OE3 Trust Funds

Following is only a summary of the Supplemental benefits provided by the Fund. For an explanation of these self-funded benefits, please see page 37 regarding the Oxygen benefit, page 38 for the Supplemental Anesthesiologist benefit.

SUPPLEMENTAL BENEFITS PROVIDED DIRECTLY BY THE TRUST FUND

Medically Necessary Oxygen during Air Travel
(for all Participants)

80% of the airline’s applicable charges, up to a maximum of $400 per round-trip travel

Supplemental Anesthesiologist Benefit (for HMSA Participants who receive anesthesia benefits from a Non-Participating Provider)

Surgeon who performed the surgery must be a Participating Provider; and
The surgical procedure must be a covered benefit under the HMSA Plan.

Fund will pay:

20% of the Allowed Charge from a Non-Participating anesthesiologist; and
100% of any deductible amount applied to such charge under the HMSA Plan.

Following is only a summary of the Life Insurance, Accidental Death & Dismemberment, Weekly Disability and Burial Benefits. For a complete explanation, please contact the insurance company listed on the Quick Reference Chart at the beginning of this SPD.

LIFE INSURANCE, ACCIDENTAL DEATH & DISMEMBERMENT, WEEKLY DISABILITY INCOME BENEFIT
Life Insurance
Engineer	$30,000
Spouse	$2,000
Children (according to age)
14 days but less than 6 months 6 months but less than 2 years 2 years but less than 3 years 3 years but less than 19 years	$100 $200 $400 $500
Accidental Death & Dismemberment (Engineer Only)	$20,000
Weekly Disability Income Benefit (Engineer Only)	Up to $632/week for 1st 26 weeks; $200/week for 2nd 26 weeks.

Following is only a summary of the Burial Expense Benefit. For a complete explanation, please contact the Trust Fund Office.

Burial Expense Benefit
Burial Expense Benefit (for the Engineer only)	$2,500