More Plan Information from Lumenos Georgia Health Insurance

Other Plan Information

Refer to the following sections for other Plan information:

• Payment Due to Incompetency
• Amendment to or Termination of the Plan or Lumenos plan Option
• Other Documents

Payment Due to Incompetency

If a person entitled to receive benefits under the Plan is legally, physically or mentally incapable of receiving benefits, the Plan Administrator may make payment to another person or institution determined to maintain or have custody of the individual.

Amendment to or Termination of the Plan or Lumenos Plan Option

Although the company expects and intends to continue the Plan and the Lumenos plan option indefinitely, it may change or end the Plan and/or Lumenos plan option at any time for any reason. If the Plan or Lumenos plan option is changed or ends, you may not receive benefits as described here. However, you may be entitled to receive different benefits, or benefits under different conditions. The benefits under this plan do not vest.

Other Documents

To the extent that this Summary Plan Description (SPD) summarizes the plan documents governing the plan, if the SPD conflicts with the plan documents, the plan documents will control.

Plan Administration

The Lumenos plan is an option under the State Health Benefit Plan. The State Health Benefit Plan is the sponsor of the Plan. You and the company pay for the cost of the Plan. The company has delegated certain responsibilities of the Plan Administrator to the Claims Administrator. The Claims Administrator is not responsible for funding the payment of any benefits.

For important administrative information about the Plan and your rights as a Plan participant, see:

• Use of Health Information
• Plan Information

Use of Health Information

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that, in part, requires group health plans to protect the privacy and security of your confidential health information. This means that the Plan will not use or disclose your protected health information without your authorization, except for purposes of treatment, payment, health care operation, or Plan administration, or as required or permitted by law. A description of the Plan's uses and disclosures of your protected health information and your rights and protections under the HIPAA privacy rules is set forth in the Plan's notice of privacy practices, which has been furnished to you, which is incorporated herein by reference. You may obtain a copy of the Plan's notice of privacy practices by contacting your personnel/payroll office.

Plan Information

Refer to the following for important administrative information about the:

• Plan Name/Number
• Plan Sponsor/Employer Identification Number (EIN)
• Plan Administrator
• Agent for Legal Process
• Future of the Plan
• Plan Type
• Source of Funding
• Plan year
• Claims Administrator
• Claims Fiduciary

Plan Name/Number

The Plan name is the State Health Benefit Plan. The Lumenos plan is an option under the Plan.

Plan Sponsor/Employer Identification Number (EIN)

The State Health Benefit Plan is the sponsor of the Plan under which the Lumenos plan is an option.

The Plan sponsor's EIN is 58-1282972

Plan Administrator

The Plan Administrator is:
State Health Benefit Plan
PO Box 38342
Atlanta, GA 30334
(800) 610-1863

Except as otherwise provided herein (see "Claims Fiduciary" below) the Plan Administrator has the exclusive right and discretion to interpret the terms and conditions of the Plan, and to decide all matters arising in its administration and operation, including questions of fact and issues pertaining to eligibility for, and the amount of, benefits to be paid by the Plans. Any such interpretation or decision shall, subject to the claims procedure described herein, be conclusive and binding on all interested persons, and shall, consistent with the Plans' terms and conditions, be applied in a uniform manner to all similarly situated participants and their covered dependents. The Plan Administrator may delegate certain discretionary authority to one or more individuals, entities, or committees.

Your participation in the Plan does not guarantee your continued employment with the company. If you quit, are discharged or laid off, this Plan does not give you a right to any benefit or interest in the Plan except as specifically provided in the Plan document.

Future of the Plan

The company intends to continue the Plan at this time. However, the company reserves the right to amend, change or end the Plan, in whole or in part, at any time for any reason.

Plan Type

• The Plan is a group health benefit plan providing:
• hospital expense coverage
• surgical expense coverage
• major medical expense coverage

Source of Funding

The Plan is funded by company and participant contributions. Benefits are paid solely from Plan funds.

Plan year

The Plan year begins on January 1, 2006 and ends the following December 31, 2006.

Claims Administrator

The Plan Administrator has delegated certain administrative functions to the Claims Administrator. The Claims Administrator is Lumenos.

Claims Fiduciary

The Claims Fiduciary identified below has been delegated with the final and binding discretionary authority to decide all questions of fact and to interpret the terms of the plan for the purposes of making benefit claim determinations. The Claims Fiduciary is Lumenos.

Notice Regarding Cost Sharing And Certain Discounts

Some of the contracts with medical, dental, and vision providers may allow discounts, allowance, incentives, adjustments and settlements. These amounts are for the sole benefit of the Plan and the Plan will retain any such payments. Claims submitted to the Plan may have copayment and the Deductible amounts calculated according to the provider's charge for covered expenses without regard to the applicable discounts, allowances, or incentives.