IT IS UNDERSTOOD AND AGREED THAT THE FOLLOWING MODIFICATIONS SHALL BE MADE:

1. The following provision will be added to the BENEFITS section of the Plan document:
   The Total Maximum Out-of-Pocket do not include any drug manufacturer’s assistance.
2. In the COMPREHENSIVE MEDICAL EXPENSE BENEFIT – COVERED CHARGES section of the Plan document, the Ambulances provision will be revised to read as follows:
   Ambulances Charges for professional ambulance service (ground or air) to or from a facility where
   eligible, Medically Necessary care or treatment may be rendered or may have been
   rendered when the Covered Person’s condition mandates such transportation. Benefits are
   provided for air ambulance transportation when all of the following criteria have been met:
   (1) the Covered Person is transported to the nearest facility having the capability to treat
   the condition; (2) no other method of transportation is appropriate (including emergency
   ground transport); and (3) the Plan Administrator determines that the Covered Person’s
   condition, the type of service required for the treatment of the Covered Person’s condition,
   and the type of facility required to treat the Covered Person’s condition justify the use of
   air ambulance instead of another means of transport.
3. In order to correctly communicate the intent and administration of the Plan that has been in place since March 1, 2020, the MISCELLANEOUS – CONFORMITY WITH LAW provision of the Plan document will be revised to read as follows:
   CONFORMITY WITH LAW
   If any provision of this Plan is contrary to any law or regulation to which it is subject, that
   provision is deemed amended to conform to such law or regulation.
   In accordance with guidance issued by the U.S. Department of Labor and the U.S.
   Department of Treasury (Joint Notice and Disaster Relief Notice 2020-01), certain
   deadlines mandated by the Plan will be extended in response to the COVID-19 pandemic
   beginning March 1, 2020 until 60 days after the announced end of the National Emergency
   Period (Outbreak Period). Specifically, the Plan must disregard the Outbreak Period when
   calculating these deadlines. However, in accordance with Disaster Relief Notice 2021-01,
   the Outbreak Period shall apply on an individual basis for each Covered Person and shall
   end the earlier of (a) one year from the date that the Covered Person was first eligible for
   relief, or (b) 60 days after the announced end of the National Emergency Period (the end
   Kalamazoo College, G-1013 Amendment to the Health Benefit Plan of the Outbreak Period). In no event will an Outbreak Period deadline extension exceed one year.
4. In the DEFINITIONS section of the Plan document, the TELEMEDICINE definition will
   be revised to read as follows:
   TELEMEDICINE
   The term “Telemedicine” means medical care provided through electronic or telephonic
   communications. Telemedicine care is typically rendered as an alternative to a traditional
   office visit and provides “on demand” medical care as well as remote evaluations/monitoring by phone, computer, or mobile device. The Plan may also cover other types of medical care provided through electronic or telephonic communications, and when eligible, such services will be paid the same as any other Illness (cost-sharing
   provisions such as Deductibles, Coinsurance, or co-payments may apply depending upon the type of service rendered).
   All other provisions of the Plan shall remain in effect and unchanged.

In Witness Whereoff, the undersigned has casued this amendment to be duly adopted as of July 1, 2021.

Signatures on file in Human Resources,