            placement for adoption shall be a Special Enrollee hereunder, if the eligible Employee or
            Dependent enrolls within thirty (30) days of the acquisition of the new Dependent.

            Coverage for a Special Enrollee (other than a Newborn or newly adopted child) shall begin
            as of the first day of the calendar month following the enrollment request. Coverage for a
            newly adopted child or Newborn Special Enrollee shall begin as of the date of the adoption,
            birth or placement of adoption.

      64.   TEFRA means the Tax Equity and Fiscal Responsibility Act of 1982, or as later amended.

      65.   Terminally Ill - A life expectancy of six (6) months or less.

      66.   Total Disability shall mean that the Covered Employee is prevented, solely because of a non-
            occupational injury or non-occupational disease, from engaging in his regular or customary
            occupation and is performing no work of any kind for compensation or profit, or if a Covered
            Dependent or Retired Employee is prevented solely because of a non-occupational injury or
            non-occupational disease, from engaging in all of the normal activities of a person of like age
            and sex and in good health.

            In the case of a Dependent, the term “Total Disability” means a physical state of the
            Dependent resulting from a non-occupational illness or non-occupational injury which
            wholly prevents such Dependent from performing the normal activities of a person of like
            age and sex in good health; however, a Dependent who is normally gainfully employed will
            not be deemed Totally Disabled if he is engaging in any occupation or employment for which
            he is, or becomes qualified by education, training, or experience, and a Dependent who is

San Benito CISD                                          20                             October 2002
                normally a student will not be deemed Totally Disabled if he is attending an educational
                institution on a full-time or part-time basis.

      67.       Treatment is any specific procedure that is medically necessary and used for the cure or
                improvement of an illness, disorder, or injury.

      68.       Usual, Customary, and Reasonable
                a.   The usual charge is the most consistent charge by a physician or provider of service to
                     patients for a given service;

                b.     A charge is customary when it is within the range of usual charges for a given service
                       billed by most physicians or providers of services with similar training and experience;

                c.     A charge is reasonable when it meets the usual and customary criteria as determined by
                       the Plan; or it may be reasonable, if upon review, it merits special consideration based
                       on the nature and extent of treatment of the particular case;
                d.     A usual, reasonable, and customary charge for a surgical procedure includes the total
                       amount allowable as an eligible expense under the Plan for the surgery, hospital visits,
                       and post-operative visits following the surgical procedure by the doctor performing the
                       surgery and/or any associates, partners, or affiliated physicians;

                e.     A usual, reasonable, and customary charge is based on the geographical area in which
                       services were provided; geographical area is a country or greater area as necessary to
                       establish a representative cross-section of persons or other entities regularly furnishing
                       the services.

      69.       Utilization Review (Med-Watch) is the review of a hospital confinement by the Plan both
                prior to the date of such confinement and during such confinement.

      70.       Waiting Period means the term that must pass under this Plan (or for purposes of determining
                Creditable Coverage, or any other health plan) before an Employee or Dependent is eligible
                to enroll in the Plan (or other health plan as the case may be). Notwithstanding the
                foregoing, the time between the date a Late Enrollee or Special Enrollee first becomes
                eligible for enrollment under the Plan and the first day of coverage shall not be treated as a
                Waiting Period.


B.    DEFINITIONS OF PARTICIPANTS

      1.        Persons eligible for coverage:

           a.        An Employee is a person in a permanent status (as defined by the employer) and who is
                     regularly scheduled to work at least thirty (30) hours per week.

           b.        Dependent is the legal spouse or eligible UNMARRIED child of a Covered Employee who
                     is enrolled in the Plan.

                     A child may be covered from birth to his/her 19th birthday provided the child is dependent
                     upon his/her parents for support and maintenance. The term "child" shall include a natural
San Benito CISD                                              21                             October 2002
                  child or an adopted child. A child to be acquired by adoption is eligible for coverage upon
                  proof of physical placement in the custody of the employee. It shall also include a foster
                  child, stepchild, or grand child who is: 1) dependent upon the employee for support and
                  maintenance; and 2) resides with the employee in a parent-child relationship; and 3) under
                  the legal guardianship or managing conservatorship of the employee. It will also include
                  any child for whom an employee (or employee’s spouse in absence of other coverage
                  available) is responsible for coverage by court order provided the child meets all other
                  provisions for coverage and eligibility in the Plan. If the child is a newborn, the child is
                  covered from birth as would be a natural child.

                  Such term shall also include a child from his/her 19th birthday to their 23rd birthday
                  providing he/she is: 1) attending an institution recognized as a school on a full-time basis
                  (12 semester hours or more) or (9 hours for graduate students); and 2) is dependent upon
                  the Covered Employee for support and maintenance; and 3) is not employed on a full-time
                  basis; and 4) has the same permanent home address as the employee.

                  Documentation of full-time student verifying registration for at least twelve (12) semester
                  hours (9 hours for graduate) must be submitted each semester. One of the following
                  documents is acceptable:
                          1.      A copy of the student’s grade report for the semester;
                          2.       A copy of the student’s registration for the semester; or
                          3.       A letter from the school confirming full-time student status for the
                                   semester.

                  Such term shall also include a dependent child after his/her 19th birthday, provided the
                  child becomes, (while covered under this plan,) incapable of self-sustaining employment
                  by reason of mental retardation (but not mental illness) or total disability as defined by the
                  Plan, and continues to be dependent upon the covered employee for support and
                  maintenance. Proof of such incapacity or dependence must be furnished to the plan by the
                  Covered Employee within 31 days after the child's birthday and at reasonable intervals as
                  determined by the Contract Administrator.

                          Excluded as dependents are any person(s):

                          1.       That are full-time students between the age of 19 and 23 who become
                                   totally disabled (these dependents would be eligible for contribution of
                                   coverage under COBRA);

                          2.       While on active military duty for any country;

                          3.       Resides outside the United States or Canada.

      2.    Actively At Work - An Employee will be considered Actively at Work with the Employer on
            a day which is one of the Employer's scheduled work days if he is performing in the
            customary manner all of the regular duties of his employment with the Employer on a full-
            time basis on that day, either at one of the Employer's business establishments or at some
            location to which the Employer's business requires him to travel.


San Benito CISD                                            22                              October 2002
            An Employee will be considered Actively at Work on a day which is not one of the
            Employer's scheduled work days if he was performing in the customary manner all of the
            regular duties of his employment on the preceding scheduled work day.

            An Employee will be considered Actively at Work on any day when on pay status while
            using earned sick leave.

      3.    COBRA Participant is an individual who was covered under this group medical plan as an
            active employee or dependent and who was affected by a qualifying event when coverage
            would normally end (such as termination of employment), but elected continuation of
            medical coverage according to the provision of the law.

      4.    Contribution means the amount payable by the Employer, the amount payable by the
            Employee or the amount payable by the Employer and Employee jointly for participation in
            the benefits of the Plan.

      5.    Covered Employee is an Employee who is eligible for coverage and who has enrolled in the
            Plan.

      6.    Covered Person is a Covered Employee, Covered Dependent, or Covered COBRA
            Participant who has enrolled in the Plan.

      7.    Enroll is to make written application for coverage on the prescribed forms. Enrollment is not
            completed until such forms are received by the Employer.

      8.    Late Enrollee is a person who made application after 30 days from the initial eligibility
            period or who reapplies for coverage after coverage on such person was terminated on action
            of the employee. This does not include any individuals who become dependents through
            marriage, birth, or adoption. This also does not include an eligible dependent who the
            employee elected not to cover because such person(s) had coverage elsewhere, but later lost
            such coverage due to a family status change (as determined by the employer) and such
            person(s) were enrolled within thirty (30) days following such loss of coverage as a result of
            the family status change. Such person(s) is subject to the pre-existing conditions limitations
            as a Special Enrollee (i.e., a newly Covered Person).

      9.    Qualifying Retiree is an employee of the District who retired prior to 1998 and has
            maintained uninterrupted coverage on the medical plan since that time. These individuals
            are grand fathered under the current plan. No future retirees will be covered under the
            District’s medical plan.




San Benito CISD                                        23                             October 2002
                                             ELIGIBILITY


The "Date of Eligibility" is the first day of employment. The Date of Eligibility for dependents is the same
as the employee, except in the case of newly acquired dependents, then the Date of Eligibility is the date
such dependent is acquired.

“Eligibility Period” is the thirty (30) day period following the Date of Eligibility or the thirty-one (31) day
period following a Family Status Change.

The “Effective Date” is the date of hire.

                  ENROLLMENT AND EFFECTIVE DATES PROVISIONS
All persons shall become Covered Persons subject to the following:

A.      All eligible Employees may be "Covered Employees" provided they are Actively at Work on the
        date of eligibility. All eligible Dependents may be covered simultaneously with employees. In not
        event will a dependent become effective prior to an Employee. Qualifying Retirees are also eligible
        under the Plan.

B.      The employee and/or any dependent coverage is effective on the Date of Eligibility provided that
        enrollment is made within the thirty (30) day Eligibility Period.

        If enrollment (for employee or dependent) is not made within the thirty (30) day eligibility period or
        within thirty-one (31) days following a family status change (such as marriage, birth of a child,
        involuntary change of employment or involuntary reduction hours), such person will not be eligible
        to enroll for coverage until the next annual enrollment period (as established by the Employer).

C.      According the Omnibus Budget Reconciliation Act of 1993, a dependent child may be covered by a
        Qualified Medical Child Support Order (QMCSO), in which case the employee is responsible for
        the cost of the dependent coverage as ordered by the QMCSO.

D.      No person will be eligible for coverage under this plan simultaneously as both a covered Employee
        and a dependent or as a covered dependent of more than one Employee. If husband and wife are
        both eligible to have dependents covered, a dependent child or dependent children otherwise
        eligible for coverage may be covered as dependents of the husband or dependents of the wife, but
        not both.

E.      LATE ENROLLEE

        If you do not enroll yourselves or your eligible dependents within 31 days following your benefit
        effective date and subsequently enroll, you are classified as a Late Enrollee.

F.     SPECIAL ENROLLMENT DATE

      If an eligible employee or Dependent declined coverage hereunder at the time of initial eligibility
      (and stated in writing at that time that coverage was declined because of alternative health

San Benito CISD                                           24                              October 2002
      coverage) but subsequently loses coverage under the other health plan and makes application for
      coverage hereunder within thirty (30) days of the loss, such individual shall be a Special Enrollee
      provided such person: (a) was under a COBRA continuation provision and the coverage under
      such provision was exhausted; or (b) was not under such a provision and either the coverage was
      terminated as a result of loss of eligibility for the coverage (including as a result of legal
      separation, divorce, death, termination of employment, or reduction in the number of hours of
      employment) or employer contributions toward such coverage were terminated. Individuals who
      lose other coverage due to nonpayment of premium or for cause (e.g., filing fraudulent claims)
      shall not be Special Enrollees hereunder. An eligible employee or Dependent who seeks to enroll
      in the Plan as a result of the acquisition of a new Dependent through marriage, birth, adoption, or
      placement for adoption shall be a Special Enrollee hereunder if the eligible employee or Dependent
      enrolls within thirty (30) days of the acquisition of the new Dependent.

      Coverage for a Special Enrollee (other than a Newborn or newly adopted child) shall begin as of
      the first day of the calendar month following the enrollment request. Coverage for a newly
      adopted or newborn Special Enrollee shall begin as of the date of the adoption, birth or placement
      for adoption.

F.    REINSTATEMENT FOLLOWING ACTIVE MILITARY DUTY

      With respect to any Plan Participant who receives orders to perform active duty in the Armed
      Forces of the United States, such person shall, upon resumption of employment, be immediately
      restored to the same eligibility status he held as of the last day he was Actively-at-Work, provided
      all of the following conditions are met:

      1.    The plan participant must have left employment for the purpose of entering active duty; and

      2.    The plan participant must serve satisfactorily and receive an honorable discharge; and

      3.    The plan participant must apply for re-employment within:

            a.    Thirty (30) days after release from active duty if activated under the Presidential call-
                  up authority; or

            b.    Ninety (90) days after release from active duty in all other cases; and

      4.    The plan participant’s total amount of active duty (other than training duty) cannot exceed
            five years, unless extended by the period of time the President authorizes the call-up of
            reserve units or individuals, or the individual is unable to obtain orders for release from
            active duty.

            Such Plan Participants returning from active military duty will receive credit toward the Pre-
            Existing Conditions provision for any time periods previously satisfied under this Plan
            (and/or the prior plan of the Plan Administrator which this Plan replaced) prior to military
            service. Dependents of such participants are not eligible under this provision and will be
            subject to all Plan provisions including the Pre-Existing Conditions limitation.

G.    INCONTESTABILITY

San Benito CISD                                         25                             October 2002
      In the absence of fraud, all statements contained in a written application made by a participant are
      considered representations and not warranties. Coverage can be voided or benefits reduced:

      1.    during the first two (2) years, for material misrepresentation contained in a written
            enrollment form;

      2.    after two (2) years, for a fraudulent misstatement contained in a written enrollment form.




San Benito CISD                                         26                            October 2002
                     TERMINATION OR CHANGE OF COVERAGE


A.    EMPLOYEE TERMINATION

      An Employee’s Coverage shall automatically terminate immediately upon the earliest of the
      following dates:

      1.    Last day of the month following the employee’s date of termination of employment; or

      2.    Date the employee ceases to be in a class of employees eligible for the coverage; or

      3.    Date the employee fails to make any required contribution for coverage; or

      4.    Date the Plan is terminated; or with respect to any employee benefits of the Plan, the date of
            termination of such benefit; or

      5.    Date the Plan Administrator terminates coverage for the employee; or

      6.    Date the employee dies.

      For the purpose of coverage under this Plan, an employee’s employment is considered to terminate
      on the date he ceases active work with the Plan Administrator, except as follows:

      1.    If absent from work because of illness or injury, coverage may be continued until terminated
            by the District (but no longer than six (6) months) provided such covered employee makes
            the required contributions;

      2.    If absent from work because of approved leave of absence or using donated sick days from
            sick leave bank or temporary lay-off, coverage may be continued until terminated by the
            Company (but no longer than six (6) months) provided such covered employee makes the
            required contributions.

      Continuation of Coverage During Family and Medical Leave: Regardless of the established
      leave policies of the District, the Plan shall at all times comply with the Family and Medical Leave
      Act of 1993 as outlined in regulations issued by the Department of Labor. During any leave taken
      under the Family and Medical Leave Act, the District will maintain coverage under this Plan on the
      same basis as coverage would have been provided if the participant had been continuously
      employed during the entire leave period.


B.    DEPENDENT TERMINATION

      The dependent coverage of an employee shall automatically terminate upon the earliest of the
      following dates;

      1.    Date the Dependent ceases to be an eligible Dependent as defined by the Plan; or
San Benito CISD                                         27                            October 2002
      2.    Date of termination of coverage for the employee under the Plan; or

      3.    Date the employee ceases to be in a class of employees eligible for Dependent coverage; or

      4.    Date of the end of the last pay period in which contribution ceases; or

      5.    Date the Plan is terminated; or with respect to any benefits for Dependents under the Plan,
            the date of termination of such benefits; or

      6.    Date the Plan Administrator terminates coverage for Dependents; or

      7.    Date the employee dies.


      Special Situations, Extension of Coverage: If a Dependent child is physically or mentally
      handicapped on the date coverage would otherwise cease, the child’s eligibility will be extended
      for as long as the employee is covered by this Plan, the handicap continues and the child continues
      to qualify for coverage in all aspects other than age. The Plan may require the employee at any
      time to obtain a physician’s statement certifying the physical or mental handicap.




San Benito CISD                                         28                            October 2002
        CONTINUATION OF COVERAGE IN COMPLIANCE WITH COBRA
            (Consolidated Omnibus Budget Reconciliation Act of 1985)

Coverage may be continued for a covered Employee and any Dependents covered at the time of cessation of
coverage under the following provisions:

A.      As long as the Employee makes a contribution as determined by the Employer.

B.      As long as the Employee is on an approved leave of absence as determined by the Employer and
        makes a contribution as determined by the Employer.

C.     COBRA is a federal law which requires that most employers sponsoring group health plans offer
       covered Employees and their covered family members the opportunity for a temporary extension of
       health coverage (called “continuation coverage”) at group rates in certain instances where coverage
       under the Plan would otherwise end. COBRA has been amended several times since it was
       originally enacted. This notice is intended to inform all participants in the Plan, in a summary
       fashion, of their rights and obligations under the continuation coverage provisions of COBRA, as
       amended, and where in conflict or differing from COBRA, COBRA shall govern.

Eligibility and Length of Coverage

No qualified beneficiary is eligible for continuation coverage if he/she is covered under another
group plan when the coverage is lost.

“Qualified Beneficiary” may be an Employee, Spouse, or children under the law as follows:

                                                  Employee

If you are an Employee covered by one of the Group Health Plans, you have a right to choose this
Continuation coverage for up to 18 months if you lose your group health coverage because of a
reduction in your hours of employment or the termination of your employment (for reasons other
than gross misconduct on your part).

Possible extension of 18-month period due to disability: If the Social Security Administration determines
that you were disabled at any time during the first 60 days of continuation of coverage and you inform your
Employer before the end of the 18-month period, your coverage may be extended up to 29 months. The 29-
month extension period also applies to non-disabled family members covered under COBRA. The
qualified beneficiary must notify the Employer within 30 days of any final determination that he/she is no
longer disabled. If, during the initial 18 months, another event takes place that also entitles you to coverage,
coverage may be extended. In no case may the total amount of continued coverage last beyond 36 months
from the date of the event that originally made a qualified beneficiary eligible to elect coverage.

                                                    Spouse

If you are the spouse of an Employee covered by one of the Group Health Plans, you have the right
to choose continuation of coverage for the following lengths of time if you lose group health
coverage under the plan for any of the following four reasons:

San Benito CISD                                            29                             October 2002
Continuation up to 18 months:

1.      A termination of your spouse’s employment (for reasons other than gross misconduct) or reduction
       in your spouse’s hours of employment.

Continuation up to 36 months:

2.      The death of your spouse;

3.      Divorce or legal separation from your spouse; or

4.      Your spouse (a qualified beneficiary Employee) becomes entitled to Medicare.

Possible extension of 18-month period due to disability: If the Social Security Administration determines
that you were disabled at any time during the first 60 days of continuation coverage and you inform your
Employer before the end of the 18-month period, your coverage may be extended up to 29 months. The 29-
month extension period also applies to non-disabled family members covered under COBRA. The qualified
beneficiary must notify the Employer within 30 days of any final determination that he/she is no longer
disabled. If, during the initial 18 months, another even takes place that also entitles you to coverage,
coverage may be extended. In no case may the total amount of continued coverage last beyond 36 months
from the date of the event that originally made a qualified beneficiary eligible to elect coverage.

                                                 Children

In the case of a Dependent child of an Employee covered by one of the Group Health Plans, for the
following lengths of time he or she has the right to continuation of coverage if group health coverage under
the plan is lost for any of the following five reasons:

Continuation up to 18 months:

1.    The termination of a parent/employee’s employment (for reasons other than gross
       misconduct) or reduction in a parent/employee’s hours of employment with the Employer;

2.      The termination of a parent/Employee;

3.      The parent/employee’s divorce or legal separation;

4.      The Dependent ceases to be a “Dependent child” as defined in the Plan;

5.      A parent becomes entitled to Medicare.

Possible extension of 18-month period due to disability: If the Social Security Administration determines
that you were disabled at any time during the first 60 days of continuation coverage and you inform your
Employer before the end of the 18-month period, your coverage may be extended up to 29 months. The 29-
month extension period also applies to non-disabled family members covered under COBRA. The qualified
beneficiary must notify the Employer within 30 days of any final determination that he/she is no longer
disabled. If, during the initial 18 months, another even takes place that also entitles you to coverage,
coverage may be extended. In no case may the total amount of continued coverage last beyond 36 months
from the date of the event that originally made a qualified beneficiary eligible to elect coverage.
San Benito CISD                                            30                          October 2002
 A qualified beneficiary also includes a child who is born to or placed for adoption with the covered
 Employee.

 There is no conversion coverage available at the time your continuation coverage ends.

 Continuation of Coverage May Cease

 However, the continuation of coverage for any individual will terminate for any of the following
 five reasons:

 1.      The Employer no longer provides group health coverage to any of its Employees;

 2.      The premium for the continuation of coverage is not paid in a; timely fashion;

 3.      A qualified beneficiary becomes covered under another group health plan unless that plan
         contains any exclusions or limitations with respect to any pre-existing conditions the qualified
         beneficiary may have;

 4.      You become entitled to Medicare;

 5.      You extended coverage for up to 29 months due to your disability and there has been a final
         determination that you are no longer disabled; in this case, continuation of coverage will also
         cease for non-disabled family members.

 Notification and Election

 An Employer must inform an Employee’s beneficiaries of their right of continuation of coverage
 within 14 days of notification of the following events:

        Employee’s termination of employment
        Employee’s death
        Employee’s Medicare entitlement

 The covered Employee or qualified beneficiary must notify the Employer within 60 days of the
 Following qualifying events:

        divorce or legal separation
        a Dependent child becoming ineligible
        a disability determination by Social Security

Within 14 days of the above notifications, the Employer will notify the beneficiaries of their COBRA
rights. Any notification to an Employee who is a qualified beneficiary is treated as notification to the
covered spouse. Notification to the covered spouse is deemed notification to the covered Dependents.
The Employee/beneficiary has 60 days from the later of the loss of coverage or the day on which
notification is sent to elect continuation of coverage.

If continuation of coverage is not elected, your group health coverage will end. The Employer
must be notified in writing of any change in address due to:
 San Benito CISD                                          31                              October 2002
1.      Loss of coverage to spouse and child due to death of Employee;

2.      Loss of coverage to Employee and family due to termination of Employee’s employment;

3.      Change of marital status;

4.      General address change.

Type of Coverage

If you choose continuation of coverage, the Employer is required to offer you coverage which, as
of the time coverage is being provided, is identical to the coverage provided under the Plan to
similarly situated Employees or family members.

You Pay Premiums

You do not have to show that you are insurable to choose continuation coverage. However, you have to
pay the entire premium for your continuation coverage; you have a grace period of at least 30 days to pay
the premium. If an election is made after the qualifying event, the Plan will permit payment for
continuation of coverage during the period preceding the election to be made within 45 days of the date
of the election.




San Benito CISD                                        32                            October 2002
                   PRE-EXISTING CONDITIONS LIMITATIONS

Covered Employees will not be entitled to reimbursement for eligible medical expenses that are
incurred as a result of an injury or sickness or a related injury or sickness for which the Covered Person
has consulted with a physician or received any medical care, treatment or services, medications or
prescriptions within the six (6) month period immediately preceding the effective date of his coverage,
until the first of one of the following events occurs:

A.    Twelve (12) consecutive months ending on or after the date the coverage is effective for the
      Covered Employee, and during which period the Covered Person has not received medical care,
      treatment, services, medications, or prescriptions with respect to such injury or illness.

B.    After a Covered Employee has been continuously enrolled in the Plan concurrently for twelve
      (12) consecutive months.

The pre-existing conditions limitations will not apply to:
      A. Newborns enrolled in the Plan within 30days of their birth
      B. Newly adopted children under age 18 who are enrolled within 30 days upon proof of physical
          placement in the covered employees home.


As a non-federal government plan, San Benito Consolidated Independent School District is exercising its
privilege to opt-out of the Health Insurance Portability and Accountability Act (HIPAA) effective
January 1, 1998, as it relates to recognizable creditable coverage under a previous medical plan to meet
this plans pre-existing condition requirements.




San Benito CISD                                         33                            October 2002
                  COMPREHENSIVE MEDICAL EXPENSE BENEFIT


A.    BENEFIT PROVISION

      Upon receipt of due proof, satisfactory to the Plan, that a Covered Person has an expense incurred
      for treatment of a covered illness or a covered injury, the Plan will pay the percentage payable
      indicated in the "Schedule of Benefits" of the reasonable, necessary and customary charges. Home
      Health Care and durable medical equipment charges are subject to fee guidelines established by the
      Plan.

      The benefits payable, for all covered conditions, shall not exceed the "Maximum Lifetime Benefit"
      and are subject to the "Copay Amount(s)" specified herein and are subject to all limitations and
      conditions of the Plan.

B.    AMOUNT PAYABLE

      1.    Percentage Payable shall mean the percentage payable by the Plan for the covered expenses as
            shown in the "Schedule of Benefits".

            a.    Emergency Care:

                  1. If a Covered Person is treated due to an emergency condition at a Non-PPO hospital
                     (inpatient or emergency room) or by a Non-PPO Physician outside of the PPO
                     service area, eligible charges are payable at the PPO benefit level.

                  2. If a Covered Person is transported to the nearest hospital due to an emergency
                     situation (illness or injury), eligible charges are payable at the PPO benefit level.

            b.    Specialty Care – If a specialist or a specialized procedure is not available within the
                  PPO network, eligible expenses are payable at the PPO benefit level.

            c.    Full-Time College Student – For a Dependent child that is a full-time student who
                  resides and receives treatment more than 50 miles outside the PPO service area, eligible
                  charges are payable at the PPO benefit level.

      2.    Out-of-Pocket Maximum - Once a Covered Person accumulates personal payments on a
            Covered Person for eligible expenses in the amount stated in the Schedule of Benefits
            (EXCLUDING charges beyond usual and customary, co-payments, benefits paid at 100%, and
            penalty amounts), the Plan will pay 100% of eligible expenses thereafter in the calendar year,
            unless otherwise stated.


C.    MAXIMUM BENEFITS

      1.    The Maximum Benefits as shown in the "Schedule of Benefits" are the maximum amount of
            benefits available for any Covered Person, whether or not there has been an interruption in the
            continuity of his coverage.

      2.    Payment of Benefits under this Plan with respect to a Covered Person whose coverage
            hereunder replaces his coverage under an insurance policy issued to the employer by the prior
            medical plan shall be payable to the extent of the amount of Major Medical Expense Benefits
            remaining or that would have been paid under the terms of the prior plan had such prior plan
            remained in force.
San Benito CISD                                        34                             October 2002
D.    COVERED MEDICAL EXPENSES

      Covered Medical Expenses shall include, subject to the "General Exclusions or Limitations" and
      "Schedule of Benefits", only medically necessary, usual, reasonable, and customary charges, for
      services and supplies prescribed and recommended by a physician, which are incurred by a Covered
      Person as follows:

      1.    Hospital care in a "hospital" as defined herein, for room, board, and other hospital services
            required for purposes of treatment;

      2.    Professional Services by;

            a.    A physician;

            b.    A physician’s assistant when supervised by a physician as defined herein;

                  1. Eligible Expenses from a Physician Assistants (P.A.) performing assistant surgery,
                     while working under the direct supervision of a surgeon (expenses are limited to
                     25% of the allowable for the primary physician charges and are payable according
                     to the network status of the primary physician).

                  2. Eligible expenses from a Physician Assistants (P.A.) while working under the direct
                     supervision of a physician in an office setting (100% of the allowable for the
                     primary physician charges is eligible and expenses are payable according to the
                     network status of the primary physician).

            c.    An assistant surgeon (expenses limited to 25% of the allowable for the primary
                  physician charges);

            d.    A nurse, that is non-custodial;

            e     An anesthetist or anesthesiologist;

            f.    A licensed physical therapist for restoratory or rehabilitory physical therapy for loss or
                  impairment of function due to an illness or trauma, or congenital defects for which
                  surgery has been performed;

            g.    A Doctor of Chiropractic for the detection and correction by manual or mechanical
                  means (including x-rays incidental thereto) of structural imbalance, distortion or
                  subluxation in the human body for the removal of nerve interference where such
                  interference is the result of or related to distortion misalignment or subluxation of or in
                  the vertebral column; services rendered, ordered, or prescribed by a chiropractor (refer
                  to schedule of benefits for maximum benefit for chiropractic care);

            h.    A certified nurse midwife;

            i.    A licensed speech therapist for restoratory or rehabilitory speech therapy for speech loss
                  or impairment due to an illness or trauma, or congenital defects for which surgery has
                  been performed provided such loss or impairment is not due to a functional nervous
                  disorder;


San Benito CISD                                          35                             October 2002
            j.    A licensed occupational therapist for restoratory and rehabilitory occupational therapy
                  for loss or impairment of function of an upper extremity due to an acute illness or
                  trauma, or congenital defects for which surgery has been performed;

            k.    A pathologist;

            l.    A radiologist;

            m.    A Registered Nurse First Assistants (RFNA) while working under the direct supervision
                  of a physician (expenses are limited to 25% of the allowable for the primary physician
                  charges and are payable according to the network status of the primary physician).

            n.    Masters’ level Psychotherpists’who hold the certification of LMSW (Licensed Masters
                  in Social Work) or LPC (Licensed Professional Counselor) and are eligible for
                  membership in his/her respective society or association.

      3.    Drugs and medicines requiring a physician's prescription (including oral contraceptives).
            Eligible outpatient prescription drugs are covered under the Prescription Drug Program (refer
            to the Schedule of Benefits.);

      4.    Voluntary sterilization procedures for all covered persons;

      5.    Diagnostic x-ray and laboratory service;

      6.    Oxygen and/or rental of equipment required for its administration;

      7.    X-ray, radium and radioactive isotope therapy, cobalt and chemotherapy;

      8.    Rental of durable medical equipment, up to the purchase price, required for temporary
            therapeutic use. Initial purchase of durable medical equipment and replacement of such
            equipment due to wear and tear and/or bodily change or medical necessity. Durable Medical
            equipment which requires necessary repairs and maintenance due to wear and tear and/or
            bodily change or medical necessity will also be considered covered expenses;

      9.    Braces required for the mobilization and restoration of an impaired function, initial braces,
            crutches, casts and splints to improve function when the loss or impairment of function
            occurred while covered under this Plan;

      10.   Initial artificial limbs or eyes, if prescribed by an M.D. or D.O., or other prosthetic appliances
            to replace lost physical organs or parts if the loss occurred while covered under this Plan. In
            addition, replacement of prosthetic appliance if necessitated by bodily change or medical
            necessity. Also includes charges for repair and/or adjustments, when medically necessary;

      11.   For emergency transportation (ground or air) of the Covered Person to the nearest hospital
            where care and treatment of the injury or illness can be given, or any other medical institution
            for necessary special treatment not locally obtainable which is considered a medical necessity;

      12.   For the processing and administration of blood or blood components, but not for the cost of
            the actual blood or blood components if replaced;

      13.   Initial contact lenses or glasses if required following cataract surgery;



San Benito CISD                                           36                            October 2002
      14.   Routine/Preventive Care (as shown of the schedule of benefits) not in conjunction with a
            current medical diagnoses. Covered items shall include, but not limited to physical exams or
            check-ups, immunizations, pap smears mammograms and prostate exams;

      15.   Treatment for psychiatric/chemical dependency according to Plan guidelines and limitations
            as shown on the schedule of benefits (See Plan Maximums);

      16.   Dental Charges for oral surgery (including removal of impacted wisdom teeth) or dental
            charges as a result of accidental injury while a Covered Person (including inpatient hospital
            facility expenses when medically necessary) for treatment of a fractured jaw or injury to
            sound natural teeth;

      17.   For orthopedic appliances (such as trusses, crutches and braces), orthotics or arch supports;

      18.   Second surgical opinions;

      19.   Extended care facility services and supplies as listed below, when furnished to a covered
            person for his use during confinement in the facility, and by means of a transfer from a
            hospital in which he was confined for at least three consecutive days or confined within
            fourteen (14) days after hospital discharge, and is for continued care of the same condition(s)
            which resulted in that hospital confinement;

            The following are extended care facility services and supplies:

            a.    Room and board;

            b.    Routine nursing care, but not including the services of a private-duty nurse or other
                  private-duty attendant;

            c.    Physical therapy, occupational therapy, and speech therapy provided by the extended
                  care facility or by others under arrangements with such facility;

            d.    Medical social services;

            e.    Such biologicals, supplies, appliances, and equipment as are ordinarily provided by the
                  extended care facility for the care and treatment of its inpatients;

            f.    Diagnostic and therapeutic services furnished to inpatients of the extended care facility
                  by a hospital; and

            g.    Such other services necessary to the health of patients as are generally provided by
                  extended care facilities (excluding, however, any item or service that would not be
                  provided to an inpatient of a hospital).

      20.   Ambulatory surgical center services rendered within 24 hours from, and in connection with, a
            surgical procedure, or within seven (7) consecutive days before the procedure in the case of
            diagnostic procedures;

      21.   For Hospice Home Care Services provided in accordance with a Hospice Home Care
            Program:

            a.    To a terminally ill individual who is a Covered Person;


San Benito CISD                                          37                            October 2002
            b.    To members of the immediate family of the terminally ill Covered Person as set forth in
                  the definitions while the terminally ill individual is not confined in a hospital or hospice
                  facility and the attending physician has certified that the hospice care is an alternative to
                  hospitalization.

                  The term "immediate family" means parents, spouse, and children;

      22.   For services or supplies furnished by a Home Health Care Agency for the sole purpose of
            treating a disabling illness or injury in accordance with a home care plan.

            a.    Part-time or intermittent nursing care by a registered professional nurse (R.N.) or by a
                  licensed practical nurse under the supervision of a registered nurse;

            b.    Physical therapy, occupational therapy and speech therapy provided by the Home
                  Health Care Agency; and

            c.    Medical supplies, drugs, and medications prescribed by a physician, and laboratory
                  services by or on behalf of a hospital, to the extent such items would have been covered
                  under this benefit if the Covered Person had been confined in the hospital;

      23.   Routine newborn well baby care. Eligible charges include the initial hospital confinement
            charges, Physician hospital charges and physician charges for circumcision (whether inpatient
            or outpatient);

      24.   Expenses incurred for maternity care and services (for Covered Spouses only). Covered
            Expenses shall include eligible charges for a birthing center and other medically necessary
            care and services received in connection with a pregnancy. Failure to contact Healthy
            ArrivalS during the first trimester will result in a $500 penalty.

      25.   For rhinoplasties and blepharoplasties, with pre-authorization by the Administrator, to correct
            a functional condition after a Covered Person's coverage has been in effect for at least twelve
            (12) months or in the case of a rhinoplasty, to correct an accidental injury as provided in #29;

      26.   Services and supplies provided in connection with human organ or tissue transplant
            procedures (including any technique for restoring bone marrow and/or stem cells in
            conjunction with high dose chemotherapy treatment for cancer) except for a) any procedure
            which is not medically necessary; b) any experimental treatment or transplant; or c) travel
            costs. (See Plan Maximums)

      27.   Expenses related to chemotherapy or radiation therapy which meets the Plan definition of
            “Investigational or Experimental Treatment” (for example, chemotherapy drugs that are not
            used in standard protocals) will be covered at levels equal to charges for standard
            chemotherapy or radiation therapy. Such amount will be established by the Contract
            Administrator in conjunction with the medical provider used, but will not include the
            expenses for any drug not approved by the FDA or any tests to evaluate the effect of such
            drug therapy or treatment;

      28.   Charges in connection with Cosmetic Surgery are covered only:

            a.    within 12 months after and as the result of an injury sustained while covered under this
            Plan or,



San Benito CISD                                           38                             October 2002
            b.    for the correction of a birth defect, provided the covered person was covered under the
                  Plan from birth; or

            c.    for replacement of diseased tissue surgically removed while covered under this Plan;

            d.    with Pre-Authorization by the Contract Administrator.

      29.   Charges for Reconstructive Surgery due to:

            a.    an injury that occurred while covered under this Plan; or

            b.    an illness, such as breast cancer (e.g. reconstruction of the breast on which the
                  mastectomy has been performed; surgery and reconstruction of the other breast to
                  produce a symmetrical appearance; and prosthesis and physical complications at all
                  stages of mastectomy, including lymphedemas); or

            c.    a congenital birth defect, provided the covered person was covered under the Plan from
                  birth; however, if the surgery has been delayed or diagnosis undetected until the
                  covered person reaches a specific age or growth level, or if illness at birth delayed the
                  surgery, or, the condition was undetected at birth, it would not be necessary that the
                  covered person be covered under the Plan from birth;

            c. with Pre-Authorization by the Contract Administrator.

      30.   Allergy shots and allergy testing;

      31.   Termination of pregnancy only when the life of the mother would be endangered if the fetus
            were carried to term;

      32.   Depo Provera injections (provided at a physician’s office) and Norplant for the purpose of
            birth control;

      33.   Eligible expenses for diabetic supplies and clinitest for diagnosed diabetes (syringes and
            needles covered under the Prescription Drug Program);

      34.   Eligible Expenses for the treatment of Temporomandibular Joint Disorder (TMJ); (See Plan
            Maximums)

      35.   Charges incurred for the treatment of a learning disability (by any name called) ONLY if the
            learning disability is medically related. Eligible charges shall include physician office visits
            for medicine check-ups and the medication, psychological testing, outpatient care, inpatient
            care and day treatment. Benefits are eligible under the psychiatric benefits of the plan and
            subject to the imitations as indicated on the schedule of benefits;

      36.   Charges for the treatment of Morbid Obesity: (See Plan Maximums)

            Surgical or non-surgical treatment of morbid obesity. Such coverage is subject to the following
                provisions:

            The patient's body weight is twice the ideal body weight (IBW) as determined by standard
            accepted national tables or 100 pounds over the IBW



San Benito CISD                                          39                            October 2002
            The patient has a health problem which is related to the obesity and which may ultimately be life
            threatening (such as severe hypertension, sleep apnea, congestive heart disease, or insulin
            dependent diabetes).

            Non surgical weight loss treatment is covered with respect to physician office visits, one year of
            prescribed diet medication, and consultations with a registered licensed dietitian regarding eating
            education. Items such as weight loss instructions or memberships from commercial weight loss
            programs; exercise programs or activities or equipment; over-the-counter-drugs or appetite
            suppressants; or books would not be covered.

            Gastric restrictive surgical procedures are covered subject to the additional following provisions:

                  One surgical procedure per lifetime.

                  A medical review service used by the Plan determines that the surgery meets the following
                       criteria:

                  Patients have repeated and well documented weight loss efforts that have failed. Such
                  weight loss efforts must be physician supervised programs that are medically balanced and
                  safe. As an example, the patient should have been through at least six months of
                  documented efforts in structured weight loss programs (including counseling) which have
                  resulted in no weight loss or minimal weight loss with an 80% attendance record.

                  Absence of medical comorbidity that makes surgical intervention too risky or hazardous.

                  The surgical facility and physician performing the procedure has substantial experience
                  with surgical treatment of obesity and provides an appropriate aftercare program for
                  medical management and counseling. The program should include treatment for
                  nutritional and psychiatric counseling as part of a multi-disciplinary approach to treating
                  patients being considered for surgery and for patients post surgery.

            The patient must have full understanding and acceptance (through written acknowledgment) of
            the high risks associated with gastric restrictive surgery, that the surgery itself may not be a long
            term solution for weight loss, and the surgery may result in other potentially serious medical
            complications.




San Benito CISD                                            40                              October 2002
                       GENERAL EXCLUSIONS OR LIMITATIONS


No benefits shall be payable under any part of this Plan with respect to any charges for the following,
UNLESS OTHERWISE STATED UNDER COVERED MEDICAL EXPENSES:


A.      That a Covered Person is not financially responsible for or are only made because medical
        coverage exists;

B.      Not medically necessary for diagnosis or treatment of an illness or injury;

C.      For vision care, vision exams, and eyeglasses including contact lenses or fitting thereof;

D.      For orthoptic treatment or visual training;

E.      Incurred in connection with a surgical for correction of vision;

F.      Care and treatments for loss of speech and hearing, except due to accident or illness;

G.      For Hearing Aids or fitting thereof;

H.      Incurred in connection with cosmetic surgery to improve appearance, rather than to correct a
        functional disorder; here, functional disorders do not include mental or emotional distress related
        to a physical condition;

I.      For rhinoplasty, blepharoplasty, or brow lift due to a non-functional condition;

J.      Elective Adoption expenses;

K.      Wigs and artificial hair pieces;

L.      For sleep studies or treatment of sleeping disorders, unless otherwise stated under Covered
     Medical Expenses;

M.      Elective abortions, except in life-threatening situations and any related expenses;

N.      Any injury or illness for which the person on whose behalf a claim is presented is not under the
        regular care of a physician;

O.      For any condition, disability, or expense resulting from or sustained as a result of being engaged
        in an illegal occupation, commission of, or attempted commission of an assault or a criminal act;

P.      For any condition, disability, or expense resulting from or sustained as a result of war or act of
        war, declared or undeclared;

Q.      For care or treatment which an employee is not financially responsible for that is provided or
        furnished by a hospital operated by a government unit, or the Government of any country; or any
        agency thereof, except as provided by Federal law;

R.      Expenses resulting from a voluntarily, self- inflicted injury or attempted voluntary self-obstruction
        while sane or insane.
San Benito CISD                                            41                             October 2002
S.      For any condition or disability which would entitle the Covered Person to any benefit under
        Workers' Compensation or similar legislation, or which is due to injury or sickness arising out of
        or in the course of any occupation or employment for wage or profit, whether or not he/she is
        actively a participant in a Workers' Compensation Program;

T.      For professional services performed by a person who ordinarily resides in the Covered Person's
        household or who is related to the Covered Person whether such relationship is by blood or exists
        in law;

U.      Incurred for the treatment of corns, calluses, or toenails, unless the charges are for the removal of
        nail or part thereof or for treatment of a metabolic or peripheral vascular disease;

V.      Incurred in connection with a pre-existing condition as defined herein;

W.      For injury or sickness sustained while the person is not covered hereunder;

X.      Charges for dental care or treatment that is not related to an accidental injury or oral surgery (refer
        to covered medical expenses section);

Y.      Incurred for non-human organ transplants or permanent artificial hearts; experimental or
        investigational health procedures or experimental drug therapy not approved by the Food and
        Drug Administration;

Z.      For transportation or travel other than emergency transportation service by professional
        ambulance (including air) as stated in the Covered Medical Expenses;

AA.     Biofeedback

BB.     Breast Pump expenses will not be allowed unless the expenses is for the baby’s complications
        (such as repair of cleft plate) and not solely the mother’s desire, and is specifically prescribed by
        the doctor

CC.     Genetic Counseling or testing;

DD.     For charges for hormonal disorders (not including diagnosis of menopausal conditions), male or
        female, resulting in a treatment program of periodic rapid assays of reproductive hormones (e.g.,
        estradiol, luteinizing hormone, Follicle Stimulating Hormone (FSH), progesterone and
        androgens); gonadotropin stimulation given in a sequential manner requiring laboratory tests to
        evaluate the effect of such stimulation; reproductive organ ultrasounds/echogram or biopsies
        following gonadotropin stimulation; and follow-up office visits;

EE.     In connection with infertility, invitro fertilization or embryo transfer, artificial insemination, or
        any surgical procedure for the inducement of pregnancy;

FF.     For marriage counseling, family counseling or group therapy;

GG.     For smoking cessation services, devices or medications;

HH.     For air conditioners, humidifiers, dehumidifiers, and purifiers, swimming pools, hot tubs, or
        waterbeds whether or not prescribed by a physician;

II.     In an extended skilled nursing home, except as defined herein;
San Benito CISD                                            42                            October 2002
JJ.     For Home Health Care expenses that are for:

        1. Custodial care;

        2. Transportation services; or

        3. Any period during which the Covered Person is not under the continuing care of a Physician.

KK.     For Chelation therapy;

LL.     For services or supplies rendered to any participant for treatment of obesity or for weight
        reduction. However, Morbid Obesity may be considered an eligible expense. Refer to covered
        medical expenses section for criteria to determine whether it may be an eligible expense;

MM.     For surgical procedures to reverse sterilization;

NN.     For custodial care or maintenance care;

OO.     For sex therapy, hypnotic training (including hypnosis), any behavior modification therapy
        including biofeedback, educational testing and therapy (including therapy intended to improve
        motor skill development delays) or social services;

PP.     For sex change and/or treatment for transsexual purposes;

QQ.     For sexual dysfunction of inadequacy, which includes implants, pumps and related hormones
        and/or therapy. Expenses for drug therapy may be considered eligible under this Plan when
        sexual dysfunction of inadequacy is not the primary diagnosis;

RR.     Genetic counseling or testing;

SS.     For travel or accommodations, whether or not recommended by a Physician;

TT.     Nutritional counseling;

UU.     Massage therapy or rolfing;

VV.     For nutritional and dietary supplements even if prescribed by a physician;

WW.     For outpatient prescription drugs not purchased through the Prescription Drug Program;

XX.     For drugs which are not approved for sale in the United States;

YY.     For over-the-counter drugs, even if prescribed by a physician;

ZZ.     For drugs not approved by the Food and Drug Administration;

AAA. For drug dosages that exceed the Food and Drug Administration (FDA) approval;

BBB.    For drugs approved by the Food and Drug Administration but used for conditions other than those
        indicated by the manufacturer;



San Benito CISD                                             43                       October 2002
CCC.    Hospital admission for diagnostic or evaluation procedures unless the tests could not be
        performed on an outpatient basis without adversely affecting the health of the patient;

DDD. Hospital room and board charges for admission the night before surgery unless it is medically
     necessary;

EEE.    For services by a nurse which can be performed by a person who does not have the skill and
        training of a nurse;

FFF.    If treatment is not stated as a covered item under the Health Care Financing Administration
        (HCFA) guidelines or as a covered item under Covered Expenses then it is not a covered expense
        under the Plan;

GGG. For investigational or experimental treatment, unless otherwise stated under Covered Medical
     Expenses;

HHH. For services and supplies furnished for the purpose of breaking a “habit”, including but not
     limited to overeating, smoking and thumbsucking;

III.    Incurred as a result of or in connection with the pregnancy of a Dependent child or complications
        of that pregnancy;

JJJ.    For services rendered as a result of (or due to complications resulting from) any surgery, services,
        treatments or supplies specifically excluded from coverage under this Plan;

KKK. Charges for Jobst garments;

LLL.    Any service unless otherwise stated under Covered Medical Expenses.




San Benito CISD                                          44                            October 2002
HOSPITAL ADMISSION ON FRIDAY OR SATURDAY

Regular benefits are payable for expenses incurred on a Friday and/or Saturday when confinement
commences on Friday or Saturday if such confinement on a Friday and/or Saturday is necessary so as not
to endanger the health and safety of the patient as certified by the attending physician.




San Benito CISD                                        45                          October 2002
                             PRESCRIPTION DRUG BENEFITS

Covered Prescription Drug Charges

Covered Prescription Drug Charges mean charges which are:

1.          due to Sickness or Injury; and
2.          incurred while You and your Dependents are covered hereunder; and
3.          for drugs and medicines requiring a Physician’s Prescription Order; and
4.          dispensed by a licensed pharmacist.


DEFINITIONS AS USED IN THIS PROVISION

Prescription Legend Drug means any medical substance, the label of which the Federal Food Drug and
Cosmetic Act requires to bear the legend, “ Caution: Federal Law prohibits dispensing without a
prescription.”

Eligible Prescription Drugs mean:

1.          Prescription Legend Drugs;
2.          compound medications of which at least one ingredient is a Prescription Legend Drug,
3.          any drug which under the applicable state or federal law may dispense only upon the written
            prescription of a Physician;
4.          injectable insulin prescribed by a Physician; and
5.          dietary formulas for the treatment of Phenylketonuria (PKU) or other Heritable Disease.

Prescriptions Order means the request for each separate drug or medications by a Physician and each
authorized refill or such request.

Pharmacy means a licensed establishment where prescription drugs are dispensed by a pharmacist
licensed by the state where he/she practices.

Participating Pharmacy means a pharmacy under an appropriate contract for special services and prices
for Covered Persons under this Plan.

Non-Participating Pharmacy means a pharmacy not under an appropriate contract for this Plan.

BENEFITS PAYABLE

Benefits are Payable as shown in the SCHEDULE OF BENEFITS for Covered Prescription Drug
Charge is made by:

1.          a Participating Pharmacy for each Prescription Order. Benefits are payable: subject to a price
            schedule issued to the Participating Pharmacy and approved by the Plan Sponsor.

2.          a Non-Participating Pharmacy for each Prescription Order. Benefits are payable subject to the
            same price schedule applicable to a Participating Pharmacy, less any Co-payment and less an
            amount charged by the Prescription Card Administrator for administration of claims forms.



San Benito CISD                                         46                            October 2002
                           PPRESCRIPTION DRUG EXCLUSIONS

No benefits will be paid for:

1.          Charges a Covered Person is not required to pay or charges made only because Coverage
            exists (subject to he right, if any, of the United States government to recover Reasonable and
            Customary Charges for care provided in a military or veterans’ hospital). This will not apply
            if these charges are incurred for treatment of mental illness and/or retardation in a state-owned
            Institution; or

2.          A Sickness or Injury:

            a.          for which benefits are paid or payable under Worker’s Compensation or any
                        Occupational Disease or similar whether such benefits are insured or self-insured,
                        or
            b.          that is caused by, or connected in any way to, employment of the Covered Person.
                         This includes self-employment or employment by others. It applies whether or
                        not Worker’s Compensation or any Occupational Disease or similar laws covers
                        the charges incurred. It applies whether the charges are covered on an insured or
                        uninsured basis; or

3.          Therapeutic devices or appliances; or

4.          Drugs or medicines lawfully obtainable without a Prescription Order of a Physician, except
            insulin and dietary formulas for the treatment of Phenylketonuria (PKU) or other Heritable
            Disease;or

5.          Immunization agents, biological sera, blood plasma. (This includes the giving of these items);

6.          Drugs labeled: “Caution- limited by federal law to investigational use”, or experimental
            drugs, even though a charge is made to the Covered Person; or

7.          Any charge for the administration of Prescription Legend Drugs or injectable insulin, or

8.          Any medication, legend or not, which is consumed or administered at the place where it is
            dispensed; or

9.          Any amount of drugs or medicines dispensed that is more than 100 day supply, or

10.         Drugs that maybe received at no charge under local, state and federal programs. (This will
            not apply to drugs covered by Medicaid); or

11.         Drugs or medicines to be taken by or given to a Covered Person while he or she is confined in
            a Hospital or Institution; or

12.         Any prescription or refill in excess of the number specified by the Physician or any refill
            dispensed after one year from Physician’s original order; or

13.         Drugs prescribed for Sickness or Injury resulting from war or acts of war; or

San Benito CISD                                          47                             October 2002
14.         Any drug. Medication, device or appliance not covered under the PRESCRIPTION DRUG
            BENEFITS plan selected by the Plan Sponsor.




San Benito CISD                                    48                       October 2002
                                    UTILIZATION REVIEW


A.    GENERAL OVERVIEW

      The Contract Administrator will review the hospital confinement with the physician, however, in all
      cases the necessity of hospital confinement and the length of stay is determined by the covered
      person and the doctor, not the Contract Administrator or the Plan.

      In order for the Contract Administrator to review a hospital confinement with your physician, the
      Contract Administrator must be advised of such confinement. Notification of such confinement is
      considered "compliance" and will vary based on different types of confinements as described later.

      Benefits under the Plan (as to percentages payable) will be more favorable if a Covered Person goes
      through the Utilization Review System by "Compliance". The Schedule of Benefits outlines the
      differences in payment between compliance with the Utilization Review System and non-
      compliance.

B.    DEFINITIONS

      1.    Utilization Review is the review of a hospital confinement by the Plan (through the Contract
            Administrator) prior to the date of such confinement and/or during such confinement. The
            purpose is to possibly avoid unnecessary hospital confinements and/or reduce the length of
            some confinements without affecting the quality of treatment.

      2.    Compliance is notifying the Contract Administrator: a) ten (10) working days prior to a
            scheduled admission; b) by the 1st trimester of pregnancy; c) immediately prior to admission
            for an urgent admission; or d) within 48 hours of an emergency admission (72 hours for
            weekends or employer-approved holidays).

      3.    Emergency Admission is a hospital admission that may not be scheduled at the convenience
            of the physician and the patient without endangering the patient's bodily functions.

      4.    Urgent Admission is a hospital admission that is not an emergency admission, but is necessary
            within at least 72 hours from the time a physician recommends such hospital confinement.

      5.    Scheduled Admission is a hospital admission that a physician has recommended that is neither
            an Emergency nor Urgent Admission.

      6.    Working Day is any day Monday through Friday, excluding national legal holidays.

      6.    Pre-Certification is the process of evaluating the plan and place of care before routinely
            scheduled or urgent services are provided.

      Pre-Certification authorizes medical necessity only and does not guarantee payment of
      benefits or approve providers.

C.    TYPES OF REVIEW

      1.    Pre-Admission Review - Review is performed prior to admission for scheduled procedures.

      2.    Concurrent Review - Review is performed for scheduled and non-scheduled admissions
            during confinement.
San Benito CISD                                         49                          October 2002
      3.    Discharge Planning - Where appropriate arrangements are made to facilitate the earliest
            possible discharge.

      4.    Medical Case Management - Alternate treatment plans are developed which meet the medical
            needs of the covered person and are more cost-effective than standard treatment forms.

      Hospital expenses will not be certified as eligible for hospital confinement that collectively total
      more than thirty (30) days for a patient who either has stabilized and does not require an acute level
      of care, or is not progressing in rehabilitation. Coverage for such hospital confinements could be
      covered if a specific plan for transfer to the appropriate level of care is in progress and is pre-
      approved by the Contract Administrator's Medical Case Management Department.

D.    COMPLIANCE GUIDELINES

      AN EMPLOYEE'S FAILURE TO COMPLY WITH THESE STEPS WILL RESULT IN "NON-
      COMPLIANCE" WITH PLAN PROVISIONS AND LIMITED BENEFITS WILL BE PAID
      ACCORDING TO THE SCHEDULE OF BENEFITS.

      1.    Scheduled Hospital Admission Including Pregnancy

            The Contract Administrator must be notified by the employee or a personal representative by
            telephone well before such scheduled admission so that the attending physician can submit the
            pre-admission certification form to the Contract Administrator at least ten (10) working days
            prior to scheduled admission. Pregnancies must have the pre-admission certification process
            completed by the 36th week of pregnancy.

      2.    Urgent Admission

            The Contract Administrator must be notified by either the employee, physician, or a personal
            representative by telephone immediately prior to actual admission.

      3.    Emergency Admission

            The Contract Administrator must be notified by either the employee, physician, or a personal
            representative within 48 hours of admission (72 hours on weekends or employer approved-
            holidays).

            Once the employee has complied with these provisions, the Contract Administrator will
            proceed to work with the physician and hospital in the employee's behalf for necessary
            medical care in compliance with the physician's recommendations.

E.    THE ATTENDING PHYSICIAN RETAINS FULL CONTROL OVER THE MEDICAL
      TREATMENT PROVIDED

      If there is a potential conflict with the Contract Administrator of the Utilization Review System, the
      physicians' instructions should be followed.

F.    PSYCHIATRIC AND CHEMICAL DEPENDENCY GUIDELINES

      1. Limitations for Acute-Care Hospitalization for Adolescents and Adults Are Limited to the
         Following Patient Conditions:


San Benito CISD                                          50                            October 2002
          a. The patient is psychotic - five (5) days maximum, only for the purpose of patient stabilization.
             This benefit is to be extended only if a psychiatric condition necessitates continuous maximum
             security to protect the well being of the patient. Such locked-door treatment means that the
             patient either is 1) in seclusion or 2) under twenty-four (24) hour watch. A general ward
             which is locked does not qualify as maximum security. A fifteen (15) minute notation by a
             staff member is not acceptable if the notation only has staff initials and no patient observation
             information.

          b. The patient is a danger to self or others - five (5) days maximum, only for the purpose of
             patient stabilization. This benefit is to be extended only if a psychiatric condition necessitates
             continuous security to protect the safety of the patient or others who could be harmed. Such
             locked-door treatment means that the patient either is 1) in seclusion or 2) under twenty-four
             (24) hour watch. A general ward that is locked does not qualify as maximum security. A
             fifteen (15) minute notation by a staff member is not acceptable if the notation only has staff
             initials and no patient observation information.

          c. The patient requires detoxification - the benefit is limited to what is reasonable and customary
             to pay for the medication, diet, fluids and nursing care which are necessary to restore
             physiologic functioning from alcohol or other addictive drugs. Detoxification is a process
             which may be preliminary to a recovery program, but should be distinguished from recovery.
             Detoxification is a distinct process without therapeutic effect upon the patient's addiction.
             Charges for a recovery program are not eligible during detoxification, since the patient's ability
             to focus and retain information will be extremely limited at this time. Detoxification is
             considered ended when the patient is allowed to begin attending the therapeutic programs the
             facility uses for the recovery portion of the patient treatment plan.

          d. The patient diagnosed with any other chemical dependency or behavioral problem - or other
             diagnostic category not listed in A, B, or C above shall receive a maximum of three (3) days
             certification. Acute care inpatient treatment is to be used only for patient stabilization. When
             a patient is stable, then a less restrictive level of care is more appropriate and should be used.

          e. The patient has an eating disorder - five (5) days maximum unless there is also a diagnosis of a
             physical illness which must first be treated to stabilize the patient's medical condition (in
             which case days will be certified under the medical portion of the Plan).

          f.      The patient has a condition of physical illness which requires hospitalization and the diagnosis
                  of the illness is independent of either a diagnosis of a psychiatric condition or a diagnosis of
                  chemical dependency. In this case, allowable days will be certified under the medical portion
                  of the Plan.

          g. The patient has relapsed and requires re-hospitalization - three (3) days maximum are allowed
             for a hospitalization which occurs within sixty (60) days of a previous acute care
             hospitalization. The level of care to be delivered after relapse should be determined from the
             aftercare plan developed at the previous discharge from hospitalization. In most cases,
             residential or day treatment should be a sufficient level of care subsequent to acute-care
             hospital stabilization.

          h. The patient has multiple, sequential hospitalizations at one facility (relapse) - twenty-four (24)
             hours maximum benefit is allowed after a second hospitalization at the same facility. Up to
             three (3) days maximum are allowed if a different facility is used when a relapse occurs.
             When four (4) or more hospitalizations occur within a ninety (90) day period of time, no
             additional inpatient days are allowed. The patient is expected to follow the aftercare treatment
             plan created at discharge from the previous hospitalization. Day treatment and intensive
San Benito CISD                                               51                            October 2002
                  outpatient benefits will be available. A hospital stay ends when the patient leaves the hospital.
                  This includes leaving AMA and AWOL as well as being discharged by the physician.

          i.      The patient is hospitalized for purposes which are not of an urgent or emergency nature -
                  twenty-four (24) hours maximum benefit is allowed. This benefit is available for planned
                  hospitalizations, including admissions which are anticipated more than twenty-four (24) hours
                  in advance.

          j.      The patient is repeatedly hospitalized at the acute-care level of treatment without any
                  improvement - no more days will be allowed. A patient who is kept in maximum security for
                  more than thirty (30) days without a transition to a less restrictive level of care, due to lack of
                  improvement, must be considered to be receiving custodial care. The cycling of a patient from
                  maximum security status to a lesser level of acute care or residential care and back also will be
                  considered a form of unimproved patient care making it ineligible for further certification
                  beyond thirty (30) days.

                  No more days will be certified without a specific plan for transfer of the patient to a designated
                  PPO facility (if available) or to an appropriate county or state facility. In order to facilitate a
                  transfer, a maximum of ten (10) days will be allowed (beyond the thirty (30) days) for the
                  transfer to take place. However, patient stay beyond the thirty (30) day length of time shall be
                  eligible for a fee not to exceed $200 for room and board charges. Charges for therapies, lab
                  work, and medications will be eligible for payment.

          k. The yearly or lifetime mental health/chemical dependency benefits maximum may not be
             exhausted in the course of a hospitalization or day treatment services. Enough benefits must
             be saved to allow for thirty (30) weeks of outpatient therapy (thirty (30) sessions) after
             discharge of the patient from the hospital or day treatment program.

                  If a physician deems that the needs of the patient are so extensive that the inpatient treatment
                  plan would exceed the yearly or lifetime benefit of the patient, only enough days will be
                  certified to allow the patient to be prepared for transfer and transferred to a county, state, or
                  designated "long-term" PPO facility. In no case will more than 60% of the patient's available
                  yearly or lifetime dollars for inpatient services be certified when a PPO facility is handling this
                  situation, and no more than 50% of the dollars will be certified for a non-PPO facility handling
                  the transfer situation.

      2. Other Conditions/Situations Requiring Pre-Certification Before Service Can Be Delivered in
              Inpatient:

          a. Psychological testing (if testing costs will exceed $800).

          b. Aversion therapy.

          c. Multiple psychological sessions per day by a physician or therapist who is billing
             independently from the hospital program. Without pre-certification, a maximum of one (1)
             session per day is allowed, such benefit to be paid at the reasonable and customary maximum.

          d. Multiple psychotherapy sessions per day beyond the allowed maximum for hospital program
             billed services; three (3) sessions per day is the maximum allowed. The cost per session must
             not exceed $100.

          e. Home/therapy passes.


San Benito CISD                                                52                              October 2002
          f.      Subacute (residential) inpatient - will be approved only when outpatient treatment is not
                  effective, or programmatic inpatient treatment is needed but there is not the necessity of acute-
                  care inpatient treatment. A maximum of forty-five (45) days may be certified for any one (1)
                  stay when no transition to outpatient services has occurred prior to forty-five (45) consecutive
                  residential inpatient days being delivered. Subsequent residential stays may not exceed
                  twenty-one (21) days per certification and may only be certified if it is determined that day
                  treatment or multiple sessions per week outpatient treatment have not been effective.

                  Benefits pre-certified for treatment in the category of subacute inpatient also applies to the
                  following treatment modalities: 1) residential inpatient; 2) social model inpatient; 3) social
                  psychiatric residential; 4) light psych; 5) group home; 6) halfway inpatient treatment (i.e.,
                  halfway house); and 7) psychiatric health facility. Other inpatient approaches not listed may
                  be eligible, pending review through pre-certification, of the therapeutic approach and the hours
                  per week of therapy delivered by the facility.

      3. Other Conditions/Situations Requiring Pre-Certification Before Services Can Be Delivered in
            Outpatient:

          a. Psychological testing when charges for that testing exceed one-half of the patient's standard
             outpatient benefit for a calendar year.

          b. Day treatment - only approved when outpatient sessions have not proven to be effective and a
             more programmatic treatment approach is necessary. A maximum of forty-five (45) days are
             eligible to be certified when no transition to multiple sessions or standard outpatient has
             occurred prior to the delivery of forty-five (45) consecutive days of day treatment services.

                  Subsequent day treatment certifications may not exceed fifteen (15) days and may only be
                  certified if it is determined that multiple sessions per week outpatient have not been effective.

          c. Multiple sessions per week outpatient- approved when used to: 1) prevent hospitalization (or
             re-hospitalization); 2) prevent the need for day treatment; 3) handle a severe, multiple problem
             family situation; or 4) significantly shorten the length of standard one (1) session per week
             therapy to achieve the same therapeutic goals. A maximum of thirty-six (36) sessions as
             multiple sessions per week are eligible to be given once every twelve (12) months. Multiple
             sessions may only be granted to one (1) member per family.

      4. Situations Not Eligible for Certification Include:

          a. Rest cures.

          b. Custodial care.

          c. Health and well-being enhancement programs (i.e. weight control programs, smoking
             cessation programs, stress reduction programs, marriage enrichment programs, or any other
             program which is of a set duration, with education components taking up at least 15% of the
             program, and designed as "exploring", "enlightening", "improving" or "empowering" patients
             rather than using traditional psychotherapeutic methods to treat a diagnosed illness).

          d. Inpatient care of more than five (5) days which retains the patient in a maximum security or
             ward lock-up situation when the patient is neither in a psychotic state nor in eminent danger.
             An acute care or a residential inpatient locked ward approach may not be used as a means of
             incarceration in order to force program participation nor can it be used to obtain ongoing
             benefit payments for a course of care being rejected by the patient. After the initial days of
San Benito CISD                                               53                             October 2002
                  stabilization, a patient's refusal to take medications or participate in the hospital’s program
                  shall limit to ten (10) the total number of days certifiable. Levels of outpatient care are
                  eligible for certification.

          e. Hospitalization of patients who are diagnosed as mentally retarded. However, up to seventy-
             two (72) hours may be given for the purpose of stabilizing a patient who has become
             temporarily out of control and requires a safe environment in order to adjust to new
             medication.

          f.      The incurably and/or criminally insane. However, diagnostic testing in order to determine the
                  current mental status of a patient may be certified.

          g. Admission to an inpatient, day treatment, or outpatient program of a specialized nature which
             excludes possible patients solely on the basis of gender, race, adult age (geriatric programs) or
              sexual preference, or a program which has two (2) or more of the following characteristics:

                  1) An educational component which exceeds more than 15% of the total program.

                  2) The use of therapy approaches other than individual, group, and family therapy in sections
                     of the program.

                  3) A program treatment length of a specific duration no matter what the needs are of the
                     individual patient.

                  4) The beginning of a program on the weekend (after 5:00 p.m. Friday night) and/or the
                     planning of the admission to the program seventy-two (72) hours in advance.

                      Portions of specialized programs such as certain therapy charges may be eligible. The use
                      of certain segments of a specialty program substituted for parts of a standard program is
                      acceptable if approved at the time of the certification for the standard services, and if such
                      substitutions do not increase the cost beyond the normal charge for the standard program.

          h. Experimental use of medication (non-traditional) is excluded. The term experimental includes
             the following:

                  1) Any drug classified as experimental.

                  2) Any non-experimental drug which is being used in an experimental manner (i.e., a use
                     which is not typical of the standard medical practice in relationship to the diagnosis of the
                     case when other drugs are more usually prescribed).

                  3) A non-experimental drug given in a dosage level which is not typical of standard medical
                     practice in relationship to the diagnosis of the case.

          i.      Electro-shock therapy.

          j.      The granting of extra acute care stabilization days because the patient diagnosis is changed
                  from one type of acute care diagnosis (psychiatric, chemical dependency, eating disorder, etc.)
                  to another type of acute care diagnosis (such as from a chemical dependency diagnosis to a
                  psychiatric diagnosis or from one type of psychiatric diagnosis to another type of diagnosis).
                  For example, a patient receiving five (5) days of stabilization for the diagnosis of Major
                  Depression will not receive another five (5) days because the diagnosis has been changed to an
                  Eating Disorder. Acute care stabilization is achieved, whether the patient's initial diagnosis is
San Benito CISD                                                54                             October 2002
                  changed or not. This is also true if the patient has been moved from inpatient stabilization for
                  a medical condition and then the primary diagnosis is changed to a psychiatric or chemical
                  dependency diagnosis. Benefits may, however, be available for continuing care from another
                  eligible level of care such as subacute care inpatient or day treatment.

          k. Mental and nervous conditions numerically listed from 315.0 through 319.0 in either the DSM
             III-R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised) or by
             ICD-9 CM (International Classification of Disease 9th Revision Clinic Modification) codes for
             Mental Disorders.

      5. Special Certification Situations Which May Be Negotiated for Psychiatric and Chemical
         Dependency Cases - A Non-PPO Provider May Be Certified by the Director of Mental Health UR
         for a Specific Case to Be Paid at the Higher PPO Percentage When One of the Following
         Conditions Is Present:

          a. A special service or program is required by a patient and the PPO system does not have that
             type of special service or program.

          b. The Non-PPO provider agrees to abide by the H.A.S. Reasonable & Customary (R&C) for the
             service and agrees that the patient is only responsible for their percentage of the R&C and will
             not be held responsible for the non-PPO provider’s charges which exceed that R&C.

          c. The non-PPO provider is delivering a treatment plan approved for multiple sessions per week
             outpatient.

          d. The non-PPO provider is in the process of being admitted to the PPO system and a delay has
             resulted due to the normal procedures and paper work that accompanies such admittance.

          e. The plan member is out of the area for an extended length of time (such as going to college)
             and standard one (1) session per week office psychotherapy is needed.

          f.      A plan member is seen by a PPO provider who refers that person for an immediate medication
                  evaluation to a non-PPO psychiatrist because a PPO psychiatrists cannot see the patient in a
                  timely fashion.




San Benito CISD                                               55                            October 2002
                           SUBROGATION, REIMBURSEMENT &
                          THIRD PARTY RECOVERY PROVISION


WHEN THIS PROVISION APPLIES: If you, your spouse, one of your dependents, or anyone who
receives benefits under this health plan becomes ill or is injured and is entitled to receive money from any
source, including but not limited to any party’s liability insurance or uninsured/underinsured motorist
proceeds, then the benefits provided or to be provided by the medical plan are secondary, not primary, and
will be paid only if you fully cooperate with the terms and conditions of the health plan.

As a condition of receiving benefits under this plan, the employee or covered person agrees that
acceptance of benefits is constructive notice of this provision in its entirety and agrees to reimburse the
Plan 100% of benefits provided without reduction for attorney’s fees, costs, comparative negligence,
limits of collectability or responsibility, or otherwise. If the employee or covered person retains an
attorney, then the employee or covered person agrees to only retain one who will not assert the Common
Fund or Made-Whole Doctrines. Reimbursement shall be made immediately upon collection of any
sum(s) recovered regardless of its legal, financial or other sufficiency. If the injured person is a minor,
any amount recovered by the minor, the minor’s trustee, guardian, parent, or other representative, shall be
subject to this provision regardless of state law and/or whether the minor’s representative has access or
control of any recovery funds.

The employee or covered person agrees to sign any documents requested by the Plan including but not
limited to reimbursement and/or subrogation agreements as the Plan or its agent(s) may request. Also, the
employee or covered person agrees to furnish any other information as may be requested by the Plan or its
agent(s). Failure or refusal to execute such agreements or furnish information does not preclude the plan
from exercising its right to subrogation or obtaining full reimbursement. Any settlement or recovery
received shall first be deemed for reimbursement of medical expenses paid by the Plan. Any excess after
100% reimbursement of the plan may be divided up between the employee or covered person and their
attorney if applicable. The employee or covered person agrees to take no action, which in any way
prejudices the rights of the plan.

If it becomes necessary for the Plan to enforce this provision by initiating any action against the employee
or covered person, then the employee or covered person agrees to pay the Plan’s attorney’s fees and costs
associated with the action regardless of the action’s outcome.

The Plan Sponsor has sole discretion to interpret the terms of this provision in its entirety and reserves the
right to make changes as it deems necessary.

If the employee or covered person takes no action to recover money from any source, then the employee
or covered person agrees to allow the Plan to initiate its own direct action for reimbursement.




San Benito CISD                                           56                             October 2002
                                     DENTAL EXPENSE BENEFIT


A.      BENEFIT PROVISION

        If a Covered Person incurs covered dental expenses as defined in this Article, the Plan will pay
        benefits at the percentage payable as shown in the Schedule of Benefits for expenses which exceed
        the deductible amount, but not to exceed the maximums specified in the Schedule of Benefits.

        Dental Expenses are deemed to be incurred on the date on which the service or supply is rendered or
        obtained except as follows:

         1.       With respect to a fixed partial denture, crown, inlay or onlay, on the first date of preparation
                  of the tooth or teeth involved; or

         2.       With respect to an appliance, including modification of the appliance, on the date the first
                  impression is made; or

         3.       With respect to root canal therapy, on the date the pulp chamber is opened.

B.      DEDUCTIBLE AMOUNT

        The Deductible Amount applies during each Calendar Year and is satisfied when Covered Expenses
        incurred by a Covered Person exceed the individual deductible amount shown in the Dental
        Schedule of Benefits.

C.      COVERED DENTAL EXPENSES

         1.       Type A - Preventive and Diagnostic

                  a.       Prophylaxis - cleaning and scaling of teeth, two (2) per calendar year.

                  b.       Fluorides - topical application of stannous fluoride, provided 12 months have passed
                           since the last fluoride application up to age 19.

                  c.       Space Maintainers (limited to the initial appliance) including installation, fitting and
                           all adjustments within 6 months of installation and limited to an insured person
                           under age 16.

                  d.       Removable appliance therapy or fixed or cemented appliance therapy to control
                           harmful habits, limited to the initial appliance and limited to an insured person
                           under age 16.

                  e.       Oral Examinations – two (2) per calendar year.




San Benito CISD                                              57                              October 2002
                  f.      Emergency Oral Examinations - only when made as a result of injury or sudden
                          development of dental pain and when no other service for which a benefit is payable
                          is performed during the same visit.

                  g.      Dental X-rays - full mouth x-rays (but not more than one in any period of 36
                          consecutive months), supplementary bitewing x-rays (but not more than once in any
                          period of 6 consecutive months) and such other dental x-rays as are required in
                          connection with the diagnosis of a specific condition requiring treatment.

                  h.      Tests and Laboratory Examinations - including bacteriologic cultures, pulp vitality
                          tests and diagnostic casts (study models).

         2.       Type B - Basic Services

                  a.      Oral Surgery (including customary postoperative treatment furnished in connection
                          with oral surgery) -

                          1.      Extraction of one or more teeth including impacted teeth; and

                          2.      Alveolectomy, alveoplasty, stomatoplasty, frenulectomy; excision of
                                  pericoronal gingiva, exostosis, hyperplastic tissue and oral tissue for biopsy
                                  and tooth replantation; and

                          3.      Any other oral surgery involving any tooth structure, alveolar process or
                                  gingival tissue, except excision of a tumor or cyst or incision and drainage
                                  of an abscess or cyst.

                  b.      Periodontics - treatment of periodontal disease of the gums and tissues of the mouth,
                          including gingivectomy, gingival curettage and osseous surgery (including
                          postsurgical visits), pedicle soft tissue grafts, occlusal adjustments and occlusal
                          guards related to periodontal surgery.

                  c.      Endodontics - treatment of disease of the non-vital dental pulp including
                          apicoectomy and root canal therapy.

                  d.      Following services and supplies:

                          1.      Emergency palliative treatment;

                          2.      General anesthetics and the administration thereof, including intravenous
                                  sedation, when performed in conjunction with cutting procedures in the oral
                                  cavity;

                          3.      Antibiotic drug injection by attending dentist;

                          4.      Visits and professional consultation by other than the treating dentist.

                  e.      Amalgam, silicate, acrylic, synthetic porcelain, and composite filling restorations to
                          restore diseased or accidentally broken teeth including stainless steel crowns.

                  f.      Stainless steel crown.

         3.       Type C - Major Services
San Benito CISD                                              58                            October 2002
                  a.       Inlays, onlays, gold fillings, or crown restorations to restore diseased or accidentally
                           broken teeth, but only when the tooth, as a result of extensive caries or fracture,
                           cannot be restored with an amalgam, silicate, acrylic, synthetic porcelain, or
                           composite filling restoration. When a tooth can be restored with an amalgam,
                           silicate, acrylic, synthetic porcelain, or composite filling restoration, benefits will be
                           determined based on such a restoration.

                  b.       Replacement of an existing inlay, onlay, gold filling or crown restoration as
                           described above.

                  c.       Initial installation, including 6 month adjustment, of removable partial or complete
                           denture and initial installation of fixed partial denture (bridgework - including inlays
                           and crowns as abutments).

                  d.       Replacement of an existing removable partial or fixed partial denture or the addition
                           of teeth to an existing removable or fixed partial denture only if:

                           1.       The replacement or addition of teeth is required to replace one or more
                                    teeth extracted after the existing removable fixed partial denture was
                                    installed; or

                           2.       At least 5 years have elapsed prior to its replacement and it can not be made
                                    serviceable with repairs.

                  e.       Repair or recementing of crowns, inlays, onlays, fixed or removable dentures, or
                           relining or rebasing old dentures more than 6 months after the installation of an
                           initial or replacement denture, but not more than one relining or rebasing in any
                           period of 36 consecutive months.

                  f.       Replacement of a complete denture only if at least 5 years have elapsed prior to its
                           replacement and it can not be made serviceable with repair or:

                           The existing denture is an immediate temporary denture which cannot be
                                  made permanent, and replacement by a permanent removable
                                  denture takes place within 12 months from the date of initial
                                  installation of the immediate temporary denture.

D.      LIMITATIONS TO DENTAL EXPENSE BENEFITS

        Payments will not be made by the Plan for any of the following:

         1.       Dental care not included in the list of defined eligible expenses.

         2.       Dental care which is provided solely for the purpose of improving appearance, including
                   charges for personalization or characterization of dentures and precision attachments when
                   form and function of the teeth are satisfactory and no pathological condition exists.

         3.       Dental care which does not meet the standards of dental practice accepted by the American
                   Dental Association.




San Benito CISD                                               59                              October 2002
         4.       Any charges in excess of the usual, customary and reasonable charge of the least expensive
                   alternate service or material consistent with adequate dental care, when such alternate
                   services or materials are customarily provided.

         5.       Charges for appointments not kept, or for completion of claim forms.

         6.       Expenses related to services or supplies of the type normally intended for sport or home use.

         7.       For education or training in and supplies used for dietary nutritional counseling, personal oral
                   hygiene, or dental plaque control.

         8.       For the replacement of a lost, missing, stolen or duplicate prosthetic device, or other dental
                   appliance.

         9.       For implantology, or transplants including implants and appliance constructed in association
                   therewith, and the surgical removal of implants; and for other procedures, services or
                   supplies which are experimental in nature.

        10.       Treatment of temporomandibular joint dysfunction.

        11.       Charges for any crown unless the tooth is prepared (drilled or filled) for the crown while the
                   covered person's Dental Coverage is in force.

        12.       Charges for any dental care directly or indirectly due to or resulting from:

                  a.       War, insurrection or the hostile action of the armed forces of any country.

                  b.       Any cause for which indemnity or compensation is provided under any Worker's
                           Compensation Law or similar legislation.

        13.       Dental care or treatment when rendered to insured persons by spouses, children, brothers,
                   sisters, parents, or similar family members of such person's spouses.

        14.       Charges for root canal therapy unless therapy begins on that particular tooth while the
                   covered person's Dental Coverage is in force.

        15.       For bonding or sealants.

        16.       Charge for any work in progress as of the covered person's effective date.

        17.       Charges that are made by a hospital.

        18.       Any procedure, appliance, therapy, adjustment, manipulation, or modality utilized to
                   examine, diagnose, plan treatment, prevent, relieve or repair, the effects of
                   temporomandibular joint disease or syndrome in any of its manifestations.

        19.       Charges for orthodontic service or treatment.

E.      PREDETERMINATION OF BENEFITS

        The Predetermination provision is included to help prevent misunderstanding concerning the type
        and amount of benefits approved by the Plan with respect to a proposed plan of treatment by a
        dentist.
San Benito CISD                                               60                             October 2002
        When a Covered Person is about to incur dental expenses, it is highly recommended that the Covered
        Person have the dentist complete the predetermination form and submit it to the Contract
        Administrator prior to the commencement of the treatment. If this procedure is not followed, the
        plan may still pay on an alternate method of treatment which could be much less than the treatment
        plan actually provided.

        The Contract Administrator will calculate the extent of the Plan's liability and inform the Staff
        Member of the amount of benefits payable if the intended course of treatment is followed.
        Occasionally, the Contract Administrator may determine that an alternate, less expensive treatment
        which is consistent with good dental practice is available, and base the amount of benefits payable
        according to the alternate plan of treatment.

F.      TIME OF PAYMENT

        Benefits will be paid promptly upon receipt of satisfactory proof of claim.




San Benito CISD                                           61                          October 2002
                               COORDINATION OF BENEFITS


The amount of benefits payable under this Plan and any other group plan or no-fault auto insurance will be
coordinated so that the combined benefits paid by both plans will never exceed the total of all eligible
expenses. However, benefits payable under this Plan will never exceed the amount that would have been
paid if there were no other plans involved.

This Plan will have a right of recovery for any expenses paid under the Plan where recovery is made due
to a cause of action for these expenses. This right of subrogation in no way obligates the patient to
reimbursement of legal expenses unless agreed to by the Plan.


A.    DEFINITIONS APPLICABLE TO THIS PROVISION

      1.    Plan – The term “Plan” includes the following plans under which a person is entitled to
            receive or received benefits or services for or by reason of medical, dental, or vision care or
            treatment:

                  a.    Group Plans, insured or non-insured; group, blanket, or franchise insurance
                        coverage; group hospital or medical service plans, and other group pre-payment
                        coverage; any coverage under labor management trusteed plans, union welfare
                        plans, employer organization plans, or employee benefit organization plans;

                  b.    Any coverage required or provided by any statute, including any no-fault
                        automobile insurance provided or required by statute; or

                  c.    Any Plan sponsored by or provided through a school or other educational
                        institution.

      2.    Primary – The Plan that makes the first payment as if no other coverage existed except that
            Plan.

      3.    Secondary – The Plan that makes the payment after the Primary Plan. The secondary carrier
            calculates benefits as though there is no other coverage. It then pays the lesser amount of the
            calculated benefit and the balance remaining from the primary carrier.

      4.    Allowable Expense – Means any necessary, reasonable and customary item of expense at least
            a portion of which is covered under at least one of the Plans insuring the individual for whom
            claim is made. When a Plan provides benefits in the form of services rather than cash
            payments, the reasonable cash value of each service rendered will be considered to be both an
            Allowable Expense and a benefit paid.

      5.    Claim Determination Period – The term Claim Determination Period means a period
            commencing with any January 1st, and ending at twelve (12:00) o’clock midnight on the next
            succeeding December 31st.


B.    ORDER OF BENEFIT DETERMINATION

      The rules establishing the order of benefit determination are:

San Benito CISD                                          62                           October 2002
      1.    If the claim is on a person who is covered as both an employee (or a member) under one Plan
            and as a dependent under another Plan, then the primary payor is the Plan where the person is
            employed (or a member), with the exception of number 7.

      2.    If the claim is on a person who is a dependent child under both parents’ Plan, this Plan
            adheres to the birthday rule (the parent with the earlier birth date, month and day, in the year
            is primary). If both parents have the same birth date, the plan covering the child for the longer
            period of time will be primary.

      3.    When rules 1. and 2. Do not establish an order of benefits determination, the benefits of a plan
            which has covered the individual for whom claims are made for the longer period of time will
            be the primary payor.

      4.    If the parents are divorced or legally separated, it is necessary to determine if there is a court
            decree which establishes financial responsibility for medical, dental, or other health care
            expenses for the child. If there is such a decree, the plan covering the parent who has that
            responsibility will be the primary payor.

      5.    If there is no such court decree, the plan covering the parent who has custody of the child will
            be the primary payor.

      6.    If there is no such court decree, and the parent with custody of the child has remarried, the
            order of priority is:

            a.    The plan covering the parent who has custody;

            b.    The plan covering the spouse of the parent who has custody (that is, the step-parent of
                  the child); and

            c.    The plan covering the parent without custody.

      7.    If the claim is on a person covered under a plan in which the Covered Person is a retiree or
            dependent of a retiree (with the exception of a spouse who is an active employee of the
            Employer), primary coverage will be established as to the plan first effective.

      8.    If a COBRA participant is covered under this Plan and covered under another group plan, this
            Plan, as defined in this document, will be secondary.

      Only the benefits paid by this Plan will serve to reduce applicable benefit limit(s) of this Plan.

C.    ORDER OF FILING A CLAIM

      Since the secondary payor cannot make a calculation of payment until they are aware of the amount
      paid by the primary payor, it is important that the primary payor be sent all allowable expenses.
      After the primary payor has made payment, the secondary payor must receive the Explanation of
      Benefits made by the primary payor along with the allowable expenses.

D.    RELEASE OF INFORMATION

      The purpose of determining the applicability of and implementing the terms of the above provisions
      of this Plan or any similar provision of another Plan, the Plan may, without the consent of or notice
      to any individual, release to or obtain from any other insurance company or other organization or
      individual any information, concerning any individual, which the Plan considers to be necessary for
San Benito CISD                                            63                            October 2002
      those purposes. Any individual claiming benefits under this Plan will furnish the information that
      may be necessary to implement the above provisions.

E.    PAYMENTS

      Whenever payments, which should have been made under this Plan in accordance with the above
      provisions, have been made under any other plans, the Plan will have the right, exercisable alone
      and in its sole discretion, to pay to any organization making those payments any amounts it
      determines to be warranted in order to satisfy the intent of the above provisions. Amounts paid in
      this manner will be considered to be benefits paid under this Plan and to the extent of these
      payments, the Plan will be fully discharged from liability under this Plan.

F.    RECOVERY

      Whenever payments have been made by the plan, at any time, in excess of the maximum amount of
      payment necessary at that time to satisfy the intent of the above provisions, the plan will have the right
      to recover these payments, to the extent of the excess, from among one or more of the following, as the
      plan will determine: Any individuals to or for or with respect to whom these payments were made, any
      other insurance companies, or other organizations.


G.    TREATMENT OF MEDICARE BENEFITS

      Covered Persons are encouraged to enroll in Medicare when eligible and should be aware of penalties
      for late enrollment (premium penalties and limited enrollment periods each year). According to federal
      law, the group plan is primary to Medicare coverage for all active employees and their dependents.




San Benito CISD                                            64                             October 2002
                                     CLAIM FILING PROCEDURE



A.      The Contract Administrator, upon receipt of notice, will furnish to the Covered Employee or to any
        other person notifying the Employer or the Contract Administrator of claim, such forms as are
        usually furnished by it for filing proof of loss.

B.      All bills must be submitted in the original form when this plan is the primary carrier.

C.      COBRA participants are required to submit a COBRA claim form for each month in which claims
        are incurred.

D.      Eligible expenses incurred in any calendar year are required to be submitted to the Contract
        Administrator within twelve (12) months following the date expenses are incurred.

E.      The Plan at its own expense will have the right and opportunity to examine the person whose injury
        or sickness is the basis of claim when as often as it may be reasonably required during the pendency
        of claim hereunder.

F.      Failure to furnish notice of eligible expenses within the time provided in the Plan or proof of loss
        shall not invalidate or reduce any claims if it shall be shown not to have been reasonably possible to
        furnish such notice or proof and that such notice or proof was furnished as soon as possible.

G.      No action at law or in equity shall be brought to recover on the Plan prior to the expiration of 60 days
        after written Proof of Loss has been furnished in accordance with the requirement of the Plan. No
        such action shall be brought after the expiration of three years after the time written Proof of Loss is
        required to be furnished.




San Benito CISD                                            65                             October 2002
                                      PAYMENT OF BENEFITS



A.      Subject to proof of loss, the Contract Administrator will determine if benefits are payable according
        to Plan Provisions and Administrative Guidelines. Benefits will be paid or denied within 30 days
        upon receipt of due written proof unless additional information is required to determine amounts
        payable.

B.      Benefits are payable to the Covered Employee whose injury or sickness or whose dependent’s injury
        or sickness is the basis of claim under this Plan.

C.      If, in the opinion of the Contract Administrator, a Covered Person by or for whom a claim has been
        made is incapable of furnishing a valid receipt for any payment due him and in the absence of
        written evidence to the Plan of the qualification of a guardian for his estate, the Plan may, in its sole
        discretion, make any and all such payments to the individual or institution which is providing the
        care and support of such employee.

D.      If a Covered Person dies before all amounts payable to him have been paid, the Plan will pay such
        amounts to his executors or administrators, provided that the Plan may, in its sole discretion, pay all
        or part of such amounts to the spouse of such employee, if living, otherwise to his surviving children
        equally, or if there is no surviving child, to the employee’s parents, or to the survivor of them.

E.      Subject to any written direction of the Covered Person in any application or otherwise, all or a
        portion of any benefits provided by the Plan on account of hospital, nursing, medical, or surgical
        service may, at the Plan’s option, and unless the Covered Person requests otherwise in writing not
        later than the time for filing proof of such loss, be paid directly to the hospital or person rendering
        such services, but it is not required that the services be rendered by a particular hospital or person.

F.      At the option of the Contract Administrator, payments may be made directly to providers of service
        when in the Contract Administrator’s opinion an Assignment of Benefits may exist. Payments to
        PPO providers may in the Contract Administrator’s opinion be made as if an Assignment of Benefits
        exists.

G.      Any payment made by the Plan in accordance with this Section will fully discharge the Plan’s
        liability to the extent of such payment.




San Benito CISD                                             66                              October 2002
                        DENIAL, INQUIRY, AND APPEAL OF A CLAIM



A.    DENIAL

      In the event a claim is denied by the Contract Administrator, the denial shall be in writing, delivered
      to the claimant, and shall set forth the reasons for denial based on either Plan provisions or
      administrative guidelines. The written notification is generally in the form of an Explanation of
      Benefits (EOB) sent by the Contract Administrator

      If additional information is necessary to process a claim, the denial shall state and/or describe any
      additional material or information needed to process the claim.

B.    CLAIM INQUIRY

      The Contract Administrator will address an inquiry concerning a denial. This procedure, whether in
      writing or by telephone, is considered an informal inquiry. The Covered Employee, or his duly
      authorized representative, may submit additional information that the Contract Administrator will
      review for reconsideration.

C.    APPEAL PROCEDURE

      1.    A Covered Employee or his duly authorized representative has a right to appeal denial of a
            claim to the Contract Administrator, Health Administration Services, Inc.. The request for
            review shall be made in writing and addressed as a formal “appeal”, clearly outlining the facts
            of the claim and reasons as to why there is a disagreement. Send to:

                                             Attn: Appeals
                               Health Administration Services, Inc. (H.A.S)
                                           P.O. Box 672448
                                      Houston, Texas 77267-2448

      2.    Written application for review of denial of a claim must be received in the office of H.A.S.
            not later than 60 days following receipt by the claimant of the denial of his claim, or no appeal
            will be allowed.

      3.    Health Administration Services, Inc. shall decide the appeal within 60 days after receipt of the
            appeal, unless special circumstances require an extension of time for processing, in which
            case a decision shall be rendered as soon as possible, but in no event more than 120 days after
            receipt of the application for review.

      4.    The decision on review shall be in writing, specify the reason for the decision, and make
            specific reference to the pertinent plan provisions upon which the decision is based.

D.    LIMITATION ON ACTIONS

      No action at law or in equity shall be brought to recover on the Plan prior to the expiration of sixty
      (60) days after written Proof of Loss has been furnished in accordance with the requirement of the
      Plan and all appeal rights pursuant to the Plan have been exhausted. No such action shall be

San Benito CISD                                           67                            October 2002
      brought after the expiration of three years after the time written Proof of Loss is required to be
      furnished.




San Benito CISD                                        68                           October 2002
                                    GENERAL PROVISIONS


A.    ENTIRE PLAN DOCUMENT

      The Plan Document constitutes the entire Plan. The Plan shall not be deemed to constitute a
      contract of employment, contract for benefits, or give any employee the right to be retained in the
      service of the Employer or to interfere with the right of the Employer to discharge any employee.

B.    AMENDMENTS TO OR TERMINATION OF PLAN

      The Plan may be amended, canceled, or discontinued at any time by the Employer without the
      consent of, or notice to any Covered Person or beneficiary. In the event of an amendment which
      affects any rights under the Plan, information describing the change will be distributed.

C.    ASSIGNMENT

      The Covered Person's benefits may not be assigned except by consent of the Plan.

D.    OPERATION AND ADMINISTRATION OF THE PLAN

      The Employer has the authority to control and manage operation and administration of the Plan.

      1.    General Administration. The general administration of the Plan is vested in the Plan
            Administrator (San Benito Consolidated Independent School District).           The Plan
            Administrator shall have all powers and duties necessary or proper, as determined in its
            discretion, to administer the Plan and to discharge its duties under the Plan.

      2.    Discretion to Interpret. The Plan Administrator shall have absolute discretion to construe and
            interpret any and all terms and provisions of the Plan, including, but not limited to, the
            discretion to resolve ambiguities, inconsistencies, or omissions conclusively; provided,
            however, that all such discretionary interpretations and decisions shall be applied in a uniform
            and nondiscriminatory manner to all Covered Persons similarly situated. The interpretations
            and decisions of the Plan Administrator upon all matters within the scope of its authority shall
            be binding and conclusive upon all persons and shall control over the treating physician of a
            Covered Person.

      3.    Right to Delegate. The Plan Administrator may from time to time allocate to one or more of
            the Employer's officers, employees, or agents, and may delegate to any other person or
            organization, any of its powers, duties, and responsibilities with respect to the operation and
            administration of the Plan, including, without limitation, the administration of claims, the
            authority to authorize payment of benefits, the review of denied or modified claims, the
            determination of reasonable, customary, and medically necessary medical expenses, and
            procedures, the discretion to decide matters of fact and interpret Plan provisions (subject to
            the ultimate discretion of the Plan Administrator) and may employ and authorize any person
            to whom any of its responsibilities have been delegated to employ persons to render advice
            with regard to any responsibility held hereunder.

E.    PROCEDURE FOR FUNDING THE BENEFITS



San Benito CISD                                          69                            October 2002
      The Employer and eligible employees will contribute to the Plan the amount determined by the
      Employer to be appropriate for the benefits to be provided under the Plan. Such amount is subject
      to change at any time during the Plan year.




San Benito CISD                                        70                          October 2002
F.    MISSTATEMENT OF AGE

      If the age of a Covered Person has been misstated and if the amount of contribution is based on age,
      an adjustment of contributions shall be made based on the Covered Person's true age. If age is a
      factor in determining eligibility or amount of coverage and there has been misstatement of age, the
      coverage’s or amount of benefits, or both, for which the person is covered shall be adjusted in
      accordance with the Covered Person's true age. Any such misstatement of age shall neither continue
      coverage otherwise validly terminated nor terminate coverage otherwise validly in force.
      Contributions and benefits will be adjusted on the contribution due date next following the date of
      discovery of such misstatement.

G.    MISSTATEMENT OF MEDICAL FEES

      Any misstatements of fees by a medical provider which are known to the employee at the time, and
      result in overpayment become the responsibility of the employee.

H.    MISSTATEMENT OF DIAGNOSIS

      If diagnosis is a factor in determining eligibility or amount of coverage and there has been a
      misstatement of diagnosis, the coverage’s or amount of benefits, or both, for which the person is
      covered will be adjusted in accordance with the Covered Person's true diagnosis.

I.    RECOVERY

      Whenever payments have been made by the Plan, at any time, in excess of the maximum amount of
      payment allowed, the Plan will have the right to recover these payments, to the extent of the excess,
      from among one or more of the following, as the Plan will determine: Any individuals to or for or
      with respect to whom these payments were made, any other insurance companies, or other
      organizations.

J.    FACILITY OF PAYMENT

      If, in the opinion of the Contract Administrator, a valid release cannot be rendered for the payment
      of any benefit payable under this Plan, the Contract Administrator may, at its option, make such
      payment directly to health care provider, or to the guardian or conservator, or the parents of minor
      child, or an individual or individuals as have, in the Contract Administrators discretion to that
      person having the custody, the care and principal support of the Covered Person.

      In the event of the death of the Covered Person, the payment shall be made to the personal
      representative of the Covered Person's estate. Any payment made by the Contract Administrator in
      good faith pursuant to this provision, shall fully discharge the Plan and/or the Contract
      Administrator to the extent of such payment.

K.    ADMINISTRATIVE GUIDELINES

      The Plan Document cannot include complete explanations of all claims payment procedures;
      therefore, Administrative Guidelines are used by the Contract Administrator for clarification.

L.    GENDER

      As used herein the singular form of any word shall include the plural wherever necessary for the
      proper interpretation of this Plan, and wherever used herein a pronoun in the masculine gender shall
      be considered as including the feminine gender unless the context clearly indicates otherwise.
San Benito CISD                                          71                           October 2002
                           PLAN DOCUMENT APPROVAL PAGE



IT IS AGREED BY San Benito Consolidated Independent School District that the provisions contained in
this Plan Document are acceptable and will be the basis for the administration of said Employer's Employee
Benefit Program described herein.


SIGNED at San Benito, Texas, this     day of                 .


PLAN ADMINISTRATOR:

SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT




WITNESS:                                                         BY:




TITLE:                                                  TITLE:




San Benito CISD                                         72                           October 2002
                                AMENDMENT TO THE
               SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                          EMPLOYEE MEDICAL BENEFIT PLAN

It is hereby agreed that effective April 14, 2003, the San Benito Consolidated Independent School District
Employee Medical Benefit Document is being amended to conform with the privacy provision of the
Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), establishing the extent to which
the Plan Sponsor may receive, use or disclose protected health information as defined in 45 CFR 164.501.
 This Amendment implements the requirements of 45 CFR 164.504(f)(2) and is to be construed in
accordance with the HIPAA privacy regulation and guidance issued thereunder.

In order to make various revisions required by the HIPAA Privacy Regulations, the following is added and
incorporated into the Plan:
A.      Plan’s Disclosure of Protected Health Information to the Plan Sponsor Upon                       Receipt
of Certification of Compliance by Plan Sponsor
          The Plan may disclose protected health information to the Plan Sponsor only upon receipt of a
          certification by the Plan Sponsor that the Plan documents have been amended to incorporate the
          following provisions and that the Plan Sponsor agrees to:
          1)      Not use or further disclose the information other than as permitted or required by the Plan
                  documents or as required by law;
          2)      Ensure that any agents, including a subcontractor, to whom it provides protected health
                  information received from the Plan agree to the same restrictions and conditions that
                  apply to the Plan Sponsor;
          3)      Not use or disclose the information for employment-related actions and decisions or in
                  connection with any other benefit or employee benefit plan;
          4)      Report to the Plan any use or disclosure of the information that is inconsistent with the
                  uses or disclosures provided for or which it becomes aware;
     5)   Make available protected health information in accordance with 45 CFR 164.524;
          6)      Make available protected health information for amendment and incorporate any
                  amendments to protected health information in accordance with 45 CFR 164.526;
          7)      Make available the information required to provide an accounting of disclosures in
                  accordance with 45 CFR 164.528;
          8)      Make its internal practices, books and records relating to the use and disclosure of
                  protected health information received from the Plan available to the Secretary Health and
                  Human Services for purposes of determining compliance by the Plan with the HIPAA
                  Privacy Regulations;

          9)      If feasible, return or destroy all protected health information received from the Plan that
                  the Plan Sponsor still maintains in any form and retain no copies of such information
                  when no longer needed for the purpose for which disclosure was made, except that, if
                  such return or destruction is not feasible, limit further uses and disclosures to those
                  purposes that make the return or destruction of the information infeasible; and
          10)     Ensure that adequate separation between the Plan and the Plan Sponsor has been
                  established.


B.        Permitted Uses and Disclosures of Protected Health Information to the Plan Sponsor

San Benito CISD                                             73                            October 2002
        The Plan (and any business associate acting on behalf of the Plan) will disclose protected health
        information to the Plan Sponsor only to permit the Plan Sponsor to carry out administrative
        functions in relation to the Plan. Such disclosures shall be consistent with the provisions of 45
        CFR 164.
        All disclosures of protected health information to the Plan Sponsor will comply with the
        restrictions and requirements set forth in this Amendment. The Plan (and any business associate
        acting on behalf of the Plan) may not disclose protected health information to the Plan Sponsor for
        employment-related actions or decisions, or in connection with any other benefit plan of the Plan
        Sponsor. Further, the Plan Sponsor shall not use or disclose protected health information for
        employment-related actions and decisions, or in connection with any other benefit or employee
        benefit plan of the Plan Sponsor. The Plan Sponsor shall not use or further disclose protected
        health information other than as permitted by the Plan or the HIPAA privacy regulations.
        The Plan Sponsor shall ensure that any agent or subcontractor to whom it provides protected
        health information received from the Plan agrees to the same restrictions and conditions that apply
        to the Plan Sponsor with respect to protected health information. The Plan Sponsor shall report to
        the Plan any use or disclosure of protected health information that is inconsistent with the uses or
        disclosures provided for in the Plan or in the HIPAA privacy regulations, of which the Plan
        Sponsor becomes aware.
C.      Additional Duties of the Plan Sponsor
        The Plan Sponsor shall make protected health information of the individual who is the subject of
        the protected health information available to such individual in accordance with 45 CFR 164.524.
         The Plan Sponsor shall make individuals’ protected health information available for amendment
        and incorporate any amendments to individuals’ protected health information in accordance with
        45 CFR 164.526. The Plan Sponsor shall make and maintain records of disclosures so that it can
        make available an accounting of such disclosures to individuals in accordance with 45 CFR
        164.528.


        The Plan Sponsor shall make its internal practices, books and records relating to the use and
        disclosure of protected health information received from the Plan available to Health and Human
        Services for purposes of determining compliance with HIPAA’s privacy rules.
        The Plan Sponsor shall, if feasible, return or destroy all protected health information received
        from the Plan that the Plan Sponsor still maintains in any form after such information is no longer
        needed for the purpose for which the use or disclosure was made. Additionally, the Plan Sponsor
        will not retain copies of such protected health information after such information is no longer
        needed for the purpose for which the use or disclosure was made. However, if such return or
        destruction is not feasible, the Plan Sponsor will limit further uses and disclosures to those
        purposes that make the return or destruction of the information infeasible.
        The Plan Sponsor shall ensure that an adequate separation between the Plan and Plan Sponsor is
        established and maintained.


D.      Disclosures of Summary Health Information and Enrollment and Disenrollment
        Information to the Plan Sponsor
        The Plan (and any business associate acting on behalf of the Plan) may disclose summary health
        information to the Plan Sponsor if the Plan Sponsor requests summary health information for the
        purpose of 1) obtaining premium bids from health plans for providing health insurance coverage
        under the Plan or 2) modifying, amending or terminating the Plan.
        The Plan may disclose to the Plan Sponsor information on whether an individual is participating
        in the Plan or whether an individual is enrolled in or has disenrolled from the Plan.
San Benito CISD                                          74                            October 2002
E.      Required Separation Between the Plan and the Plan Sponsor
        In accordance with 45 CFR 164.504(f)(2)(iii), the following classes of employees or workforce
        members under the control of the Plan Sponsor may be provided access to protected health
        information received from the Plan:
           1.     JANIE GONZALEZ, INSURANCE COORDINATOR
          2.      LORENZO SANCHEZ. ASST. SUPT. FOR FINANCE & HUMAN RESOURCE
           3.     JOE D. GONZALEZ, SUPERINTENDENT
           4.     LUCY GARCIA, SENIOR RISK MGMT. SECRETARY
           5.     GRACIE CARPIO, W/C RISK MGMT. SECRETARY


        The above list includes the classes of employees or workforce members of the Plan Sponsor who
        receive protected health information relating to payment under, health care operations, or other
        matters pertaining to plan administration functions that the Plan Sponsor provides for the Plan.
        These individuals shall have access to protected health information solely to perform their job
        functions for the Plan Sponsor and they will be subject to disciplinary action for any use or
        disclosure of protected health information in violation of the provisions of this Amendment or the
        provisions of 45 CFR 164. The Plan Sponsor shall promptly report any such breach or violation
        to the Plan and will cooperate with the Plan to correct the violation, to impose appropriate
        disciplinary action and to mitigate any deleterious effect of such violation.


The Employer has executed this Amendment on this 18TH day of             JUNE       , 2003.
                                                    SAN BENITO CONSOLIDATED
                                                    INDEPENDENT SCHOOLD DISTRICT

                                                    By


                                                    Name:


                                                    Title:




San Benito CISD                                          75                           October 2002

				
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