Exhibit 10(m)


 


Schedule of Benefits

Plan 843-003


 


	
  Benefit
  Period

  	
  Calendar
  Year

  
	
   

  	
   

  
	
  Dependent
  Age

  	
  End
  of the calendar year of age 19, or to end of the calendar year in which the
  child attains age 25 if allowed as a federal tax exemption.

  
	
   

  	
   

  
	
  Pre-Existing
  Condition

  	
  None

  
	
   

  	
   

  
	
  Deductible
  Per Year Per Individual

  	
  $30.00

  
	
   

  	
   

  
	
  Co-Insurance

  	
  None,
  except as specified

  
	
   

  	
   

  
	
  Out-of-Pocket
  Limit

  	
   

  
	
   

  	
   

  
	
  Individual

  	
  $1,000.00

  
	
  Family

  	
  $2,000.00

  
	
   

  	
   

  
	
  Outpatient
  Services Surgery
  100% Coverage

  	
   

  
	
  Routine Office Visits

  	
  100%
  Coverage after Deductible

  
	
  Diagnostic X-Ray & Lab

  	
  100%
  Coverage

  
	
  Prenatal Care

  	
  100%
  Coverage after Deductible

  
	
  Well Baby Care

  	
  100%
  Coverage after Deductible

  
	
  Child Immunizations

  	
  100%
  Coverage

  
	
  Pap Smears (Annually)

  	
  100%
  Coverage

  
	
  Therapy, Physical
  Rehabilitation, Speech, etc.

  	
  100%
  Coverage After Deductible

  
	
  Allergy Testing

  	
  100%
  Coverage

  
	
  Allergy Serum &
  Injections

  	
  100%
  Coverage

  
	
  Emergency Room/Facilities

  	
  90%
  Coverage after Deductible

  
	
  Emergency Room/Physician

  	
  90%
  Coverage after Deductible

  
	
  Ambulance Service

  	
  90%
  Coverage

  
	
  Urgent Care

  	
  100%
  Coverage

  
	
   

  	
   

  
	
  Inpatient
  Services

  	
   

  
	
  Semi-Private Room &
  Board

  	
  100%
  Coverage

  
	
  Hospital Services
  (operating room, x-rays, lab, drugs. supplies. etc.)

  	
  100%
  Coverage

  
	
  Surgery-Physician Charge

  	
  100%
  Coverage

  
	
  Physician Visits in
  Hospital

  	
  100%
  Coverage

  
	
  Maternity Benefits

  	
  100%
  Coverage

  
	
   

  	
   

  
	
  Mental
  Health Care and Substance Abuse

  	
   

  
	
  Outpatient Services

  	
  80%
  Coverage after Deductible

  
	
  Inpatient Services

  	
  80%
  Coverage after Deductible

  
	
   

  	
   

  
	
  Miscellaneous

  	
   

  
	
  Prescription

  	
  $5.00
  Co-Pay with Prescription Card at Participating Pharmacies

  
	
  Eye Examinations

  	
  Not
  Covered

  
	
  Medical Equipment &
  Supplies

  	
  80%
  Coverage

  
	
  Home Health Care Services

  	
  100%
  Coverage

  
	
  Skilled Nursing
  Facility/Hospice Care

  	
  100%
  Coverage

  
			



 

















 


The Dayton Power and Light Company


Group Insurance Plan - Summary Plan Description


Plan #843-003


 


The Dayton Power and Light
Company Group Insurance Plan is a comprehensive indemnity medical plan
maintained by The Dayton Power and Light Company, P. O. Box 8825, Dayton, Ohio,
45401. The Company’s Employer Identification Number is 31-0258470.
The plan’s number as filed with the United States Department of Labor is 501.


 


Any service of legal process
about this plan should be made to Human Resource Administration, The Dayton
Power and Light Company, 1065 Woodman Drive, Dayton, Ohio, 45432.


 


ELIGIBILITY


 


Active employees and their
dependents who have not otherwise been enrolled in an insured plan offered
during annual open enrollment.


 


Eligible dependents include:


 


•                  Your
spouse.


•                  Your
unmarried children under age 19.


•                  Your
unmarried children under 25 years of age who are principally dependent upon you
for maintenance and support, are not regularly employed on a full-time basis
and are full-time students in a college or university.


•                  A
dependent child who is physically or mentally incapable of self-support.


 


The term “children” includes
your own child, stepchild, legally adopted child and any child who is
principally dependent upon you for maintenance and support and living with you.


 


Dependents who are on active
duty with the military are not covered.


 


PLAN
BENEFITS


 


Plan 843-003 is a
comprehensive medical plan that covers most medical expenses at 100% after the
plan deductible of $30 is met. The deductible is an individual deductible that
applies to each family member each calendar year. See the Schedule of Benefits
for specific coverage levels.


 


This plan allows members to
go to any licensed medical provider. However, the plan does require
pre-approval for certain major procedures. Your medical provider should submit
a request for pre-authorization to assure that medical expenses win be covered
for major elective procedures.


 


Prescription
Benefit


 


Your prescription benefit
allows you to fill prescriptions at any participating Paid Prescriptions
pharmacies. Simply show your DP&L HealthCare card to a participating
pharmacy and it will be filled for a $5 co-pay. Generic drugs will be provided
when available.


 


The Paid Prescriptions pharmacy network includes most major pharmacies throughout the United States. Locally,
it includes locations such as Revco, Kroger, Meijers and Cub Foods.


 

















 


Out-of-Pocket
Maximum


 


Annual out-of-pocket costs
for covered expenses are limited to $1,000 per person and $2,000 per family.


 


Plan
Maximum


 


You and each of your covered
dependents are eligible for up to $1,000,000 lifetime coverage.


 


PAYMENT OF
MEDICAL CLAIMS


 


In order for your medical
expenses (excluding prescriptions) to be paid, you and your medical provider
must complete a claim form and submit it Klais & Company, Inc. at the
address listed on the form. Claim forms are available through Human Resource
Administration.


 


Most medical providers will
accept a claim form for your medical benefits instead of requiring cash payment
and submit the form on your behalf for payment directly from Klais &
Company, Inc. If you have to pay for the claim yourself, submit the claim form
along with copies of your paid receipt for reimbursement


 


When the claim has been
processed, you wilt be notified of the benefits paid. If any benefits have been
denied, you will receive a written explanation.


 


PLAN
ADMINISTRATOR


 


The Dayton Power and Light
Company Group Insurance Plan is administered by Klais & Company, Inc. Their
address and telephone number are:


Klais & Company, Inc.


1867 West Market Street


Akron, OH 44313-6977


(800) 331-1096


 


COVERED
EXPENSES


 


Most medical expenses are
covered including hospital, surgical, and doctor’s charges; testing; treatment;
and supplies.


 


The plan covers the
following charges as specified by the plan Schedule Of Benefits for medically
necessary services and supplies ordered by your doctor:


 


•                  Hospital
room and board at the semi-private rate.


•                  Intensive
care and cardiac care unit charges.


•                  Hospital services and supplies while confined
in the hospital (Only medically necessary services
and supplies are covered Items such as television, telephones and newspapers
are not covered.)


•                  Hospital outpatient treatment, services and
supplies for illness, injury or outpatient surgery. (Certain surgical procedures are performed on  an outpatient basis.)


•                  Hospital
outpatient pre-admission tests performed prior to inpatient admission.


•                  Medical
treatment by a physician for an illness, diagnosis of an illness or accident.


•                  Surgery by a physician, including elective
sterilization and abortion. (Certain
surgical procedures require a second opinion.)


•                  Charges
for pregnancy are covered the same as any other medical expense for you or your
spouse.


•                  Active
services of an assisting surgeon.


•                  Anesthetics
and their administration by a physician or professional anesthetist.


•                  Services
and supplies provided by an approved ambulatory surgical center.


•                  Doctor’s
examination and reporting charges for second surgical opinions by a
board-certified specialist are fully paid.

















 


•                  Local professional ground ambulance service
when emergency transportation is required. (Non-emergency
transportation by taxicab, limousine, railroad, air ambulance or other
non-emergency vehicle is not covered.)


•                  Drugs
and medicine prescribed by a physician and dispensed by a pharmacist. Only
drugs and medications that require a prescription are covered.


•                  Home
health care services benefit is limited to 8 hours per 24-hour period.


•                  Skilled
nursing facility/hospice care services benefit is limited to 180 days per
calendar year.


•                  Insulin,
hypodermic syringes and needles and other associated medically necessary
supplies.


•                  Diagnostic
x-rays and laboratory services; blood, blood plasma and its administration;
oxygen and its administration; radium, radioactive isotopes and x-ray therapy.


•                  Surgical
dressings, casts, splints, trusses, braces, orthopedic shoes attached to
braces, crutches, support-type surgical stockings or sleeves, and colostomy
supplies.


•                  Prosthetic
devices to replace lost physical parts or organs, including artificial limbs,
hands and eyes.


•                  Initial
cost and fitting of external breast prosthesis after mastectomy.


•                  Rental
of necessary durable medical equipment including (but not limited to) a wheelchair, hospital bed, glucose
monitor, apnea monitor, iron lung or other equipment for administration of
oxygen, and supplies necessary in use of durable medical equipment. Medical
equipment is covered if medically necessary and cost effective. (The cost purchasing this equipment and the
replacement and repair of equipment may be covered. Before purchasing equipment
you must receive written pre-authorization for the purchase from the Plan
administrator.)


•                  Initial
cost of contact lens and its replacement when required after cataract surgery.


•                  Services
of a registered physical therapist or occupational therapist who is not a close
relative and does not live in your home.


•                  Speech
therapy by a licensed speech therapist under the supervision of a physician for
a condition resulting from injury, sickness, or congenital disorder (such as cleft lip or palate). Benefits
are not paid for a speech condition resulting from developmental or learning
disabilities or personality disorder.


•                  Non-surgical
procedures of the spine including, but not limited to subluxations,
manipulations, traction and adjustments are covered. Such charges must be
performed by a licensed provider and be considered medically necessary in terms
of generally accepted medical standards. Covered is limited to 20 visits in a
calendar year unless the chiropractor can provide acceptable proof of the need
for continued treatment.


•                  Certain
procedures involving oral surgery are covered. Cutting procedures necessary for
the care of teeth and gums and for repair of extractions will be covered, if
the cause is accidental.


•                  Certain
other cutting procedures such as the removal of bone impacted teeth, surgery of
the bone structure (osseous), bone cavities (alveolectomy), roots (apicoetomy)
and gum structure (gingivectomy) will be covered.


 


CHARGES
THAT ARE NOT COVERED


 


Although the plan covers
most medical expenses, some charges are not eligible. The Plan does not cover
the following expenses:


 


•                  Any
service or supplies that are not prescribed by a physician, that are not
medically necessary, that do not meet generally accepted professional
standards, or that are experimental or controversial in nature.


•                  Services or supplies that are for personal
comfort or of a luxury nature (such as
television, telephone, beauty or barber services, newspapers, guest cots, or
guest meals).


•                  Dental
work or oral appliances including but not limited to services, supplies, or
appliances provided in connection with treatment to alter, correct, fix,
improve, remove, replace, reposition, restore, or treat:


•                  the jaw, any jaw implant, or the joint of the
jaw (the temporomandibular joint);


•                  teeth;


•                  the parts of the upper or lower jaw which
contain the teeth (the alveolar process and ridges);


•                  the meeting of upper and lower teeth; or


•                  the chewing muscles.


 


[These services, supplies or
appliances are not covered even if they are:


 


(1)
needed because of symptoms, sicknesses or injuries which affect some other part
or parts of the body; or


 


(2)
provided in connection with any examination or treatment of the teeth, gums,
jaw or chewing muscles because of pain, injury, decay, malformation, disease or
infection.]


 

















 


•                  Any charges not reported to the insurance company
within one year after which the charge was incurred. (A claim should be
submitted within 90 days or as soon as reasonably possible.)


•                  Drugs, medicines or other pharmaceuticals
that can lawfully be obtained without a prescription (such as patent medicines, dietary supplements or vitamins and sickroom
supplies).


•                  Treatment
of any injury or sickness that is
covered by Workers’ Compensation or occupational disease law. Expenses incurred
by a donor or potential donor of an
organ or tissue for use in a transplant operation - whether you are the donor
or recipient.


•                  Custodial
care/rest cure.


•                  Expenses
for weight control or treatment of obesity
not caused by an organic condition.


•                  Travel
or transportation expenses except as specifically explained in an earlier
section.


•                  Radial
keratotomy.


•                  Expenses for sex transformation, treatment of
sexual dysfunction, reversal of sterilization, or direct attempts
to cause pregnancy such as hormone therapy, artificial insemination and in
vitro fertilization. (Treatment to determine
the cause of infertility - such
as examinations, diagnostic testing and surgery - is covered in the same way as any other illness. If a
medical condition is established, treatment of the  condition is also covered. But treatment to cause
pregnancy when no medical condition is established, or to reverse
sterilization, is not covered.)


•                  Treatment of eye refractions, eye exercises
or vision training, or the fitting or cost of eyeglasses or contact lenses. (Contact lenses are covered only when required as a
result of cataract surgery.)


•                  Foot
orthotics, orthopedic shoes, cervical collars (except
as specifically provided), athletic equipment, or protective wear.                .


•                  Services
provided or paid by the U.S. Government or any of its agencies.


•                  Nonmedical
equipment used in the home, such as sun or heat lamps, heating pads, whirlpool
baths, exercise devices, ramps, handrails, air conditioners, purifiers or humidifiers.


•                  Cosmetic
or reconstructive surgery except for repair of congenital birth defects in a
newborn infant, repair of injuries received while covered by the plan, or
repair of defects which result from surgery for which plan benefits were paid,


•                  Custodial
care.


•                  Injury
or sickness resulting from war or armed aggression, or incurred during active
duty or training in the armed forces, National Guard, or Reserves of any state or country.


•                  Expenses
that would be payable in the absence of this
coverage under the extension of benefits provision of a prior group health
plan.