Benefits Guide - American Airlines

262 Pages·2013·1.97 MB·English

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Flight Employee Benefits Guide
Benefits Guide
American Airlines 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 describes the major provisions of the plans and
explains how you can use them effectively.

The benefits described in this Guide include:
Medical Options, specifically
• STANDARD Medical Option with Health Reimbursement Account
• VALUE Medical Option with Health Incentive Account
• CORE Medical Option with Health Savings Account
• OUT-OF-AREA Medical Option with Health Reimbursement Account
• HMOs
Dental Coverage
Vision Coverage
Flexible Spending Accounts
• Health Care Flexible Spending Account
• Limited Purpose Flexible Spending Account
• Dependent Care Flexible Spending Account
• Employee Assistance Program
Life Insurance & Accident Insurance
Disability Benefits

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.

Forms & guides can be located in Our Policies at
1
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Table of Contents

About This Guide 10
How do I determine my eligibility? 12
Benefits Effective Date 13
Employee Eligibility 13
Proof of Eligibility 13
Eligibility During Leaves of Absence and Disability 14
Family Medical Leave of Absence (FMLA) or Military Leave 14
Eligibility After Age 65 14
Dependent Eligibility by Benefit 15
Medical Coverage 15
Dental and Vision Coverage 15
Child Life Insurance and Child Accidental Death and
Dismemberment (AD&D) Insurance 15
Spouse Life Insurance and Spouse Accidental Death and
Dismemberment (AD&D) Insurance 16
Dependent Eligibility Requirements 16
Determining a Child’s Eligibility 16
Dependents of Deceased Employees 17
Determining a Spouse (SP), Domestic Partner (DOMESTIC PARTNER (DP))
or Common Law Spouse Eligibility 17
Employees Married to Other Employees 19
Other Information 21
Ineligibility 22
What benefits could I be eligible for? 23
Medical Benefit Options Overview 24
Medical Benefit Options 25
Network/Claims Administrators 26
Administrator’s Discretion 26
Medical Benefit Options Comparison 26
Mid-Year Medical Benefit Option Change: Impact on Deductibles and
Out-of-Pocket Maximums 46
Mental Health and Chemical Dependency Care 47
Gender Reassignment Benefit (GRB) 49
GRB Coverage 49
Surgical Benefit 49
Travel Reimbursement 50
Preauthorization for the GRB 50
Forms & guides can be located in Our Policies at
2
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Wellness Resources 50
Covered Expenses 51
Excluded Expenses 59
CheckFirst (Predetermination of Benefits) 62
QuickReview (Pre-Authorization) 63
Standard Medical Option 65
Your Network/Claims Administrator 66
Network/Claims Administrator- Buy-up Option 66
How the Standard Medical Option Works 67
In-Network Services 67
Out-of-Network Services (OON) 68
Other Information 68
Special Features of the Standard Medical Option 68
Covered and Excluded Expenses 71
Filing Claims 72
Claims Filing Deadline 72
Prescription Drug Benefits 73
Retail Drug Coverage 73
Retail Refill Allowance — Long-Term Medications 74
Retail Prescription Clinical Programs 75
Mail Order Prescription Clinical Programs 77
Internet Refill Option 78
Other Refill Options 78
Claims Filing Deadline 79
Reimbursement of Co-insurance 79
HRA - Health Reimbursement Account 79
Notice for Employees Who Work in (Are Based in) Massachusetts 80
Value Medical Option 81
Your Network/Claims Administrator 82
Network/Claims Administrator- Buy-up Option 82
How the Value Medical Option Works 83
In-Network Services 83
Out-of-Network Services (OON) 84
Other Information 84
Special Features of the VALUE Medical Option 84
Covered and Excluded Expenses 87
Filing Claims 88
Claims Filing Deadline 88

Forms & guides can be located in Our Policies at
3
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Prescription Drug Benefits 89
Retail Drug Coverage 89
Filling Prescriptions and Filing Claims 90
Retail Refill Allowance — Long-Term Medications 90
Retail Prescription Clinical Programs 91
Specialty Pharmacy Services 92
Express Scripts Mail Order 93
Mail Order Prescription Clinical Programs 93
Internet Refill Option 94
Other Refill Options 94
Claims Filing Deadline 95
HIA - Health Incentive Account 95
Core Medical Option 96
Your Network/Claims Administrator 97
Network/Claims Administrator- Buy-up Option 97
How the CORE Medical Option Works 98
In-Network Services 98
Out-of-Network Services 99
Special Features of the CORE Medical Option 99
Covered and Excluded Expenses 101
Filing Claims 101
Prescription Drug Benefits 102
Retail Drug Coverage 102
Filling Prescriptions and Filing Claims 102
Retail Refill Allowance — Long-Term Medications 103
Retail Prescription Clinical Programs 103
Specialty Pharmacy Services 104
Express Scripts Mail Order 105
Mail Order Prescription Clinical Programs 105
Internet Refill Option 106
Other Refill Options 106
Reimbursement of Co-insurance 106
HSA - Health Savings Account 107
HSA Funds 107
Setting Up an HSA 107
Using Your HSA Funds 108
Limited Purpose Flexible Spending Account (LPFSA) 109

Forms & guides can be located in Our Policies at
4
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Out-of-Area Coverage 110
How Out-of-Area Coverage Works 111
Network/Claims Administrator 111
Special Provisions 111
Covered and Excluded Expenses 112
Filing Claims 112
Claims Filing Deadline 112
Prescription Drug Benefits 113
Retail Drug Coverage 113
Retail Refill Allowance — Long-Term Medications 114
Retail Prescription Clinical Programs 114
Specialty Pharmacy Services 115
ESI Mail Order 116
Mail Order Prescription Clinical Programs 116
Internet Refill Option 117
Other Refill Options 117
Claims Filing Deadline 117
Reimbursement of Co-insurance 118
HRA - Health Reimbursement Account 118
Health Maintenance Organizations (HMOs) 119
Eligibility 120
Children Living Outside of the Service Area 120
Termination of Coverage 120
If You Reach Age 65 and are Still an Active Employee 120
How HMOs Work 121
HMO Contact Information 121
Dental Benefits 122
How the Dental Benefit Works 123
Eligibility 123
Plan Comparison Chart 123
Special Provisions 124
Covered Expenses 124
Preventive Services 124
Basic and Major Services 124
Orthodontia 125
Excluded Expenses 126
Filing Claims 127
Claim Filing Deadline 127

Forms & guides can be located in Our Policies at
5
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Vision Benefit 128
How the Vision Insurance Benefit Works 129
Eligibility 129
Covered Expenses 130
Filing Claims 131
Flexible Spending Accounts 132
How the HCFSA - Health Care Flexible Spending Account Works 133
Special Provisions 133
Covered Expenses 134
Excluded Expenses 136
Filing Claims 136
How the LPFSA -Limited Purpose Flexible Spending Account Works 137
How the DCFSA- Dependent Care Flexible Spending Account Works 138
Covered Expenses 140
Filing Claims 141
If You Elect Both an HCFSA/LPFSA and a DCFSA 141
Life Insurance Benefits 142
Pilot Term Life Insurance 144
How the Life Insurance Benefit Works 144
Basic Term Life Insurance Benefit 144
Voluntary Term Life Insurance Benefit 144
Pilot Additional Life Insurance Benefit 145
Spouse and Child Term Life Insurance Benefit 145
Flight Attendant Life Insurance 146
How the Life Insurance Benefit Works 146
Basic Term Life Insurance Benefit 146
Voluntary Term Life Insurance Benefit 147
Spouse and Child Term Life Insurance Benefit 148
Designating Beneficiaries 149
Coverage if You Become Disabled 150
Special Provisions 151
Accelerated Benefit Option (ABO 151
Taxation of Life Insurance 151
Conversion and Portability 152
Assignment of Benefits 153
Total Control Account 153
Verbal Representation 154
Filing Claims 154

Forms & guides can be located in Our Policies at
6
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Accident Insurance Benefits 155
Accidental Death & Dismemberment Insurance (AD&D) and
Voluntary Personal Accident Insurance (VPAI) Benefits 157
What is Covered 157
Special VPAI Benefit Features 158
Exclusions 162
Filing a Claim 162
Conversion Rights 163
Policy Aggregates 163
Disability Benefits 165
Pilot Disability Benefits Overview 166
Pilot Short-Term Disability (STD) 166
Definition of Total Disability 167
Filing a Claim 167
When Benefits Begin 167
When Benefits End 167
Exclusions and Limitations 168
Pilot Long-Term Disability (LTD) 168
Flight Attendant Optional Short-Term Disability (OSTD) 168
Optional Short Term Disability (OSTD) Insurance 168
Definition of Total Disability 169
Appropriate Care and Treatment 169
OSTD Insurance Benefits 169
Return-to-Work Program 170
Family Care Incentive 170
When Benefits Begin 171
When Benefits End 171
Exclusions and Limitations 171
Flight Attendant Long-Term Disability (LTD) 172
How the Plan Works 172
Definition of Total Disability 172
Appropriate Care and Treatment 173
LTD Plan Benefits 173
Severe Condition Benefit 174
LTD Benefit Elimination Period 176
Duration of LTD Benefits 176
Filing a Claim for LTD Benefits 177
When LTD Benefits Begin 177
When LTD Benefits End 178
LTD Exclusions and Limitations 178
Benefits from Other Sources 180
Forms & guides can be located in Our Policies at
7
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
CHAT
Flight Employee Benefits Guide
Return-to-Work Program 181
Vocational Rehabilitation Program 182
Employee Assistance Program (EAP) 183
How do I enroll? 184
Annual Enrollment 185
How to Enroll 185
New Employee Enrollment 185
When Coverage Begins as a Newly Hired Employee 186
When Coverage Begins as a Current Employee 186
Waiving Coverage 186
Default Coverage 186
HIPAA Special Enrollment Rights – Medical Benefit Option Only 188
When Coverage Ends 189
Making Changes During the Year: Life Events 190
Life Events 190
If Your Dependent(s) Lose Eligibility Under the Plan 199
If You Process Your Life Event after the Deadline 199
Special Life Event Considerations 199
HIPAA Special Enrollment Rights – Medical Benefit Option Only 201
What if I have questions? 202
Additional Health Benefit Rules 203
Qualified Medical Child Support Orders (QMCSO) Procedures 203
Coordination of Benefits 206
Coordination with Medicare 208
When Coverage Ends 209
Continuation of Coverage – COBRA Continuation 210
How to Elect Continuation of Coverage 211
HIPAA Certificate of Creditable Coverage 215
Plan Administration 216
Plan Information 217
Administrative Information 218
Plan Amendments 219
Plan Funding 220
Collective Bargaining Agreement 220
Assignment of Benefits 221
Claims — For Non-Grandfathered Medical Options
(Standard, Core, Value, Out-of-Area and HMO Medical Options) 221
Confidentiality of Claims 221
Payment of Benefits 221
Forms & guides can be located in Our Policies at
8
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
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Flight Employee Benefits Guide
Right to Recovery 222
Subrogation 222
Claim Processing Requirements 223
Appealing a Denial — For Non-Grandfathered Medical Options
(STANDARD, CORE, VALUE, OUT-OF-AREA)and HMO Medical Options 227
Notice of Privacy Rights — Health Care Records 232
Other Uses or Disclosures of Protected Health Information 233
Rights You May Exercise 234
How AMR Corporation Subsidiaries May Use Your Health Information 237
Separation of AMR Corporation Subsidiaries and the Group Health Plans 239
Your Rights Under ERISA 243
Reference Information 245
Contact Information 245
Glossary 251
Archives 262

Forms & guides can be located in Our Policies at
9
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome
CHAT
Flight Employee Benefits Guide
About This Guide
This Employee Benefits Guide for:
• Pilots
• Flight Attendants

This “Guide” contains the legal plan documents and the summary plan descriptions (SPDs) for the
following plans for Pilots and Flight Attendants:
• Group Life and Health Benefits Plan for Employees of Participating AMR
• Corporation Subsidiaries (the “Group Life and Health Plan”), the American Airlines Inc. Long-
Term Disability Plan (Flight Attendants only), Long-Term Care Insurance Plan for Employees of
Participating AMR Corporation Subsidiaries (collectively the “Plans”).

The provisions of this Guide apply to eligible employees of the participating subsidiaries of AMR
Corporation, including employees on the United States payroll, spouses, dependents and surviving
spouses who elect coverage under the benefits program.

The Company 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 received before the change.

Only the Pension Benefits Administration Committee (PBAC) is authorized to change the Plans. 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.

In the event of a conflict between the Plans’ provisions contained in this Guide and the
provisions contained in any applicable collective bargaining agreement (and/or insurance policies for fully-
insured programs), the collective bargaining agreement (and/or insurance policy for fully-insured
programs) shall govern in all cases with respect to employees covered by such agreement.

American Airlines, Inc., sponsor and administrator of the Group Life and Health Benefits Plan for
Employees of Participating AMR Corporation Subsidiaries, believes that the medical coverages in this
plan meet the requirements to be deemed non-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:

Forms & guides can be located in Our Policies at
10
https://www.jetnet.aa.com/jetnet/go/ssoehr.asp?TargetDoc=XML=385 TOC
The Benefits Service Center is available at https://www.jetnet.aa.com/jetnet/go/ssomercer.asp?AppId=FWHome