General Information Concerning Plan Coverage

The benefits provided by this Plan are for reimbursement of incurred expenses, and payment by the Plan will be made only for those costs actually incurred and paid for by the eligible Participant. Reimbursement will not be made for any amounts for which the Participant is not legally liable in the absence of coverage by this Plan.

This booklet describes the main features of the Plan. The benefits provided may be changed by the Board of Trustees. All provisions of the Plan are subjected to such rules and regulations adopted by the Trustees.

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PRE-CERTIFICATION/APPEALS

In the event a part or all of a claim is denied due to the enforcement of the Plan document, you may appeal to the Trustees. If an appeal is not made prior to the work being completed on a pre-certified claim, the appeal will not be honored. All appeals must be in writing and directed to:

Preferred Group Plans
P.O. Box 15136
Albany, NY 12212-5136
(800) 573-7474
FAX: (518) 641-0325
CLAIMS@TPGPLANS.COM

Please provide all information needed to support your appeal. Your appeal will be presented to the Trustees at the next scheduled meeting of the trust. Appeals must be received no later than 60 days after you receive the determination in question.

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RIGHT OF RECOVERY

A. Whenever we have made payments for Covered Services in excess of the maximum amount of payment necessary at the time to satisfy the intent of this provision, irrespective of to whom paid, we have the right to recover the excess payment from one or the following: any person to or for whom such payments were made, any insurance companies or any other organization.

B. You, personally and on behalf of your Enrolled Family Members will, upon request, execute and deliver such documents as may be required and to recover excess payments. Your failure to comply will result in a withdrawal of benefits already provided or a denial of benefits requested.