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Vision Care Plan for Salaried Employees Summary Plan Description Effective: January 1, 2013 This document is your Summary Plan Description of the Vision Care Plan for Salaried Employees for purposes of the Employee Retirement Income Security Act of 1974. Your Vision Care Plan Coverage Choices Options The Vision Care Plan Selecting a Coverage Level No Coverage Eligibility Employees Providing Coverage for Others: Spouse (including a common law spouse) Same-Sex Domestic Partner Child (as defined by Health Care Reform) Child of a Same-Sex Domestic Partner Child covered by a Qualified Medical Child Support Order Covered Child Who Become Totally and Permanently Disabled Principally Supported Children (no further enrollments as of 6/1/2003) Child by Legal Guardianship (no further enrollments as of 6/1/2003) Sponsored Dependents (no further enrollments as of 1/1/2013) Dependent Eligibility Verifications Medically Necessary Leave of Absence for Dependents covered as Full Time Students Enrollment When Coverage Is Effective Cost How the Vision Care Plan Works The Plan in Brief Network Provider Information 1 FRD-GCH 1/13
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Vision Care Plan for Salaried Employees

Summary Plan Description

Effective: January 1, 2013 This document is your Summary Plan Description of the Vision Care Plan for Salaried Employees for purposes of the Employee Retirement Income Security Act of 1974.

Your Vision Care Plan Coverage Choices

Options The Vision Care Plan Selecting a Coverage Level No Coverage

Eligibility

Employees Providing Coverage for Others:

Spouse (including a common law spouse) Same-Sex Domestic Partner Child (as defined by Health Care Reform) Child of a Same-Sex Domestic Partner Child covered by a Qualified Medical Child Support Order Covered Child Who Become Totally and Permanently Disabled Principally Supported Children (no further enrollments as of 6/1/2003) Child by Legal Guardianship (no further enrollments as of 6/1/2003) Sponsored Dependents (no further enrollments as of 1/1/2013)

Dependent Eligibility Verifications Medically Necessary Leave of Absence for Dependents covered as Full Time Students

Enrollment

When Coverage Is Effective Cost

How the Vision Care Plan Works

The Plan in Brief Network Provider Information

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Visiting a Network Provider Visiting a Non-Network Provider

Schedule of Benefits

Plan Benefits

What the Plan Covers

What the Plan Does Not Cover

Contacts for Additional Information

General Administrative Information

Basic Information Authorization to Approve Plans or Programs Plan Amendment or Termination Your Rights Under ERISA

Claims and Appeal Procedures

Life Events Affecting Vision Plan Benefits

Employment Status Changes Family Status Changes If Your Employment Ends Leaves of Absence

Continuation of Coverage Under COBRA

COBRA Provisions Trade Act of 2002 Uniformed Services Employment and Reemployment Rights Act (USERRA) Leaves of Absence

Your Vision Care Plan Coverage Choices You may elect vision coverage under the Flexible Benefits Plan. Vision insurance is provided by Heritage Vision Plans. Options

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Your options are:

Vision Care Plan Coverage o Several coverage levels are available

No Coverage

The Vision Care Plan (the "Plan")

You may elect vision care coverage through the Vision Care Plan coverage through the Flexible Benefits Plan during the Annual Enrollment period, when you first become eligible to participate in the plan or if you have an event that permits a change in your flex elections. The Plan offers a network of qualified optometrists and some ophthalmologists established by Heritage, the insurer of vision benefits. The Plan provides different levels of benefits depending on whether you use network or non-network providers.

You do not need to submit any claim forms if you use a Heritage network provider.

When you go to a non-network provider, your out-of-pocket costs will be higher. You will need to submit an itemized bill to Heritage Vision Plans for reimbursement for covered services from a non-network provider.

Vision benefits are paid under the provisions of the insurance contract with Heritage, and only Heritage is responsible for the payment of benefits. Ford Motor Company has no responsibility for providing vision benefits.

Selecting a Coverage Level

You may elect coverage for:

yourself only you and your spouse or same-sex domestic partner you and your children and certain tax dependents you and your spouse or eligible same-sex domestic partner and your eligible

children

No Coverage

You may choose No Coverage. You do not need to have vision coverage from another source in order to decline coverage.

Eligibility

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Employees

You are eligible to elect vision plan participation during the Flexible Benefits Plan Annual Enrollment period or upon your initial eligibility for the Flexible Benefits Plan if you are a U.S. salaried employee of Ford Motor Company or a participating subsidiary on the full-time active employment rolls, which includes being on short-term disability at 100% of pay; a flex-eligible co-op, or on Transitional Work Arrangement status including:

Ford Motor Credit Company Ford Motor Credit International, Inc. The American Road Services Company Ford Motor Land Services Corporation Ford Motor Land Development Ford International Business Development, Inc. Ford Automotive Components Operations, Inc. AAI Employee Services Company, L.L.C. Ford Global Technologies, L.L.C. DFO Holdings Ford Credit Bank Automotive Components Holdings, LLC

If you are a salaried employee covered by a collective bargaining agreement, you may participate in the Plan only if the agreement so provides. Salaried union represented employees should refer to the current Collective Bargaining Agreement (CBA) for a listing of their vision care benefits. Salaried union represented employees and their beneficiaries may request, in writing, a copy of the current CBA from the Union Local office or may examine a copy of the CBA by contacting their local union representative.

If you participated in the Benefits Annual Enrollment period, but you are not receiving pay from the Company for January 1, your election will be cancelled, and you will be eligible to reenroll for the voluntary vision plan after you return to work.

Non-Company Personnel

Persons classified by the Company as non-Company personnel, including consultants, independent contractors, contract personnel, or project/program/service personnel as well as people classified as supplemental employees are not eligible to participate in this Plan. Non-Company personnel who are determined to be common-law employees of the Company by a court or government agency also are not eligible to participate in the Company's benefit plans.

Providing Coverage for Others

When enrolling eligible dependents to your vision plan coverage option, you must provide the Company with their Social Security Number. If the eligible dependent has not

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been assigned a Social Security Number at the time they are enrolled, one must be obtained and reported to the Company within six months of the date coverage becomes effective.

You may choose to cover the following people, subject to the requirements noted:

Spouse (including a common law spouse) Same-Sex Domestic Partner Child (as defined by Health Care Reform) Child of a Same-Sex Domestic Partner Child covered by a Qualified Medical Child Support Order Covered Child who become Totally and Permanently Disabled

Spouses (including a common-law spouse) Your spouse is eligible for coverage if you are eligible for and have enrolled in the vision plan coverage option, are making required contributions and agree to make the additional contributions to cover a spouse.

"Spouse" means an individual of the opposite sex married to an eligible employee if such marriage is recognized as legal under relevant U.S. and state laws, including a common-law marriage where such a relationship is recognized as a legal marriage by the laws of the state or province of the eligible employee's residence.

Termination Your spouse will lose eligibility for coverage:

the date your coverage ends the date of a final decree of divorce the date your marriage is annulled the last day of the month in which your death occurs (unless your spouse qualifies

as a surviving spouse under the General Retirement Plan), provided any required premiums are paid

o coverage eligibility continues for spouse and for eligible children through the month of your death but may be continued for the balance of 36 months under COBRA. Eligible dependents must be enrolled at the time of death and meet all eligibility requirements.

the date your spouse remarries if your death is the result of an occupation injury caused solely by the employment with the Company and results solely from an accident in which the cause and result are unexpected and definite as the time and place, provided any required premiums are paid

the date your spouse no longer meets any other eligibility requirements of the Plan

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Same-Sex Domestic Partners Your same-sex domestic partner is eligible for coverage if you are eligible for and have enrolled in the vision plan coverage option, are making required contributions and agree to make the additional contributions to cover a same-sex domestic partner.

you and your partner are the same gender you have shared a continuous committed relationship with each other for no less

than six months, intend to do so indefinitely, and have no such relationship with any other person

you are jointly responsible for each other's financial obligations you reside in the same household you are not related by blood to a degree of kinship that would prevent marriage

from being recognized under the laws of your state of residence you reside in a state where marriage between persons of the same-sex is not

recognized as a valid marriage or, if residing in a state that recognizes same-sex unions, enter into such union as recognized by the state

you and your same-sex domestic partner are over age 18, of legal age, and legally competent to enter into a contract

neither of you is married to a third party

If the non-employee same-sex domestic partner is not your legal dependent under the Internal Revenue Code of the United States, the benefits are taxable and are calculated as follows:

the fair market value of the benefits provided for your same-sex domestic partner is imputed (taxable) income to you

the premium contribution paid by you on behalf of your same-sex domestic partner must be paid after-tax

Termination

Your same-sex domestic partner will lose eligibility for coverage:

the date your coverage ends the date the relationship ends the date your same-sex domestic partner no longer meets any other eligibility

requirements of the Plan

A Child or Children (as defined under Health Care Reform) A "child" (as defined under Health Care Reform) includes only an employee's:

Natural Children Legally Adopted Children Children Placed for Legal Adoption Under the Age of 18

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Foster Child (under court or agency order) Stepchildren (natural or adopted children of the employee's spouse)

Age

The child must be under the age of 26.

For each person in this category, until the age of 26 you only need establish the relationship. Other criteria such as tax dependency, residence, student or marital status do not apply.

Termination

Your child(ren) will lose eligibility for coverage:

the date your coverage ends the last day of the month in which the child turns age 26, except in the case of a

totally and permanently disabled child the date your coverage ends, except that in the case of your death, coverage for

the dependent child will end on the last day of the month following the month in which you die (unless the child is eligible for coverage as a dependent child of an eligible surviving spouse in which case the child's coverage ends when the surviving spouse is no longer eligible for coverage)

the date you or your spouse, or the order of a court of competent jurisdiction, terminates the legal obligation for total or partial support for a child who met the criteria for placement for adoption under OBRA 93

the date the child no longer meets any other eligibility requirements of the Plan

Note: A child certified by the Company as Totally and Permanently Disabled prior to their 26th birthday can continue coverage after age 26 while meeting the guidelines of Relationship, Residency, Marital Status and Dependency.

Children of an Employee's Same-Sex Domestic Partner (SSDP) A child of your same-sex domestic partner is eligible for coverage if you are eligible and enrolled for coverage, make all required contributions, and the child meets all of the following requirements:

Relationship

The child must be your SSDP's child by birth or legal adoption.

Age

The child must be under the age of 19

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Coverage may continue for a child who is a full time student (and meets all of the other conditions described) until age 24.

During the year a SSDP's child reaches age 19 and through the end of the year in which they attain age 24, the child must qualify as a full-time student as defined by the approved educational institution and meet all other Company dependent eligibility requirements. Full-time students are required to be enrolled full-time at an educational institution meeting IRS requirements during each of five months in a calendar year.

Residency

The child must reside as a member of your household.

Dependency

You, the Ford employee, must claim your SSDP's child as your tax dependent for Federal income tax purposes.

Marital Status

The child of your SSDP must be unmarried.

Termination

The child(ren) of your SSDP will lose eligibility for coverage:

the date your coverage ends the date of marriage of the child the date the child ceases to be dependent upon you for Federal income tax

purposes the date the child no longer meets the residency requirement the last day in the calendar year in which the child becomes age 24, except in the

case of a totally and permanently disabled child (in the event coverage for a totally and permanently disabled child is continued, eligibility for such coverage will end as of the last day of the month in which they cease to be totally and permanently disabled)

in the case of your death, coverage for the dependent child will end on the last day of the month following the month in which you die

the date you or your same-sex domestic partner, or the order of a court of competent jurisdiction, terminates the legal obligation for total or partial support for a child who met the criteria for placement for adoption under OBRA 93

the date the child no longer meets any other eligibility requirements of the Plan

Children covered by a Qualified Medical Child Support Order ("QMCSO")

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The Ford Health Plans must follow the provisions of a Qualified Medical Child Support Order ("QMCSO"). A QMCSO is judgment, decree or order from a court or administrative agency (that the Ford health plan determines meets all QMCSO requirements) requiring a Ford health plan participant to provide coverage to an employee's child under a state domestic relations law (such as a divorce judgment) or a law relating to child support (such as a National Medical Support Notice issued by a state child support agency).

As Plan Administrator, Ford determines whether a court or agency order meets the requirements for a QMCSO. For a copy of the Ford Health Plan QMCSO procedures, write to:

Ford Motor Company National Employee Services Center P.O. Box 199721 Dallas TX 75219-9721 Attn: QMCSO Coordinator

A court or agency order will not be a QMCSO unless the child that is subject to the order meets the following requirements:

Relationship

A QMCSO can only be obtained for an employee's:

Natural Children Legally Adopted Children

If a medical child support order is determined to be a QMCSO, the effective date of coverage will be as of the 1st of the month following the receipt of the court documents.

Termination

Your court ordered child(ren) will lose eligibility for coverage:

the date your coverage ends the date the child(ren) graduates from high school or attains age 18, whichever

occurs later, but in no instance after age 19 and six months the date the qualified legal requirement to provide vision care coverage has

terminated or the qualified legal requirement to provide vision care coverage no longer meets the Plan requirements

the date the child(ren) no longer meets any other eligibility requirements of the Plan

Covered Children with a Total and Permanently Disability

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The otherwise applicable age limits do not apply to a child (as defined by the Health Care Reform) who, while covered by the plan, becomes Totally and Permanently Disabled (T&PD) before attaining the age 26, when coverage would otherwise end. Totally and Permanently Disabled means a medically determinable physical or mental condition which prevents a child from engaging in substantial gainful activity which can be expected to result in death or be of long-continued or indefinite duration.

Coverage will not be reinstated for children who first become totally and permanently disabled after the end of the month in which age 26 is attained or who was eligible and enrolled for coverage as a totally and permanently disabled child, recovers, and after coverage has ended, has again a totally and permanently disability.

To continue to cover a child as totally and permanently disabled after the end of the month in which the dependent turns age 26, you must remain eligible and enrolled for coverage and the child must also continue to meet all the following requirements:

Residency

The T&PD child must reside as a member of your household.

Dependency

The T&PD child must qualify for a dependency exemption under the Internal Revenue Code for Federal income tax purposes.

Note: A T&PD child may be eligible for coverage if they earn less than $10,000 per year from regular employment, are considered dependent under Section 152 of the Internal Revenue Code for Federal income tax purposes, and meet all other eligibility requirements of the Plan.

Marital Status

The T&PD child must be unmarried.

Termination

Your T&PD child will lose eligibility for coverage:

the date your coverage ends the date they are deemed no longer to be totally and permanently disabled by the

Company the date of marriage of the child (age 26 and older) the date the child ceases to be dependent upon you or your spouse for Federal

income tax purposes and/or earns more than $10,000 per year from regular employment (age 26 and older)

the date the child no longer meets the residency requirement (age 26 and older)

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the date the qualified legal requirement to provide vision care coverage has terminated or the qualified legal requirement to provide vision care coverage no longer meets the Plan requirements

in the case of your death, coverage for the dependent child will end on the last day of the month following the month in which you die (unless the child is eligible for coverage as a dependent child of an eligible surviving spouse in which case the child's coverage ends when the surviving spouse is no longer eligible for coverage)

the date you or your spouse, or the order of a court of competent jurisdiction, terminates the legal obligation for total or partial support for a child who met the criteria for placement for adoption under COBRA 93

the date the child no longer meets any other eligibility requirements of the Plan

Children by Legal Guardianship

As of June 1, 2003, no further enrollments are allowed for legal guardianship. Dependents for whom you have legal guardianship, and who were enrolled for Company-provided coverage as of May 31, 2003, may continue to be enrolled as a dependent as long as you are eligible and enrolled for coverage and they continue to meet all other Company eligibility requirements. Once your dependent loses eligibility and is removed from your coverage, they cannot be reinstated.

Relationship

They are related by blood to the employee or the employee's spouse.

Age

The child must remain under a legal guardianship, which ends at the age of majority (usually age of 18).

Residency

The child must reside with you as a member of your household.

Dependency

The child must be claimed by you as your tax dependent for Federal income tax purposes.

Marital Status

The Child must be unmarried.

Termination

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Your child by legal guardianship will lose eligibility for coverage on the earliest to occur of:

the date your coverage ends the date the child no longer resides with you the date the child ceases to be dependent upon you for Federal income tax

purposes the date of marriage of the child the last day of the month in which the child becomes age 18 the last day of the month the employee's legal guardianship of the child is

terminated the date of the child's death the date the child no longer meets any other eligibility requirements of the Plan

Principally Supported Child(ren) (e.g. grandchild, niece, or nephew)

As of June 1, 2003, no further enrollments were allowed for Principally Supported dependents. Principally Supported dependents who were enrolled for coverage as of May 31, 2003, may continue to be enrolled for so long as you are eligible and enrolled for coverage and they continue to meet all other Company eligibility requirements stated below:

Relationship

They are related by blood to the employee or the employee's spouse (e.g. grandchildren, nieces and nephews, and siblings)

Age

Coverage for a principally supported dependent ends at age 19 unless you provide proof of student status (see Full-Time Student Status).

Residency

The dependent must reside with you as a member of your household.

Dependency

The dependent must be claimed by you as your tax dependent for Federal income tax purposes.

Full-Time Student Status

During the year a principally supported dependent reaches age 19 and through the end of the year they attain age 24, they must qualify as a full-time student as defined by the approved educational institution. Full-time students are required to be enrolled full-time

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at an educational institution meeting IRS requirements during each of five months in a calendar year.

Marital Status

The dependent must be unmarried.

Termination

Your principally supported dependent will lose eligibility for coverage:

the date your coverage ends the date the child no longer resides with you the date the child ceases to be dependent upon you for Federal income tax

purposes the date of marriage of the child the last day of the month in which the child becomes age 19, unless the employee,

retiree or surviving spouse responds to a written notification to continue coverage the date the child is no longer enrolled as a full-time student the date of the child's death the date the child no longer meets any other eligibility requirements of the Plan

Sponsored Dependent

Sponsored Dependents are not eligible for vision coverage.

Note: As of January 1, 2013, no further enrollments for medical coverage are allowed for Sponsored Dependents.

Dependent Eligibility Verifications

As Plan Administrator, the Company has retained Xerox Business Services, LLC to determine the eligibility of employees and dependents, consistent with the provisions of the Vision Care Plan for Salaried Employees of Ford Motor Company. In order to verify the eligibility of dependents, the Xerox Business Services, LLC will request verification during initial or annual enrollment and conducts random dependent eligibility verifications.

Upon receipt of a Dependent Eligibility Verification letter, you will be required to substantiate the eligibility of all or some of your dependents. Employees claiming initial or continued eligibility of a dependent must furnish all documentation requested to substantiate the eligibility of a dependent. Refusal or failure to furnish such documentation may results in loss of vision coverage for your dependent.

Medically Necessary Leave of Absence for Dependents Covered as Full Time Students

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The covered child of a Same-Sex Domestic Partner (SSDP) or a Principally Supported dependent, who has to leave school due to a serious illness or injury while their coverage was continuing due to full-time student status, may be able to extend their vision coverage after leaving school by requesting a "Medically Necessary Leave of Absence". If approved for a Medically Necessary Leave of Absence, coverage may continue as described below.

Xerox Business Services, LLC, as Ford's master of eligibility, determines whether the requirements for a Medically Necessary Leave of Absence have been met. A dependent child whose coverage is continued as the result of an approved Medically Necessary Leave of Absence has the same vision benefits as if the child had continued to be a full-time student.

To qualify for a Medically Necessary Leave of Absence, a dependent child must have been covered as a full-time student and must have changed from full-time student status where the change:

Begins while such child is suffering from a serious illness or injury Is medically necessary, and Causes such child to lose student status for purposes of coverage under the terms

of the Plan.

The ability to maintain coverage for a child approved for a Medically Necessary Leave of Absence ends one (1) year after the first day of the Medically Necessary Leave of Absence or, if sooner, the date on which such coverage would otherwise terminate under the terms of the vision plan (age 24 for full-time students).

Dependents must continue to meet all other plan eligibility requirements (relationship, residency, dependency, age, marital status) and their parent must continue to have Ford vision plan coverage.

The employee must complete and file an application for a Medically Necessary Leave of Absence with the Company within 60 days of the date the dependent's illness or injury caused them to lose full-time student status. A copy of the application can be obtained by calling the NESC at 1-800 248-4444.

Enrollment You must elect to participate in this Plan through the Flexible Benefits Plan to receive coverage. You may make changes to your Vision Care Plan elections during the Plan Year, if you experience a qualifying life event. You must report the qualifying event, within sixty days by going to www.myfordbenefits.com, Health & Welfare, Coverage Change to report the event or by contacting the NESC. Qualifying life events include employment status changes, loss of other health care coverage, loss of eligibility, marriage, divorce, birth or adoption. There may be an increase or decrease in your

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Flexible Benefits Pan contributions, if you make changes in your elections that affect the coverage level (i.e., you change from employee and spouse coverage to employee, spouse and children coverage).

When Coverage Is Effective

If you elect Vision Plan coverage during Flexible Benefits Plan annual enrollment, your vision coverage becomes effective on the first day of the Flexible Benefits Plan Year and continues through the end of the Flexible Benefits Plan Year (on a calendar basis). For mid-year enrollees, coverage becomes effective on the same date as your eligibility for Flexible Benefits Plan.

Cost

The voluntary Vision Care Plan has different annual price tags, depending on the level of coverage you elect. You pay for coverage on a pre-tax basis through the Flexible Benefit Plan. Price information may be found by accessing the www.myfordbenefits.com website.

How the Voluntary Vision Care Plan Works You may use either a network or non-network provider each time you seek services through Heritage Vision Plans. The Plan in Brief

The Vision Care Plan runs on the same Plan Year as your medical and dental plans: January 1st through December 31st. The Plan covers a vision examination, frames, and lenses (or contact lenses in lieu of eyeglasses) once during the Plan Year. You may have the examination and receive eyewear at the same time, or you may have the examination and receive eyewear at another time during the Plan Year. If you choose to split your benefits and receive eyewear later, you will not be eligible for another examination.

The benefits you receive depend on whether you use network or non-network providers. You will maximize the benefits available when you receive services from a Heritage Vision Plans National Network Provider. If you use a Heritage Vision Plans network provider, you will be responsible for making a co-payment, then the Plan will pay most covered services in full. If you use a non-network provider, you will have to pay the full

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cost of the services, and submit a claim to Heritage Vision Plans for reimbursement according to the non-network benefit schedule.

Each covered dependent may choose his/her own provider.

Network Provider Information

To obtain information about network providers in your area, call Heritage Vision Plans toll-free at 1-800-352-5667 or visit their website at www.heritagevisionplans.com/ford.

Visiting a Network Provider

Once you have located a network provider utilizing the information above, call the provider to schedule an appointment. Identify yourself as a Ford Motor Company employee and a Heritage Vision Plans/NVA (National Vision Administrators) program member. The provider will ask for the covered member's ID number (usually the Ford employee's Social Security Number) and will verify your eligibility for services.

The provider will perform your vision examination and order any eyewear you need. Then, you make the applicable co-payment and pay additional charges for cosmetic options you may have selected. Network providers will handle the necessary paperwork and will file a claim with Heritage Vision Plans on your behalf.

Visiting a Non-Network Provider

If you decide to use a non-network provider, you should first call Heritage Vision Plans at 1-800-352-5667 to verify your eligibility for services. Once you know that you are eligible for services, call the provider to schedule an appointment. You will need to pay the non-network provider in full for all services you receive and file a claim with Heritage Vision Plans for reimbursement. Be sure to request a complete itemized bill from the provider that you can send to Heritage Vision Plans. All charges must be identified separately, and the itemized bill must clearly state the following information in order for Heritage to process your reimbursement:

the full name, mailing address, and the last four digits of the Social Security the number of the Ford employee

the employer's name (Ford Motor Company) the patient's full name, date of birth, and relationship to the employee the date of service the eye exam charge the frame charge, if applicable the lens charge the lens type (i.e., single vision, bifocal, trifocal, or complete description of

contact lenses)

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A claim form is not required. Simply mail your itemized receipt with the above information to:

National Vision Administrators P.O. Box 2187 Clifton, NJ 07015 Attention: Heritage Ford Reimbursement

If you use a provider located outside of the United States, you will receive non-network benefits, calculated according to the exchange rate in effect at the time Heritage Vision Plans receives your claim. Reimbursement checks are issued in U.S. currency.

Schedule of Benefits Vision Care Plan benefits differ depending on whether you visit a network provider or a non-network provider. Plan benefits

The chart below outlines the schedule of benefits presently provided under the Vision Plan.

Plan feature

What the plan pays if you use a . . .

How often you can use the

services1

Heritage Vision Plans

network provider

Non-network provider

Comprehensive vision examination

Fully covered after $10 co-payment

Up to $30 Once per Plan Year

Lenses and a frame2 After a $15 co-payment for lenses and a frame, the plan pays:

Once per Plan Year

Type of lenses3 (glass or plastic)

Maximum benefit varies by type of lenses:

Once per Plan Year

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Single 100% Up to $30 Once per Plan Year

Bifocal (including blended invisible)

100% Up to $35 Once per Plan Year

Trifocal 100% Up to $40 Once per Plan Year

Lenticular 100% Up to $50 Once per Plan Year

Additional Lens Options o Oversized o Blended Bifocal o PGX glass o Tints (solid, gradient,

sun) o Ultraviolet Coating o Polycarb (for children

only to age 14)

100% Not Covered Once per Plan Year

Frames (Standard) 100% Up to $30 Once per Plan Year

Frames (Premium) Wholesale allowance of $50. Member charges based on wholesale prices.

Up to $30 Once per Plan Year

Standard Contact Lens Fitting Fee**

100% Not Covered Once per Plan Year

Elective/Cosmetic Contact Lenses in lieu of lenses and a frame - any type (benefit includes materials and, evaluation fee)

$105 allowance applied toward cost

Up to $50 Once per Plan Year

Medically Necessary Contact Lenses*** Prior approval required

Fully covered after $15 co-payment

Up to $50 Once per Plan Year

Other Services

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Non-covered lens options and material upgrades

25% discount off of retail price

Not Covered Once per Plan Year

Second pair of prescription eyeglasses or sunglasses

25% discount off of retail price

Not Covered Once per Plan Year

Lasik Surgery 15% discount on retail fees charged at designated locations

Not Covered Once per Plan Year

1 Whether or not you use a Heritage Vision Plans network provider.

2 Lenses and frames may be purchased at the same time or separately; if they are purchased separately from a Heritage Vision Plans network provider, the $15 co-payment for frames and lenses need be paid only once.

3 Subject to Plan limits (for example, you're responsible for extra charges for progressive addition lenses).

** A Standard Contact fitting is performed for patient's that are able to wear conventional or disposable spherical contact lenses. Patient's who require specialty or non-conventional contact lenses, i.e. hard, toric, bifocal, etc. require more extensive fitting and follow-up. Often times extended trial periods and additional doctor visits are necessary with non-conventional contacts which necessitates higher professional fees. In these cases, the provider will charge the member the difference between the standard and specialty fitting fees

*** Medically necessary contact lenses are covered in full (after a $15 co-payment) when a Heritage Vision Plans Network Provider determines that contact lenses are required to correct the better eye to at least 20/70, or for one of the following conditions:

Keratoconus irregular astigmatism irregular corneal curvature post cataract surgery significant anisometropia extreme visual acuity problems not correctable with spectacle lenses

What the Plan Covers The Vision Care Plan covers most basic

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vision services after a small co-payment and offers discounts on other products purchased from network providers. An examination and a frame and lenses (or contact lenses) are covered once per Plan Year. In addition, the following products are covered under the Vision Care Plan:

choice of glass or plastic lenses in single vision, bifocal, or trifocal all ranges of prescriptions, including cataract lenses oversized lenses PGX (sun-sensitive) glass lenses fashion, sun, or gradient tinted plastic lenses ultraviolet coating glass, grey #3 prescription glass polycarbonate lenses for children (subject to co-pay for adults) blended invisible bifocal lenses low vision lenses

In addition, when services are received from a Heritage Vision Plan participating provider discounts are available for non-covered lens options, material upgrades, a second pair of prescription glasses and Lasik surgery as outlined in the Schedule of Benefits

What the Plan Does Not Cover The voluntary Vision Care Plan does not cover the items listed below:

orthopetics or vision training and any associated supplemental testing plano (non-corrective) lenses two pairs of eyeglasses instead of bifocals medical or surgical treatment of eye conditions (this may be covered under your

medical Plan) any eye examination or any corrective eyewear required by an employer as a

condition of employment protective eyewear special lens designs (such as progressive addition lenses) and coatings replacement of lost eyewear

You may use a health care spending account to be reimbursed for your eligible out-of-pocket expenses on a pre-tax basis.

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Contacts for Additional Information For eligibility/enrollment information:

Call the National Employee Services Center at 1 800-248-4444. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

For benefits information:

Heritage Vision Plans-website: www.heritagevisionplans.com/ford/ or phone toll free at 1-800-352-5667

Heritage Vision Plans representatives are available:

Monday through Friday 8:00 a.m. to 6:00 p.m. Eastern time

Saturday 8:30 a.m. to 5:00 p.m. Eastern time

General Administrative Information

Basic Information

Plan Name: Vision Care Plan

Plan Sponsor: Ford Motor Company

Employer Identification Number: 38-0549190

Plan Number: 547

Type of Plan: Insured Welfare Plan

Type of Administration: Insurance Administration

Plan Administrator: Ford Motor Company

Trustee: None

Agent for Service of Legal Process: Ford Motor Company One American Road Dearborn, MI 48126

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Source of Contribution: Employee contributions

Funding Medium: Insurance Contract with Heritage Vision Plans

Insurer: Heritage Vision Plans 400 E. Congress, Suite 300 Detroit, Michigan 48226 Phone: (313) 863-9585 Toll-free: 1-800-352-5667

Plan Year: Calendar Year (Effective January 1, 2011)

Authorization to Approve Plans or Programs

As part of normal business planning, the Company is continually reviewing and evaluating various proposals for changes in employee programs. Your supervisors typically do not know whether the Company will or will not adopt any such programs and are not authorized to give any information about future programs. Until new programs are formally adopted and announced, no one is authorized by the Company to give any assurance that such changes will or will not occur.

Plan Amendment or Termination

Ford Motor Company reserves the right to end, suspend, or amend the Vision Care Plan at any time. Should the Vision Care Plan ever be ended, suspended, or modified, reasonable efforts will be made to make these changes effective as of the beginning of the Plan Year.

The Company's benefit plans may be amended pursuant to the amendment procedure applicable to the Plan. Designated officers or their designees may approve amendments to employee benefit plans.

The detailed provisions of the Plan, not this summary, govern the actual rights and benefits to which you may be entitled. If there is a conflict between this summary and the Plan document, the Plan document will control.

Your Rights under the Employee Retirement Income Security Act (ERISA)

As a participant in the Company's benefit plans that are subject to ERISA, you are entitled to certain rights and protections under ERISA. Included are the right to receive certain Plan information and the right to file a lawsuit if you believe your rights have been violated.

Here is a listing of your rights under ERISA:

You may visit the NESC, and in some cases Ford World Headquarters, and examine all Plan documents without charge, (contact the NESC on where you

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must visit). These include the plans themselves, the annual financial reports, the plan descriptions, and all other official plan documents.

With reasonable written notice, copies of Plan documents will be made available for review at other locations.

You may obtain copies of Plan documents by writing the Plan Administrator at:

o National Employee Services Center o P.O. Box 1045 o Totowa, NJ 07511-1045

The Company may make a reasonable charge for copies. You will receive a written summary of the Plans' annual financial report; the Plan

Administrator is required by law to furnish you with a copy of this summary annual report.

You may not be discharged or discriminated against to prevent you from obtaining a benefit or for exercising your ERISA rights.

If your claim for a benefit is denied in whole or in part:

you will receive a written explanation from the Plan Administrator; you have the right to have your claim reviewed and reconsidered.

Besides creating rights for plan participants, ERISA also spells out certain duties for people who are responsible for operating the Plan. These people are called fiduciaries. The fiduciaries of a plan have a duty to operate the plan prudently and in the interest of plan participants and beneficiaries.

There are steps you can take to enforce your ERISA rights. For example:

If you request materials from a Plan and don't receive them within 30 days, you may file suit in a federal court (in such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials-unless the materials were not sent because of reasons beyond the control of the administrator).

If your claim for benefits is denied in whole or in part after a final review, you may file suit in a state or federal court.

If the fiduciaries misuse a plan's money or if you are discriminated against for asserting your ERISA rights, you may seek help from the U.S. Department of Labor or file suit in a federal court.

If you file a suit, the court will decide who should pay costs and legal fees. If you win your suit, the court may order the person you have sued to pay the costs and fees. If you lose your suit, or if the court decides your suit was frivolous, the court may order you to pay the costs and fees.

If you have any questions about your plans, you should contact the National Employee Services Center. If you have any questions about this statement or your rights under

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ERISA, you should contact the nearest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefit Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.

Claims and Appeal Procedures All group health plans must have claim and appeal procedures that meet the U.S. Department of Labor's ("DOL") requirements. Ford Motor Company's Health Care Plan claim and appeals procedures were developed and are administered in compliance with the (DOL's) regulations. Most providers, especially those who participate with your vision plan, will submit claims to the plan on your behalf. Participating providers will receive payment directly from the Plan for covered services. You may be required to pay the provider for any co-payment amounts, services that are not covered, and amounts that exceed the Plan's maximum payment allowed. In certain situations, typically when you pay for services upfront or see a non-participating provider, you may need to file a claim yourself. Some non-participating providers may file the claim for you but still require payment at the time of service. Always ask whether or not the provider will submit a claim for you. If the provider will not, ask for an itemized statement of services and send it to the Plan along with proof of payment and a completed claim form. The Plan will reimburse you directly, less any co-payment and not-covered amounts. If you need to file a claim for vision benefit, a claim form is not required. Simply mail your itemized receipt with the information outlined in the "Visiting a Non-Network Provider" section of this document and mail to:

National Vision Administrators P.O. Box 2187 Clifton, NJ 07015 Attention: Heritage Ford Reimbursement

Properly filed claims are the key to fast, efficient claims processing.

Follow the guidelines below to ensure your quick and efficient claims processing:

1. Make sure a claim is filed promptly whenever you receive covered services. 2. Don't file a claim yourself if the provider is billing the Plan for services.

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3. If your provider is not billing the Plan directly, ask for an itemized statement of services. Be sure the statement includes:

o the provider's or supplier's name, address, tax ID number, and telephone number

o full name of the patient o full name of the Ford employee (the insured) o exact date of each service o breakdown of charges for each service o detailed description of each service o the group or contract number and Social Security Number, if different

4. Make copies of statements and forms for your records. The originals will not be returned to you.

5. Review all claim materials before mailing to ensure they are accurate and complete. Incomplete information will delay payment.

6. Mail the requested information, along with all original itemized billing statements (and proof of payment, if you already paid the provider for services), to the address shown above.

Inquiry and Appeals Procedures RLS - The whole Heritage C&A procedure should be included here. It is not enough to just say that there is a procedure.

Inquiry

If a claim is denied in whole or in part, you'll receive written notification from Heritage Vision. The notice will describe the specific reasons for the denial. If you have a question about your coverage on a claim, you can submit a verbal or written inquiry to the Heritage Vision. An appeal may be submitted without a prior inquiry. Please note that while Heritage Vision will handle claims for benefit coverage, eligibility-only appeals and inquiries will continue to be handled at the National Employee Services Center. The DOL regulations apply to any appeal involving a claim for benefits. The regulations do not apply to determinations of eligibility that are not attached to a claim. Please contact the customer service department of Heritage Vision for detailed information about their appeals process and timing requirements, or refer to the Plan's Explanation of Benefits (EOB) for more information. You can request claim filing information, file an appeal, or ask claims-related questions by contacting Heritage Vision Plans.

VISION PLAN

Heritage Vision Plans Claims National Vision Administrators P.O.Box 2187

Toll free: 1-800-352-5667

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Clifton, NJ 07015 ATTN: Heritage Ford Reimbursement Appeals Heritage Vision Plans 400 E. Congress Ste 300. Detroit, MI 48226 ATTN: Claims Appeals

Life Events Affecting Vision Plan Benefits Employment Status Changes

Transfer to hourly rolls Contributions cease; participation commences under appropriate hourly plan

Transfer to a non-Flexible Benefit Plan participating subsidiary Contributions cease; COBRA available if not eligible in new status

Transfer to or from TWA status Election remains in place; no change in benefit allowed during Plan Year

Transfer from flex-eligible co-op at work to school status You may continue coverage through COBRA

Family Status Changes

Marriage No dependents may be added until next Plan Year

Divorce Ex-spouse is ineligible; children may or may not retain eligibility; COBRA available; you must notify the National Employee Services Center (NESC) of the change through the www.myfordbenefits.com website or by calling the National Employee Services Center at 1 800-248-4444. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Addition of dependent child through birth or adoption Coverage continues at elected level; new child can be covered only if you have coverage for other children and add child to coverage through the www.myfordbenefits.com website or by calling the National Employee Services Center at 1 800-248-4444. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Loss of dependent child through age, divorce, marriage or death Coverage for child ends; COBRA available; you must notify the National Employee Services Center at 1 800-248-4444 or through the

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www.myfordbenefits.com website. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Death of spouse Spouse coverage ends; You must notify the National Employee Services Center at 1 800-248-4444 or through the www.myfordbenefits.com website. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Change in spouse's employment or a significant change in health care coverage Coverage continues at elected level

If Your Employment Ends

Retirement Coverage ends at the end of the month you leave; COBRA available. You may elect the voluntary vision plan as a retiree during next annual enrollment period.

Total and permanent disability Coverage ends at the end of the month you leave; you may direct pay for the remainder of the Plan Year; COBRA available

Death Coverage ends at the end of the month of your death; COBRA available for eligible dependents

Release under mutually satisfactory conditions or at Company option Coverage ends at the end of the month you leave; COBRA available

Release under the Salaried Involuntary Separation Process (SIRP) Coverage ends at the end of the month you leave; COBRA available

Quit, discharge, or release in the best interest of the Company Coverage ends as of the date the last premium is deducted; COBRA may be available

Leaves of Absence

Medical Leave of Absence, paycheck issued by Ford Coverage and payroll deduction continues

Medical Leave of Absence, payment issued by Unicare You may continue coverage by direct payment through the end of the Plan Year; COBRA available

Leave and return from Medical Leave of Absence during the same Plan Year If payroll deductions have ceased, you may continue coverage by direct payment through the end of the Plan Year

Return from Medical Leave of Absence in a different Plan Year You may enroll for the current Plan Year

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Unpaid family leave for the birth or adoption of a child You may continue coverage through COBRA

Unpaid care of family member leave You may continue coverage through COBRA

Any other unpaid leave, such as educational, personal, etc. You may continue coverage through COBRA

You should contact the NESC at www.myfordbenefits.com or 1-800-248-4444 regarding questions related to COBRA or direct bill. Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Continuation of Coverage Under COBRA COBRA Provisions

You and your dependents also may be entitled to continue your vision care coverage at your own expense under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA is a federal law that gives employees and their families certain protection against the sudden loss of their group health care coverage. If you or a covered family member should become ineligible for coverage under the Flexible Benefits Plan because of what COBRA calls a "Qualifying Event" (described in this section), you may be able to continue your coverage at 102% of the Company's group rates for a limited period of time. The group health care plans that you may continue under COBRA include: medical (including prescription drug), dental, vision, and health care flexible spending account coverage. Any period of Company-provided coverage following a qualifying event will be counted as part of your COBRA continuation period. If you're not eligible for Company-provided coverage following a qualifying event but have the option to continue coverage at your own expense under Company cash-pay rules or through direct payments to a vendor, you may choose to continue coverage under either COBRA or under Company rules, but not both.

Qualifying Events Employees

If you're an active employee covered by the Plan, COBRA provides that you may continue Ford coverage at your own expense if you lose coverage because of:

The termination of your employment (for any reason other than gross misconduct on your part), including a termination by reason of your failure to return to work at the conclusion of a leave taken under the Family and Medical Leave Act of 1993

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A reduction in your hours of employment

Qualifying Events Spouses

COBRA provides that spouses of active employees covered by the Plan may continue Ford coverage at their own expense if they lose coverage as the result of:

A termination of the employee's employment (for reasons other than gross misconduct), including a termination by reason of the employee's failure to return to work at the conclusion of a leave taken under the Family and Medical Leave Act of 1993

A reduction in the employee's hours of employment The death of the employee Divorce from the employee The employee becoming eligible for Medicare

Qualifying Events Dependent Children

COBRA provides that a dependent child of an active employee covered by the Plan may continue Ford coverage at their own expense if he/she loses these coverage as the result of:

The termination of the employee's employment (for reasons other than gross misconduct), including a termination by reason of the employee's failure to return to work at the conclusion of a leave taken under the Family and Medical Leave Act of 1993

A reduction in the employee's hours of employment The death of the employee The divorce of the parents The covered parent becoming eligible for Medicare The child ceasing to be a "dependent child", as defined in the Company's group

health care plans

Notification of Qualifying Events

The covered employee, spouse, or dependent child who wishes to elect to continue coverage at his/her own expense under COBRA must notify the Company or its designated COBRA Coordinator within 60 days of a qualifying event if the event is:

Divorce A dependent child ceasing to be a "dependent child", as defined in the Company's

group health care plan Death of the employee if it results in loss of coverage

For other qualifying events, the Company will notify the COBRA Coordinator within 30 days. Upon notification, the COBRA Coordinator will, within 14 days, send additional

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information to those individuals eligible to elect to continue coverage. If you wish to continue coverage under COBRA, you must return a completed election form to the COBRA Coordinator within 60 days of the date the COBRA Coordinator sends you the election form, or the date coverage stopped, whichever is later. If you don't choose to continue coverage, your coverage will end according to the provisions of that Plan as outlined in the "Life Events Affecting Vision Plan Benefits" section above.

Your Cost

Your cost to continue coverage under COBRA will be 102% of the full rate in effect at the time continued coverage begins. Cost-of-coverage information will be provided by the COBRA Coordinator if a qualifying event occurs. If the rate changes in the future, you'll be required to pay the revised amount. Payment must be received by the COBRA Coordinator within 45 days of the election of COBRA coverage and on a continuing monthly basis thereafter.

Other Provisions

If you or your eligible dependents elect to continue your vision care coverage, it will be the same coverage you were eligible for before the qualifying event if available.

Duration of COBRA Coverage

If you lose Ford coverage because your employment is terminated or your hours are reduced, you generally can choose to continue coverage under COBRA for 18 months

If you're disabled (as defined by Social Security) at the time of your termination, you are eligible for COBRA coverage for 29 months rather than 18 months; the cost of coverage for the additional 11 months is 150% of the regular full group rate rather than the normal 102%

If you're continuing coverage for 18 months and a second qualifying event occurs that would cause your spouse or dependent children to lose coverage (e.g., death of the employee or retiree, divorce, or a child ceasing to be a dependent child), the COBRA continuation period is expanded so your spouse or dependent children may continue coverage for a maximum of 36 months measured from the date of the first event

If your dependent loses coverage because of other qualifying events, COBRA coverage can continue for 36 months

Termination of COBRA Coverage

Vision Plan coverage continued under COBRA will be terminated before the end of the 18-, 29-, or 36-month period for any of the following reasons:

Failure to make the required payment on time

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Coverage under any other group health care plan unless such plan has preexisting condition provisions restricting coverage (in such cases you may be eligible for coverage under both plans)

Voluntary cancellation of coverage The Company no longer provides coverage to any of its employees or retirees

After coverage under COBRA has been terminated, it will not be reinstated.

If you have any questions about COBRA, contact the NESC at 1-800-248-4444 or by mail at:

Ford National Employee Services Center P.O. Box 1045 Totowa, NJ 07511-1045

NESC Personal Benefits Representatives are available 9 a.m. to 9 p.m. Eastern Time, Monday through Friday, except on New York Stock Exchange holidays. For TDD communication services, call 1-800-833-8334.

Trade Act of 2002

The Trade Act of 2002 amended COBRA to provide for a special second COBRA election period for certain trade-displaced workers. Covered employees who are eligible to make a COBRA election during this special second election period, Trade Adjustment Assistance (TAA) eligible employees, must satisfy each of the following requirements:

They must be receiving a trade readjustment allowance under the Trade Act of 1974 (or be eligible for such an allowance once unemployment compensation is exhausted) or receiving alternative trade adjustment assistance under the Trade Act of 1974;

They must have lost group health plan coverage due to a termination of employment or reduction of hours that resulted in eligibility for a trade readjustment allowance or alternative trade adjustment assistance; and

They did not elect COBRA during the regular COBRA election period available to them as a result of their termination of employment or reduction of hours.

For further information regarding eligibility for COBRA under the Trade Act of 2002, contact the Department of Labor toll free at 1-866-628-4282.

The Uniformed Services Employment and Reemployment Rights Act (USERRA)

For employees on Military Leave or Operation Noble Eagle, the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) established requirements which are similar to COBRA but not identical. Any COBRA election that you make will also be an election under USERRA if it applies to you, and COBRA and USERRA will both apply with respect to the continuation coverage elected for up to 24

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months while on active military duty. If COBRA and USERRA give you (or your covered spouse and dependent children) different rights or protections, the law that provides the greater benefit will apply. COBRA and USERRA coverage run concurrently. If you elect to continue your coverage (or your spouse or dependent children's coverage) pursuant to USERRA, you will be required to pay 102% of the full premium for the coverage elected (the same rate as COBRA). However, if your Uniformed Service leave of absence is less than 31 days, you are not required to pay more than the amount that you pay as an active employee for that coverage.

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