This Plan provides coverage at three Plan Levels: Employee-Only, Employee-Plus, and Family. The Employee-Only level covers only you, as the employee with employer contributions made on your behalf to the Plan. The Employee-Plus level covers either you and your eligible spouse, or you and your eligible children. The Family level covers you, your eligible spouse, and your eligible children.

The cost of each Plan Level is determined by the Trustees. When you begin having employer contributions made for your coverage under the Plan, you will have a choice about which Plan Level to select. If you do not make a selection when required, you will be enrolled in the Employee-Only Plan Level. Plan Level selections can only be changed at yearly Open Enrollment, for coverage effective January 1 of the following year, or when certain qualifying events have occurred in your family.

Employer contributions properly made to the Trust on your behalf are credited to your Dollars Bank account under the Plan. You first become eligible for the Plan based on a sufficient amount of employer contributions being made to the Plan and credited to your Dollars Bank account over a six-month period.

Once you are eligible for the Plan, continued payments for your coverage at your Plan Level are made month by month from your Dollars Bank. If your Dollars Bank reaches a certain level but does not have sufficient funds to pay for the next month of coverage at your Plan Level, you have the option of making self-payments (using approved payment methods) to maintain coverage. To make self-payments automatically, you can deposit up to the amount of the cost of one month of coverage at your Plan Level into a Self-Payment Account. With a Self-Payment Account, a deduction from your Self-Payment Account will automatically be made in the amount needed for you to maintain coverage at your Plan Level.