Document:

exh1045.htm

  

  

  

Exhibit 10.45

 

L.B. FOSTER COMPANY

MEDICAL REIMBURSEMENT

PLAN

MRP1

Summary Plan Description

As Amended and Restated Effective January 1, 2006

LE 01/17/06

  

  

  

MEDICAL REIMBURSEMENT PLAN OF BENEFITS

Maximum Yearly Benefit for Plan  - MRP1                                                                                                                     $3,000

Maximum Lifetime Maximum for Substance Abuse                                                                                                                     $25,000

 

Medical Reimbursement Plans provide Benefits for in-network covered services allowed, but not covered in their entirety by the Premium Medical and Dental Plans. Deductibles and Co-payments may be reimbursed by these Plans, up to the Usual, Reasonable and Customary Charge. Services for which coverage is limited by the Premium Plan, such as Orthodontics, may be reimbursed up to the Reasonable and Customary charge. Penalties for failure to Pre-notify or charges declined due to a Pre-Existing Condition are not allowable under these Plans, as well as charges above any limits set by the Medical Reimbursement Plans.

Additionally, the Medical Reimbursement Plans contain provisions for vision care as listed in this schedule.

Schedule of Benefits for MRP1

	  	
 

Benefits

	  	
Benefit Percentage:

Medical Plan Pays

Covered Person Pays

	
 

100%

0%

 

	
 

 

Benefits and Services

	
 

 

Plan Pays

	
 

 

COMMENTS

	
HOSPITAL BENEFIT

	
Inpatient Hospital Services

	
100% of UCR

 

	
Pre-notification required.

Benefit based on Semi-private room rate.

	
Outpatient Hospital

	
100% of UCR

 

	  
	
Skilled Nursing Facility

 

	
100% of UCR

 

	
Pre-notification required.

	
Emergency Room

	
100% of UCR

	
Non-emergency care is not covered.

	
MENTAL HEALTH & SUBSTANCE ABUSE BENEFITS

	
Inpatient Mental Health Treatment

	
100% of UCR

 

	
Pre-notification required.

 

  

  

  

 

	
Outpatient Mental Health Treatment including Psychological Testing

	
100% of UCR

	  
	
Inpatient Substance Abuse Treatment

	
100% of UCR

 

 

	
Pre-notification required.

	
Outpatient Substance Abuse Treatment

	
100% of UCR

	
Limited to 50 paid visits per year.

	
MISCELLANEOUS SERVICES AND SUPPLIES

	
Home Health Care

	
100% of UCR

 

	  
	
Hospice Care

Inpatient

	
100% of UCR

 

	
Pre-notification required.

	
Hospice Care

Outpatient

	
100% of UCR

	  
	
Bereavement Counseling

 

	
100% of UCR

	  
	
Ambulance Service

	
100% of UCR

 

	  
	
Durable Medical Equipment

	
100% of UCR

 

	  
	
Other outpatient care

 

	
100% of UCR

	  
	
PROFESSIONAL SERVICES BENEFIT

	
Physician’s visits

· Office Visit

 

· Inpatient Hospital Visit or Consultation

 

· Allergy

 

· Other Covered Injections

	
100% of UCR

 

 

100% of UCR

 

 

100% of UCR

 

 

100% of UCR

	  
	
Second Surgical Opinion

	
100% of UCR

	
If a second surgical opinion is required by Utilization Review but not obtained, the penalty will not be allowed under these Plans.

	
Obstetrics & Newborn Care

	
100% of UCR

 

	  

 

  

  

  

 

	
Surgical Services

	
100% of UCR

 

	
Includes surgeon and facility. Pre-notification required for all inpatient and outpatient surgical procedures. Pre-notification not required for office surgery.

	
Transplant Services

	
100% of UCR

 

	
Donor/Procurement related to a transplant is NOT COVERED.

	
Diagnostic Laboratory & X-ray Expenses

	
100% of UCR

 

	  
	
Supplemental Accident Benefit

	
100% of UCR

	  
	
REHABILITATION THERAPY

	
Chiropractic Care

	
100% of UCR

 

	  
	
Acupuncture Treatment

	
NOT COVERED

 

	  
	
Temporomandibular Joint Disorders (TMJ)

	
NOT COVERED

 

	  
	
Cardiac Rehabilitation

	
100% of UCR

	
Pre-notification required.

	
Chemotherapy

	
100% of UCR

 

	  
	
Radiation Therapy

	
100% of UCR

	  
	
Respiratory Therapy

	
100% of UCR

 

	  
	
Speech Therapy

	
100% of UCR

 

	  
	
Physical Therapy

	
100% of UCR

 

	  
	
Occupational Therapy

	
100% of UCR

	  
	
PREVENTIVE CARE

	
Well Care

· Physical Exam

 

· Other Well Services

	
 

100% of UCR

 

100% of UCR

	  
	
Mammogram

	
100% of UCR

	  
	
GYN & Pap

	
100% of UCR

	  

 

  

  

  

 

	
PSA testing

	
100% of UCR

	  
	
Well Child Care includes reimbursement for the following services: office visits, physical examination, laboratory tests, x-rays, immunizations and cancer screenings.

	
DENTAL BENEFITS

	
Preventive Services

 

	
100% of UCR

	  
	
Basic Services

 

	
100% of UCR

	  
	
Major Services

	
100% of UCR

	  
	
Orthodontics

	
100% of UCR

	  
	
VISION BENEFITS

	
Exams

	
100% of UCR

	
Limited to 1 per 12 months.

	
Frames

	
100% of UCR

	
Limited to 2 pair per 24 months.  $135 maximum.

	
Lenses

 

	
100% of UCR

	
Limited to 2 pair per 24 months.

Includes polycarbonate lens material for children under 19 Includes lenses coating

	
Contacts

	
100% of UCR

	
Limited to 1 pair per 12 months.  $100 maximum

	
Disposable Contacts

	
100% of UCR

 

	
Limited to $100 maximum

per 12 months.

	
PRESCRIPTION BENEFITS

	
Retail or Mail Order

Prescriptions

 

	
100% of UCR

 

	
Reimbursable after prescription deductible has been met.

Benefits for this coverage may be increased if a prescription change occurs.  Also, if a medical condition requires more frequent services, these Benefits may be increased to meet that requirement.  Any such condition will have to be documented by a letter of Medical Necessity.

 

  

  

  

EXCLUSIONS FOR MEDICAL REIMBURSEMENT PLANS

(In addition to those outlined in the Group Insurance Plan Medical Exclusions and Limitations)

Medical Exclusions

Amounts over the Usual, Reasonable and Customary Charge;

Charges already paid by the L.B. Foster Company’s basic medical and dental plans;

Charges that are not covered in part by the L.B. Foster Company’s medical and dental Plans, unless specifically stated in the Schedule of Benefits;

Out-of-network Services will not be paid under this Plan.

Penalties accessed for non-compliance assessed with Utilization Review Requirements.

Vision Exclusions

Non-prescription eye glasses;

Oversized  lenses, special tinting, special polishing.

Prescription Exclusions

Covered Prescription Drugs

	
·  

	
Drugs prescribed by a physician that require a prescription by federal law unless otherwise excluded.

	
·  

	
All compound medications containing at least one prescription ingredient in a therapeutic amount.

	
·  

	
Insulin when prescribed by a physician; needles, syringes and diabetic supplies, i.e. blood test strips, lancets, alcohol swabs, diabetic meters.

	
·  

	
Oral contraceptives

	
·  

	
Immunosuppressants

	
·  

	
Dermatological agents used to treat acne

	
·  

	
Immune Response Modifiers, such as. Betaseron, Avonex and Copaxone and Rebif

	
·  

	
Oral and injectable sexual dysfunction drugs

     Limits to Covered Prescription Drug Benefit

The covered benefit for any one prescription will be limited to:

	
·  

	
The quantity limits established by the plan

	
·  

	
Refills only up to the time specified by a physician

	
·  

	
Refills up to one year from the date of order by a physician

	
·  

	
Certain prescription drugs require prior-authorization.  A partial list is below:

-All anabolic steriods

-Drugs to treat Attention Deficit Hyperactivity Disorder or Narcolepsy

-Remicade for treatment of Crohn’s Disease

  

  

  

-Infertility Drugs are limited to 7 cycles per lifetime; 30 days supply per prescription

-Dermatological agents used to treat acne over the age of 25

-Xolair

-Synagis

-Lotronex; Zelnorm

-Synvisc; Hylagan  Limit to 2 cycles of injections per lifetime

-Weight Loss medications (dx of morbid obesity)

-Migraine Medications are limited to the manufacturer or FDA standard guidelines

-Toradol;Stadol NS (quantity limits will apply)

       Excluded Prescription Drugs

	
·  

	
Over the Counter products that may be bought without a written prescription or their equivalents. This does not apply to injectable insulin, insulin syringes and needles and diabetic supplies, which are specifically included.

	
·  

	
Devices of any type even though such devices may require a prescription. This includes (but not limited to) therapeutic devices or appliances such as Implantable insulin pumps and ancillary pump products.

	
·  

	
Immunization Agents, biological serum, biological immune globulins and vaccines.

	
·  

	
Implantable time-released medications.

	
·  

	
Experimental or Investigational Drugs or drugs prescribed for experimental, Non-FDA approved, indications.

	
·  

	
Drugs approved by the FDA for cosmetic use only, i.e. Renova

	
·  

	
Compound chemical ingredients or combination of federal legend drugs in a Non FDA approved dosage form.

	
·  

	
Nutritional Supplements except for metabolic conditions only.

	
·  

	
Weight loss medications

	
·  

	
Injectable arthritis medications: Enbrel, Kineret, Humira and Remicade

	
·  

	
Influenza medications

	
·  

	
Growth Hormones

	
·  

	
Miscellaneous supplies, i.e. batteries, logbooks, adapters, videotapes

	
·  

	
Hair reduction agents or hair replacement agents, i.e. Propecia or Vaniqa

	
·  

	
Fluoride

	
·  

	
Ceredase, Cerezyme

	
·  

	
Xyrem

	
·  

	
Pravigard

	
·  

	
Sarafem

	
·  

	
Blood Products and blood factor

	
·  

	
Amieve and Raptiva

	
·  

	
Any prescription that you are entitled to receive without charge from any Workers Compensation or similar law or municipal state or Federal program.

	
·  

	
Charges for the administration of a drug by an attending physician

	
·  

	
Charges for medication that is to be taken by or administered to you, in whole or part, while you are a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital or nursing home.

	
·  

	
Drugs for tobacco dependency.

	
·  

	
Cosmetic drugs, even if ordered for non-cosmetic purposes.

	
·  

	
Charges for giving or injecting drugs.exh10451.htm

  

  

  

Exhibit 10.45.1

 

L.B. FOSTER COMPANY

MEDICAL REIMBURSEMENT

PLAN

MRP2

Summary Plan Description

As Amended and Restated Effective January 1, 2006

LE 01/17/06

  

  

  

MEDICAL REIMBURSEMENT PLAN OF BENEFITS

Maximum Yearly Benefit for Plan – MRP2                                                                                                           $6,000

Maximum Lifetime Maximum for Substance Abuse                                                                                                                     $25,000

 

Medical Reimbursement Plans provide Benefits for in-network covered services allowed, but not covered in their entirety by the Premium Medical and Dental Plans. Deductibles and Co-payments may be reimbursed by these Plans, up to the Usual, Reasonable and Customary Charge. Services for which coverage is limited by the Premium Plan, such as Orthodontics, may be reimbursed up to the Reasonable and Customary charge. Penalties for failure to Pre-notify or charges declined due to a Pre-Existing Condition are not allowable under these Plans, as well as charges above any limits set by the Medical Reimbursement Plans.

 

Additionally, the Medical Reimbursement Plans contain provisions for vision care as listed in this schedule.

Schedule of Benefits for MRP2

	  	
 

Benefits

	  	
Benefit Percentage:

Medical Plan Pays

Covered Person Pays

	
 

100%

0%

 

	
 

 

Benefits and Services

	
 

 

Plan Pays

	
 

 

COMMENTS

	
HOSPITAL BENEFIT

	
Inpatient Hospital Services

	
100% of UCR

 

	
Pre-notification required.

Benefit based on Semi-private room rate.

	
Outpatient Hospital

	
100% of UCR

 

	  
	
Skilled Nursing Facility

 

	
100% of UCR

 

	
Pre-notification required.

	
Emergency Room

	
100% of UCR

	
Non-emergency care is not covered.

	
MENTAL HEALTH & SUBSTANCE ABUSE BENEFITS

	
Inpatient Mental Health Treatment

	
100% of UCR

 

	
Pre-notification required.

 

  

  

  

 

	
Outpatient Mental Health Treatment including Psychological Testing

	
100% of UCR

	  
	
Inpatient Substance Abuse Treatment

	
100% of UCR

 

 

	
Pre-notification required.

	
Outpatient Substance Abuse Treatment

	
100% of UCR

	
Limited to 50 paid visits per year.

	
MISCELLANEOUS SERVICES AND SUPPLIES

	
Home Health Care

	
100% of UCR

 

	  
	
Hospice Care

Inpatient

	
100% of UCR

 

	
Pre-notification required.

	
Hospice Care

Outpatient

	
100% of UCR

	  
	
Bereavement Counseling

 

	
100% of UCR

	  
	
Ambulance Service

	
100% of UCR

 

	  
	
Durable Medical Equipment

	
100% of UCR

 

	  
	
Other outpatient care

 

	
100% of UCR

	  
	
PROFESSIONAL SERVICES BENEFIT

	
Physician’s visits

· Office Visit

 

· Inpatient Hospital Visit or Consultation

 

· Allergy

 

· Other Covered Injections

	
100% of UCR

 

 

100% of UCR

 

 

100% of UCR

 

 

100% of UCR

	  
	
Second Surgical Opinion

	
100% of UCR

	
If a second surgical opinion is required by Utilization Review but not obtained, the penalty will not be allowed under these Plans.

	
Obstetrics & Newborn Care

	
100% of UCR

 

	  

 

  

  

  

 

	
Surgical Services

	
100% of UCR

 

	
Includes surgeon and facility. Pre-notification required for all inpatient and outpatient surgical procedures. Pre-notification not required for office surgery.

	
Transplant Services

	
100% of UCR

 

	
Donor/Procurement related to a transplant is NOT COVERED.

	
Diagnostic Laboratory & X-ray Expenses

	
100% of UCR

 

	  
	
Supplemental Accident Benefit

	
100% of UCR

	  
	
REHABILITATION THERAPY

	
Chiropractic Care

	
100% of UCR

 

	  
	
Acupuncture Treatment

	
NOT COVERED

 

	  
	
Temporomandibular Joint Disorders (TMJ)

	
NOT COVERED

 

	  
	
Cardiac Rehabilitation

	
100% of UCR

	
Pre-notification required.

	
Chemotherapy

	
100% of UCR

 

	  
	
Radiation Therapy

	
100% of UCR

	  
	
Respiratory Therapy

	
100% of UCR

 

	  
	
Speech Therapy

	
100% of UCR

 

	  
	
Physical Therapy

	
100% of UCR

 

	  
	
Occupational Therapy

	
100% of UCR

	  
	
PREVENTIVE CARE

	
Well Care

· Physical Exam

 

· Other Well Services

	
 

100% of UCR

 

100% of UCR

	  
	
Mammogram

	
100% of UCR

	  
	
GYN & Pap

	
100% of UCR

	  

 

  

  

  

 

	
PSA testing

	
100% of UCR

	  
	
Well Child Care includes reimbursement for the following services: office visits, physical examination, laboratory tests, x-rays, immunizations and cancer screenings.

	
DENTAL BENEFITS

	
Preventive Services

 

	
100% of UCR

	  
	
Basic Services

 

	
100% of UCR

	  
	
Major Services

	
100% of UCR

	  
	
Orthodontics

	
100% of UCR

	  
	
VISION BENEFITS

	
Exams

	
100% of UCR

	
Limited to 1 per 12 months.

	
Frames

	
100% of UCR

	
Limited to 2 pair per 24 months.  $135 maximum.

	
Lenses

 

	
100% of UCR

	
Limited to 2 pair per 24 months.

Includes polycarbonate lens material for children under 19 Includes lenses coating

	
Contacts

	
100% of UCR

	
Limited to 1 pair per 12 months.  $100 maximum

	
Disposable Contacts

	
100% of UCR

 

	
Limited to $100 maximum

per 12 months.

	
PRESCRIPTION BENEFITS

	
Retail or Mail Order

Prescriptions

 

	
100% of UCR

 

	
Reimbursable after prescription deductible has been met.

Benefits for this coverage may be increased if a prescription change occurs.  Also, if a medical condition requires more frequent services, these Benefits may be increased to meet that requirement.  Any such condition will have to be documented by a letter of Medical Necessity.

  

  

  

EXCLUSIONS FOR MEDICAL REIMBURSEMENT PLANS

(In addition to those outlined in the Group Insurance Plan Medical Exclusions and Limitations)

Medical Exclusions

Amounts over the Usual, Reasonable and Customary Charge;

Charges already paid by the L.B. Foster Company’s basic medical and dental plans;

Charges that are not covered in part by the L.B. Foster Company’s medical and dental Plans, unless specifically stated in the Schedule of Benefits;

Out-of-network Services will not be paid under this Plan.

Penalties accessed for non-compliance assessed with Utilization Review Requirements.

Vision Exclusions

Non-prescription eye glasses;

Oversized  lenses, special tinting, special polishing.

Prescription Exclusions

Covered Prescription Drugs

	
·  

	
Drugs prescribed by a physician that require a prescription by federal law unless otherwise excluded.

	
·  

	
All compound medications containing at least one prescription ingredient in a therapeutic amount.

	
·  

	
Insulin when prescribed by a physician; needles, syringes and diabetic supplies, i.e. blood test strips, lancets, alcohol swabs, diabetic meters.

	
·  

	
Oral contraceptives

	
·  

	
Immunosuppressants

	
·  

	
Dermatological agents used to treat acne

	
·  

	
Immune Response Modifiers, such as. Betaseron, Avonex and Copaxone and Rebif

	
·  

	
Oral and injectable sexual dysfunction drugs

      Limits to Covered Prescription Drug Benefit

The covered benefit for any one prescription will be limited to:

	
·  

	
The quantity limits established by the plan

	
·  

	
Refills only up to the time specified by a physician

	
·  

	
Refills up to one year from the date of order by a physician

	
·  

	
Certain prescription drugs require prior-authorization.  A partial list is below:

-All anabolic steriods

-Drugs to treat Attention Deficit Hyperactivity Disorder or Narcolepsy

-Remicade for treatment of Crohn’s Disease

  

  

  

-Infertility Drugs are limited to 7 cycles per lifetime; 30 days supply per prescription

-Dermatological agents used to treat acne over the age of 25

-Xolair

-Synagis

-Lotronex; Zelnorm

-Synvisc; Hylagan  Limit to 2 cycles of injections per lifetime

-Weight Loss medications (dx of morbid obesity)

-Migraine Medications are limited to the manufacturer or FDA standard guidelines

-Toradol;Stadol NS (quantity limits will apply)

Excluded Prescription Drugs

	
·  

	
Over the Counter products that may be bought without a written prescription or their equivalents. This does not apply to injectable insulin, insulin syringes and needles and diabetic supplies, which are specifically included.

	
·  

	
Devices of any type even though such devices may require a prescription. This includes (but not limited to) therapeutic devices or appliances such as Implantable insulin pumps and ancillary pump products.

	
·  

	
Immunization Agents, biological serum, biological immune globulins and vaccines.

	
·  

	
Implantable time-released medications.

	
·  

	
Experimental or Investigational Drugs or drugs prescribed for experimental, Non-FDA approved, indications.

	
·  

	
Drugs approved by the FDA for cosmetic use only, i.e. Renova

	
·  

	
Compound chemical ingredients or combination of federal legend drugs in a Non FDA approved dosage form.

	
·  

	
Nutritional Supplements except for metabolic conditions only.

	
·  

	
Weight loss medications

	
·  

	
Injectable arthritis medications: Enbrel, Kineret, Humira and Remicade

	
·  

	
Influenza medications

	
·  

	
Growth Hormones

	
·  

	
Miscellaneous supplies, i.e. batteries, logbooks, adapters, videotapes

	
·  

	
Hair reduction agents or hair replacement agents, i.e. Propecia or Vaniqa

	
·  

	
Fluoride

	
·  

	
Ceredase, Cerezyme

	
·  

	
Xyrem

	
·  

	
Pravigard

	
·  

	
Sarafem

	
·  

	
Blood Products and blood factor

	
·  

	
Amieve and Raptiva

	
·  

	
Any prescription that you are entitled to receive without charge from any Workers Compensation or similar law or municipal state or Federal program.

	
·  

	
Charges for the administration of a drug by an attending physician

	
·  

	
Charges for medication that is to be taken by or administered to you, in whole or part, while you are a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital or nursing home.

	
·  

	
Drugs for tobacco dependency.

	
·  

	
Cosmetic drugs, even if ordered for non-cosmetic purposes.

	
·  

	
Charges for giving or injecting drugs.

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