| LEGAL DISCLAIMERS |
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The AGC Group Health Benefit Fund publishes a Summary Plan Document that is
distributed to all AGC Health Plan participants and is available upon request.
Because exact diagnosis and procedure codes are unknown, benefits are not
guaranteed until the claim is received. Please see your Summary Plan Document
for full plan, coverage and benefit disclosure.
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Subject to the stated purposes of the Fund and the provisions of the AGC Health
Plan agreement, the Trustees shall have full and exclusive authority to
determine all questions of coverage and eligibility, methods of providing or
arranging for benefits and all other related matters. They shall have full
power to construe the provisions of this Agreement, the terms used herein and
the by-laws and regulations issued thereunder. Any such determination and any
such construction adopted by the Trustees in good faith shall be binding upon
all of the parties hereto and the Beneficiaries hereof.
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It is the intent of the drafters of this Plan document that the Trustees
possess the discretion to determine eligibility for benefits and to construe
the terms of the Trust and/or plan governing benefits. It is also the intent of
the drafters of this Trust, by adopting the discretionary power specified
above, the decisions of the Trustees as to the rating or denial of benefits
and the construing of terms of the Trust and benefit Plan, are reviewed
pursuant to an “arbitrary and capricious” standard by a reviewing court, as
enunciated by the United States Supreme Court in Firestone Tire and Rubber
Company et al. v. Richard Brucha 57LW4194 (February 21, 1989).
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