AMRA TRICARE SUPPLEMENT PLAN

1. AMRATRICARE SUPPLEMENT PLAN

2. AMRA TRICARE SUPPLEMENT PLAN A voluntary supplemental health benefit option available to employees and their dependents who are eligible for TRICARE. Employees who enroll in the TRICARE Supplement Plan are responsible for 100% of the monthly premium amounts. Monthly premium payments are made with pre-tax dollars through payroll deduction. Monthly Premium Rates are as follows: Employee Only $67.16 Employee plus Spouse $133.31 Employee plus Child(ren) $133.31 Employee plus Family $180.12 Dues of $1.00 will be deducted from the monthly premium for payment of membership to AMRA.

3. WHO WE ARE PLAN ADMINISTRATOR Association & Society Insurance Corporation, Rockville, MD PLAN UNDERWRITER Monumental Life Insurance Company, Cedar Rapids, IA Transamerica Financial Life Insurance Company, Harrison, NY AEGON companies PLAN SPONSOR American Military Retirees Association (AMRA), Plattsburgh, NY

4. Eligible Employees • Are under age 65 and retired from any branch of the armed services. They are: • Military retirees entitled to retired, retainer or equivalent pay • TRICARE Retired Reserve members under age 60 (“Gray Area” retirees) • Spouses and surviving spouses of retired Military personnel • Unmarried dependent children up to age 21 or 23 if a full-time student • Coverage continues past age 21 or 23 if incapacitated and TRICARE eligibility continues. • Military retirees and/or spouses over age 65 are eligible if they reside outside the U.S. and its territories. They must still be eligible for Medicare Part A and enrolled in Medicare Part B. • Military retirees and/or spouses who are not eligible for Medicare. They must have received a Statement of Disallowance from Social Security Administration • These eligible individuals must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) • (DEERS is a worldwide, computerized database of uniformed services members, their family members and others who are eligible for military benefits)

5. What the TRICARE Supplement Plan Pays after TRICARE Standard/Extra Pays

6. ASI Contact Information Employees - contact Customer Service at 1-800-638-2610, ext. 255 Call Center hours of operation - 8:30 am to 8:00 pm Employers (HR Representatives/Benefits Specialists) -contact Client Services at 1-800-638-2610, ext. 253 Fax number for Client Services Dept: 301-816-1171 or 800-311-3126 Fax number for claims: 301-816-1125 or 1-800-310-5514 Claims Address: ASI Claims Dept P.O. Box 2510 Rockville, MD 20847 ASI Web Site Address: www.asicorporation.com