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INTRODUCTION Recognizing that personal problems can adversely impact one's effectiveness at work, Employer has contracted with OHS to provide its Employees and their enrolled Family Members coverage under this plan for counseling and treatment for certain marital and family problems, alcoholism and drug dependency, financial and credit concerns, emotional problems, stress, childcare, eldercare, interpersonal conflicts, si tuational- life problems, federal tax problems, and legal problems. All of us encounter some of these problems at some time in our lives. These problems not only affect our mood and behavior, they frequently affect others close to us. Employer encourages its Employees and their enrolled Family Members to use this plan. The specific benefits of this plan are set forth in the section entitled "Covered Services" below and in the attached Benefits Schedule. There is no claim form submission requirement for Covered Services. Claims for Covered Services are submitted directly by the Participating Providers and are processed by OHS or an agent or independent contractor of OHS. You are required to take an active part in ensuring the success of your plan. Read this Evidence of Coverage as it will help you understand your responsibilities and benefits as a Member. If you have any questions regarding this plan, please contact OHS at (800)227-1060. HOW TO USE THIS PLAN For counseling services to be covered under of this plan, you must obtain Prior Authorization of coverage and a referral from OHS. This means that you must contact OHS at (800)227-1060 to request that the service be approved for coverage before it is rendered and to receive the name and telephone number of the Participating Provider selected by OHS to assist you with your problems. Members may call OHS 24 hours a day, 365 days a year. Prior Authorization of coverage will be denied if the requested services are not Medically/Psychologically Necessary or otherwise not covered under this plan. PARTICIPATING PROVIDERS PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHICH PROVIDERS SERVICES MAY BE OBTAINED IN ORDER TO BE COVERED UNDER THIS PLAN. Members may not self refer to any non-Participating Provider or Participating Provider. Instead, OHS will refer the Member to a Participating Provider selected by OHS who will assist the Member - 3 - , . .._."~,_..,-_.... ,-_.._,-, "'....-- ,. '" ,"' "',"