THE TIDEWATER HEALTH CARE PLAN CERTIFICATE
ACTIVELY EMPLOYED OFFICERS OF TIDEWATER INC.
EXECUTIVE HEALTH AND DENTAL BENEFITS
BLUE CROSS AND BLUE SHIELD OF LOUISIANA
(Incorporated as Louisiana Health Service and Indemnity Company)
This insurance coverage is being provided by Blue Cross and Blue Shield of Louisiana and Your Employer, Tidewater Inc. It is
a fully-insured Benefit Plan. It is the intent of the Group and the Company to provide Benefits in accordance with the laws of
the state where the Group Benefit Plan is issued, unless otherwise forbidden by the laws of the state where You live. If there is
a conflict between any provision in this Certificate and the applicable state law, the state law will prevail.
This Certificate is a supplement to any other Group Employee Benefit Plan Certificate(s) previously issued to You describing
this insurance coverage and is intended to provide additional Benefits for some of the Eligible Expenses incurred by You and
Your family that are not payable under the other Group Employee Benefit Plan. Benefits will be paid at the Coinsurance
Percentage, as shown in the Schedule of Benefits, for all Eligible Expenses.
This Certificate does not waive or alter any of the terms of the Benefit Plan. If coverage questions arise, the Benefit Plan will
The Group referred to herein means Tidewater Inc. The Company referred to herein means Blue Cross and Blue Shield of
Louisiana and/or another Blue Cross and Blue Shield Plan that has entered into an agreement with Blue Cross and Blue Shield
of Louisiana to provide Benefits to eligible Members under the Benefit Plan. A word used in the masculine gender applies also
in the feminine gender.
TABLE OF CONTENTS
The following Definitions are applicable to the Benefit Plan in addition to the Definitions contained in the Group Employee
Benefit Plan Certificate previously issued to You which describes the C