American Airlines, Inc. Group Life And Health Benefits Plan

301 Pages·2015·1.35 MB·English

by  Kelley, Kim

American Airlines, Inc. Group Life and Health Benefits Plan
American Airlines, Inc. Long-Term Disability Plan
American Airlines, Inc. Long-Term Care Insurance Plan

Employee Benefits Guide for Flight Employees

Effective January 1, 2015

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2015 Employee Benefits Guide for Flight Employees
American Airlines, Inc. (the “Company”) provides you with a comprehensive benefits
package designed to help you meet the health and insurance needs of you and your
eligible family members.
To help you make the most of those benefits, this Guide, which serves as both the legal
plan document and the summary plan description, describes the provisions of the
American Airlines, Inc. Group Life and Health Benefits Plan, the American Airlines, Inc.
Long-Term Disability Plan, and the American Airlines, Inc. Long-Term Care Insurance
Plan (collectively, the “Plans”) effective January 1, 2015 for Pilots and Flight Attendants.
Additional Important Information
In addition to the descriptions of the benefits provided and how each Plan
works, this Summary Plan Description also provides general and plan specific
information in the:
About this Guide section
General Eligibility section
General Enrollment section
Life Events section
Additional Health Benefit Rules section
Plan Administration section
Reference Information section, including a Contacts list, the Glossary, and the
Archives of older versions of the Guide.
About This Guide
This Employee Benefits Guide (“Guide”) is for the eligible employees, as described in
“Employee Eligibility” section, in the following groups:
• Pilots employed by American Airlines, Inc. and US Airways, Inc.
• Flight Attendants employed by American Airlines, Inc. and US Airways, Inc1
This Guide describes separate health and welfare benefit plans sponsored by American
Airlines, Inc. and established under and operated pursuant to the Employee Retirement
Income Security Act (ERISA) and other applicable federal laws. These health and
welfare benefit plans are provided through a §125 cafeteria plan arrangement, as
described and controlled by Internal Revenue Code, and US Treasury regulations. US
Airways, Inc. is a participating employer of the plans.
This Guide serves as the legal plan documents and the summary plan description
(SPD) for the following benefit program (collectively the “Plans”):
• American Airlines Inc. Group Life and Health Benefits Plan (the “Group Life and
Health Plan”)
• American Airlines, Inc. Long-Term Disability Plan

1 This guide serves as the Legal Plan Document and Summary Plan Description for Flight Attendants employed by
US Airways, Inc. who are eligible for and/or enroll in the CORE medical option.
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• American Airlines, Inc. Long-Term Care Plan

The Company, or its authorized delegate, reserves the right to modify, amend or
terminate any of the Plans, any program described in this Guide, or any part thereof, at
its sole discretion. Changes to the Plans generally will not affect claims for services or
supplies incurred before the change.
From time to time, you may receive updated information concerning changes to the
Plans. Neither this Guide nor updated materials are contracts or assurances of
compensation, continued employment or benefits of any kind.
The Company believes that certain HMO Medical Options under the Group Life and
Health Plan are grandfathered health plan(s), under the Patient Protection and
Affordable Care Act (PPACA). The following chart specifies which medical benefit
options in this plan are grandfathered, and which are not:
Medical Option Grandfathered or Non-Grandfathered
STANDARD Medical Option Non-Grandfathered
CORE Medical Option Non-Grandfathered
VALUE Medical Option Non-Grandfathered
Out-of-Area Medical Option Non-Grandfathered
HMO Medical Options May be either, depending upon the HMO; contact
your specific HMO for this information
As permitted by the PPACA, a grandfathered health plan can preserve certain basic
health coverage that was already in effect when the law was enacted. Being a
grandfathered health plan means that your plan or policy might not include certain
consumer protections of PPACA that apply to other plans, for example, the requirement
for the provision of preventive health services without any cost sharing. However,
grandfathered health plans must comply with certain other consumer protections in the
Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions about non-grandfathered Medical Options can be addressed to:
American Airlines, Inc.
PO Box 619616
Mail Drop 5134, HDQ1
Dallas-Fort Worth Airport, TX 75261-9616

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You may also contact the Employee Benefits Security Administration, U.S. Department
of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table
summarizing which protections apply to non-grandfathered health plans.

Voluntary Offerings Provided by American Benefits Consulting (ABC)
The Company makes accessible for employees the opportunity to enroll in: Hyatt
Legal, Group Homeowners’ and Automobile Insurance, Veterinary Pet Insurance,
LifeLock, Group Accident and Critical Illness Insurance at a discounted rate. At the
request of the employee, the Company facilitates the post-tax payroll deductions to
pay for these voluntary offerings. The Company does not assume any plan
sponsorship for the Voluntary Offerings provided by American Benefits Consulting
(ABC). The details of these offerings are not included in or governed by this Guide.
Please go to www.AAaddedbenefits.com or call 1-855-550-0706 to contact ABC
directly for information about these benefits.

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Contents
About This Guide 2
How do I determine my eligibility? 12
Employee Eligibility 12
Ineligibility 13
Benefits Effective Date for New Hires 14
Proof of Eligibility 14
Eligibility During Leaves of Absence and Disability 15
Family Medical Leave of Absence (FMLA) or Military Leave 16
Eligibility After Age 65 16
Dependent Eligibility by Benefit 16
Medical Coverage 16
Dental and Vision Coverage 17
Child Life Insurance and Child Accidental Death and Dismemberment (AD&D)
Insurance 18
Spouse Life Insurance and Spouse Accidental Death and Dismemberment (AD&D)
Insurance 18
Dependent Eligibility Requirements 18
Determining a Child’s Eligibility 18
Dependents of Deceased Employees 19
Determining a Spouse (SP), Domestic Partner (DP) or Common Law Spouse
Eligibility (CLSP) 20
Employees Married to Other Employees 22
Other Information Related to Married Employees 23
Medical Benefit Options Overview 27
Medical Benefit Options 27
Medical Benefit Options Comparison 28
Covered Expenses 48
Excluded Expenses 58
Network/Claim Administrator 62
Mid-Year Medical Benefit Option Change: Impact on Deductibles and Out-of-Pocket
Maximums 64
Filing Claims 65
Claims Filing Deadline 65
CheckFirst (Predetermination of Benefits) 66
QuickReview (Pre-Authorization) 67
Mental Health and Chemical Dependency Care 69
Wellness Resources 71
Employee Assistance Programs (EAP) 72
Standard Medical Option 73
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How the Standard Medical Option Works 73
In-Network Services, Deductible and Out-of-Pocket Maximums 74
Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 75
Covered and Excluded Expenses 76
Prescription Drug Benefits 76
Retail Drug Coverage 76
Retail Refill Allowance — Long-Term Medications 78
Retail Prescription Clinical Programs 78
Mail Order Prescription Clinical Programs 82
Internet Refill Option 83
Other Refill Options 83
Claims Filing Deadline 83
Reimbursement of Co-insurance 84
HRA - Health Reimbursement Account 84
Gender Reassignment Benefit (GRB) 84
GRB Coverage 84
Travel Reimbursement 85
Preauthorization for the GRB 85
How the Value Medical Option Works 86
In-Network Services, Deductible and Out-of-Pocket Maximums 87
Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 87
Covered and Excluded Expenses 88
Prescription Drug Benefits 89
Retail Drug Coverage 89
Retail Refill Allowance — Long-Term Medications 91
Retail Prescription Clinical Programs 91
Mail Order Prescription Clinical Programs 95
Internet Refill Option 96
Other Refill Options 96
Claims Filing Deadline 97
Reimbursement of Co-insurance 97
HIA - Health Incentive Account 97
Core Medical Option 98
How the CORE Medical Option Works 98
Out-of-Network Services (OON), Deductible and Out-of-Pocket Maximums 99
Covered and Excluded Expenses 100
Prescription Drug Benefits 100
Retail Drug Coverage 101
Filling Prescriptions and Filing Claims 101
Retail Refill Allowance — Long-Term Medications 102
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Retail Prescription Clinical Programs 102
Specialty Pharmacy Services 103
Express Scripts Mail Order 104
Mail Order Prescription Clinical Programs 105
Internet Refill Option 106
Other Refill Options 106
Reimbursement of Co-insurance 107
HSA - Health Savings Account 107
HSA Funds 107
Setting Up an HSA 108
Using Your HSA Funds 108
Limited Purpose Flexible Spending Account (LPFSA) 109
Out-of-Area Coverage 110
How Out-of-Area Coverage Works 111
Network/Claims Administrator 111
Special Provisions 112
Prescription Drug Benefits 113
Retail Drug Coverage 113
Retail Refill Allowance — Long-Term Medications 114
Retail Prescription Clinical Programs 115
Specialty Pharmacy Services 116
Express Scripts Mail Order 117
Generic Drugs 118
Internet Refill Option 119
Other Refill Options 119
Claims Filing Deadline 119
Reimbursement of Co-insurance 119
HRA - Health Reimbursement Account 120
Health Maintenance Organizations (HMOs) 121
Eligibility 122
Children Living Outside of the Service Area 122
Termination of Coverage 122
If You Reach Age 65 and are Still an Active Employee 123
How HMOs Work 123
HMO Contact Information 124
Dental Benefits 126
How the Dental Benefit Works 127
Eligibility 127
Plan Comparison Chart 127
Special Provisions 128
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Covered Expenses 128
Preventive Services 129
Basic and Major Services 129
Orthodontia 130
Excluded Expenses 131
Filing Claims 132
Claim Filing Deadline 132
Vision Benefit 133
How the Vision Insurance Benefit Works 133
Eligibility 134
Covered Expenses 134
Filing Claims 135
Flexible Spending Accounts 136
How the HCFSA - Health Care Flexible Spending Account Works 136
Special Provisions 137
Covered Expenses 138
Excluded Expenses 140
Filing Claims 140
How the LPFSA - Limited Purpose Flexible Spending Account Works 141
Filing Claims 142
How the DCFSA- Dependent Care Flexible Spending Account Works 142
Covered Expenses 144
Filing Claims 145
If You Elect Both an HCFSA/LPFSA and a DCFSA 145
Life Insurance Benefits 146
Pilot Term Life Insurance 148
How the Life Insurance Benefit Works 148
Basic Term Life Insurance Benefit 148
Voluntary Term Life Insurance Benefit 148
Pilot Additional Life Insurance Benefit 149
Spouse and Child Term Life Insurance Benefit 149
Flight Attendant Life Insurance 151
How the Life Insurance Benefit Works 151
Basic Term Life Insurance Benefit 151
Voluntary Term Life Insurance Benefit 151
Spouse and Child Term Life Insurance Benefit 152
Designating Beneficiaries 154
Coverage if You Become Disabled 155
Special Provisions 156
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Filing Claims 160
Accidental Death & Dismemberment (AD&D) Insurance Benefits 161
Basic Accidental Death & Dismemberment Insurance (AD&D) and Voluntary Personal
Accident Insurance (VPAI) Insurance 163
What is Covered 164
Special VPAI Benefit Features 165
Exclusions 170
Filing a Claim 171
Conversion Rights 172
Policy Aggregates 172
Disability Benefits 174
Pilot Disability Benefits Overview 175
Pilot Short-Term Disability (STD) 176
Definition of Total Disability 176
Filing a Claim 176
When Benefits Begin 177
When Benefits End 177
Exclusions and Limitations 177
Pilot Long-Term Disability (LTD) 178
Flight Attendant Optional Short-Term Disability (OSTD) 178
Optional Short-Term Disability (OSTD) Insurance 178
Definition of Total Disability 179
Appropriate Care and Treatment 179
OSTD Insurance Benefits 179
Return-to-Work Program 181
Family Care Incentive 181
When Benefits Begin 181
When Benefits End 182
Exclusions and Limitations 182
Flight Attendant Long-Term Disability (LTD) 183
How the Plan Works 183
Definition of Total Disability 184
Appropriate Care and Treatment 184
LTD Plan Benefits 184
Severe Condition Benefit 185
LTD Benefit Elimination Period 189
Duration of LTD Benefits 189
Filing a Claim for LTD Benefits 190
When LTD Benefits Begin 190
When LTD Benefits End 191
LTD Exclusions and Limitations 192
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Benefits from Other Sources 194
Return-to-Work Program 196
Vocational Rehabilitation Program 197
How do I enroll? 198
Annual Enrollment 198
How to Enroll 199
New Employee Enrollment 199
When Coverage Begins as a Newly Hired Employee 200
When Coverage Begins as a Current Employee 200
Waiving Coverage 200
Default Coverage 200
HIPAA Special Enrollment Rights – Medical Benefit Option Only 201
Making Changes During the Year: Life Events 204
Life Events 204
If Your Dependent(s) Lose Eligibility Under the Plan 220
If You Process Your Life Event after the Deadline 220
Special Life Event Considerations 221
Additional Health Benefit Rules 223
Qualified Medical Child Support Orders (QMCSO) Procedures 223
Use of Terms 224
Procedures upon Receipt of Qualified Medical Child Support Order (QMCSO) or
State Agency Notice 224
Review of a Medical Child Support Order or Notice 226
Procedures upon Final Determination 226
Appeal Process 227
Coordination of Benefits 227
Other Plans 228
Benefits for Individuals Who Are Eligible for Medicare 230
Benefits for Disabled Individuals 230
When Coverage Ends 231
Continuation of Coverage – COBRA 231
Eligibility 232
Continuation of Coverage for You and Your Dependents Qualifying Events 232
Continuation of Coverage for Your Dependents Only (Qualifying Events) 233
How to Elect Continuation of Coverage 234
Continuation of Coverage for Employees in the Uniformed Services 236
Continuation of Coverage While on a Family and Medical Leave 237
Other Employee Obligations 237
Impact of Failing to Elect Continuation of Coverage on Future Coverage 238
Additional Questions 238
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