HEALTH INSURANCE INFO.

 HEALTH INSURANCE PLAN RIDERS 5 & 6

St. Lawrence-Lewis Counties School District Employees Medical Plan

Rider 5

Prescription Drug Benefits

            Retail Pharmacy (30 day supply only):

            The covered person pays:  $10 per generic prescription         

            The covered person pays:  $20 per preferred brand name prescription

            The covered person pays:  $30 per non-preferred brand name prescription

            Mail-Order Pharmacy (90 day supply) (Maintenance Drugs Only):

            The covered person pays:  $10 per generic prescription         

            The covered person pays:  $20 per preferred brand name prescription

            The covered person pays:  $30 per non-preferred brand name prescription

            These co-payments are capped for the base twelve month period at the following annual limits:  $300 for an individual enrollment; $600 for a two-person enrollment; and, $900 for a family enrollment.

The designation of whether a prescription drug is preferred or non-preferred will be made by the Plan's Prescription Benefit Manager (currently ProAct).  This listing will be distributed at least once each Plan Year.  Changes to the designation will only be made four times each Plan Year by the Prescription Benefit Manager, and will not be subject to the direction of the Plan Administration, Board of Directors, or Consultant.  Should the Plan's Prescription Benefit Manager be changed in the future, any new formulary will reflect tier designations that are equivalent or more favorable as an entire list to the employees, and all conditions of this clause will be binding.

The prescription drug co-payments and caps will be indexed and subject to change in the following manner: prescription drug co-payments and annual co-payment limits will increase in whole dollar amounts (e.g. $11/$22/$33 and $330/$660/$990, followed by $12/$24/$36 and $360/$720/$1,080) every time the annual cumulative per capita prescription drug costs of the Rider 5 covered persons increase by 10% over the base period per capita costs (the first twelve months of Rider 5 participation).

Prescription costs for Rider 5 participants will be totaled at the end of each month for the immediately preceding twelve month period and divided by the number of Rider 5 persons; said per capita amount must be at least 10% higher than the base period amount for the initial increase in co-pays and caps to occur, then 20% higher than the base period amount for the second increase to occur, etc.

Rider 6

 Co-Payments for the Medical Benefits

All $10 co-payments referred to in the Benefit Summary Section will be changed to $15 with the exception of the Hospital Outpatient and Ambulatory Surgery Center Co-Payments which will be changed to $20.

All $75 facility co-payments referred to in the Benefit Summary Section will be changed to $100.

The $50 Emergency Room co-payment referred to in the Benefit Summary will be changed to $75.