Benefitsthe choice is in
my hands.
2013
SOUTHWEST AIRLINES
ANNUAL ENROLLMENT
Table of Contents
Important Enrollment Information............................................................5
Eligibility Documentation.........................................................................5
Eligibility Chart.......................................................................................6
BenefitsPlus Summary.............................................................................7
Health Savings Account............................................................................8
BenefitsPlus 2013 Monthly Medical Contributions.......................................9
BenefitsPlus 2013 Medical Program Options Comparison Chart...................10
BenefitsPlus Prescription Coverage..........................................................12
BenefitsPlus Dental Program...................................................................13
BenefitsPlus Vision Program...................................................................13
Regular Plan….......................................................................................14
Flexible Spending Accounts.....................................................................16
Life Insurance........................................................................................18
Optional Accidental Death & Dismemberment (AD&D) Insurance.................20
Beneficiary Designation.........................................................................20
Long Term Disability (LTD) Insurance........................................................21
BenefitsPlus Voluntary Benefits.............................................................22
ClearSkies/Employee Assistance Program................................................23
Wellness Programs................................................................................23
Important Phone Numbers and Websites....................................back page
2013 ANNUAL ENROLLMENT
3
2013 SOUTHWEST AIRLINES
Annual Enrollment
October 25, 2012 - November 14, 2012 Closes at 11:59 P.M. Central Time
Important note: The online enrollment system will be closed on
Saturday, November 10, 2012 from 6:00 a.m. - 7:00 p.m. Central Time.
BIG CHANGES:
Employee benefit options have been redesigned for
2013 to give you more choices.
READ CLOSELY:
This Annual Enrollment guide provides an overview of the
information and tools that you need to understand these
choices and select the options that will work best for you
and your family. The benefits described in this 2013 Annual
Enrollment guide will be effective January 1, 2013.
Please read all of the information in this guide and be
sure to call or e-mail the Benefits Team if you have
questions.
ASK QUESTIONS:
Health & Welfare Benefits
Monday – Friday 8:00 a.m. – 5:00 p.m. Central Time
1-800-551-1211
askbenefits@wnco.com
4
2013 ANNUAL ENROLLMENT
ADDITIONAL INFORMATION—
SUMMARY OF BENEFITS COVERAGE:
As an Employee, the health benefits available to
you represent a significant component of your
compensation package. They also provide important
protection for you and your family in the case of
illness or injury. The Southwest Airlines Co. Welfare
Benefit Plan offers a series of health coverage options.
Choosing a health coverage option is an important
decision. To help you make an informed choice, your
plan makes available a Summary of Benefits and
Coverage (SBC) for each option, that summarizes
important information in a standard format to help
you compare across options. SBCs are available on
the online enrollment tool as well as at SWALife>My
Benefits>Benefits Information and Resources>Summary
of Benefits Coverage. A paper copy is also available,
free of charge, by e-mailing askbenefits@wnco.com or
calling 1-800-551-1211.
IMPORTANT ENROLLMENT INFORMATION
YOU MUST ENROLL ONLINE. To enroll, go to SWALife
>About Me >My Benefits and click on the Annual
Enrollment link. For detailed step-by-step instructions on
how to enroll, please refer to the 2013 Online Enrollment
User guide included in this packet.
ENROLL EARLY! Annual Enrollment begins on October
25 and ends on November 14 at 11:59 p.m. Central Time.
Late enrollments, changes, or corrections will not be
accepted. The online enrollment system will be closed
on Saturday, November 10, 2012 from 6:00 a.m. - 7:00
p.m. Central Time.
YOU MUST SAVE YOUR ELECTIONS, when you complete
the online enrollment process.
REVIEW THE BENEFITS CONFIRMATION STATEMENT.
You are not enrolled until you see the Benefits Confirmation
Statement on the computer screen and receive it in your
Company e-mail inbox. It is your responsibility to carefully
review the Benefits Confirmation Statement to confirm
that it matches your selections and print a copy of your
Benefits Confirmation Statement for your records.
DEADLINE-ELIGIBLITY DOCUMENTATION REQUIRED.
December 31, 2012 is the deadline to submit forms and
documentation for newly enrolled Family Members.
FLEXIBLE SPENDING ACCOUNT ELECTIONS DO NOT
CARRY OVER YEAR-TO-YEAR. If you would like to enroll
in the Health Care Flexible Spending Account or the
Dependent Care Flexible Spending Account then you must
make affirmative elections during Annual Enrollment.
REGISTRATION REQUIREMENT WHEN CHANGING FROM
THE REGULAR PLAN TO BENEFITSPLUS (OR FROM
BENEFITSPLUS TO THE REGULAR PLAN). Reminder:
There are two programs available for benefits coverage—
BenefitsPlus and the Regular Plan. If you would like to
switch coverage from the Regular Plan to BenefitsPlus
or from BenefitsPlus to the Regular Plan, you must
contact Health & Welfare Benefits before using the online
enrollment tool so that you can be registered with the
desired program. You will be required to complete a
Benefits Request for Program Change Form. You must
allow 24 hours to process your Benefits Request for
Program Change Form before you enroll in the desired
program using the online enrollment tool. Note: If you
switch from the BenefitsPlus program to the Regular Plan,
you and your family members over the age of 19 may be
subject to a three-month pre-existing condition limitation.
AUTOMATIC ENROLLMENT IF YOU DO NOT ELECT 2013
OPTIONS. Choice Plus PPO and Choice EPO are being
combined to form the Choice Plus Plan, and Medical Plan
C is being renamed Choice Plan C, all effective January 1,
2013. If you do not make an election online during Annual
Enrollment and you are currently enrolled in these options
then, effective January 1, 2013 you will be automatically
enrolled as follows:
2012 Election
Defaults to
Choice Plus PPO 
Choice EPO

Medical Plan C

2013 Election
Choice Plus Plan
Choice Plus Plan
Choice Plan C
ELIGIBILITY DOCUMENTATION
Southwest offers benefit coverage in the Medical, Dental,
Vision and Life Insurance programs to eligible dependents
provided that you submit all required documentation upon
enrollment and at any time upon request. To enroll a new
Family Member for coverage effective January 1, 2013,
you must complete a Family Member Documentation
Form and provide required documentation no later than
December 31, 2012. If your documentation is not received
prior to this deadline, then the family member will not be
eligible for coverage in 2013.
INSTRUCTIONS FOR SUBMITTING DOCUMENTATION:
1. Obtain Family Member Documentation Form through
the online enrollment tool.
2. Complete the Family Member Documentation Form –
including your dependent’s social security number.
3. Review the eligibility chart, gather all required
documents and write your Employee ID number on
each document.
4. Ask questions!
5. Deliver, fax, or e-mail the documentation to:
Health & Welfare Benefits
1st Floor of Headquarters in
the People Department
FAX: 214-792-4216
askbenefits@wnco.com
6. Confirm receipt with Health & Welfare Benefits.
7. Keep a copy of documentation and proof of submission
for your records.
8. Be prepared to provide additional information if needed
upon request.
2013 ANNUAL ENROLLMENT
5
ELIGIBILITY CHART
Southwest Airlines and its third party administrators may audit dependent eligibility at any time. It is each Employee’s
responsibility to provide any and all information requested. Falsifying eligibility documentation, claims, or otherwise
attempting to obtain benefits or coverage inappropriately could result in denial of claims, termination of benefits, and other
disciplinary measures, up to and including termination of employment.
Family Member Description
Required Documentation
Spouse
1. Copy of Marriage Certificate issued by a governmental agency (certified translated copy if
in a foreign language);
2. Social Security Number;
3. And ONE document from the options below:
Option 1
Page 1 of your current year’s filed Federal tax return that lists your Spouse and filing status.
Option 2
Page 1 of your previous year’s filed Federal tax return that lists your Spouse and filing status
AND a copy of your current year IRS Form 4868 requesting a filing extension.
Option 3
One item from the list below.
• Joint Ownership Document - examples include: mortgage statement, credit card statement, car note, bank statement, school taxes, or utility bills dated any time in the last three
months listing you and your Spouse
• Rental/lease agreement, deed, or property tax statement/appraisals dated anytime in the
last 12 months listing you and your Spouse
• Homeowner’s insurance policy currently in effect listing you and your Spouse
• Auto insurance policy currently in effect listing you and your Spouse
• Automobile registration currently in effect listing you and your Spouse
Your lawful Spouse (if not legally separated from you, the
Employee) who qualifies as a Spouse for purposes of the
Internal Revenue Code of 1986 (as in effect on January 1,
2004).
**If you were married within the last 12 months, then you only need to submit a copy of your
Marriage Certificate and do not need to submit the documents listed in the options.
Marriage License alone is not adequate.
Natural Child
Your natural child up to age 26.
1. Copy of Birth Certificate issued by a governmental agency, Hospital Birth Record (for
newborns), or other legal document establishing parentage. (Employee must be listed on the
birth certificate, hospital birth record or other legal document).
2. Social Security Number
Stepchild
Your stepchild, up to age 26 and who is a child of your current
Spouse by a previous union.
1. Copy of Birth Certificate issued by a governmental agency or other legal document
establishing parentage. Employee’s Spouse must be listed on birth certificate or other legal
document.
2. Social Security Number.
Your legally-adopted child, including child placed for adoption
Legally Adopted
Child (or Child Placed up to age 26.
for Adoption)
1. Copy of Adoption (or Adoption Placement) Orders proving legal obligation and issued by a
Court or other legal authority.
2. Social Security Number.
Child for Whom
You Have a Legal
Obligation
Child for whom you (or, alternatively, you and your Spouse)
have been appointed by a court of competent jurisdiction as
the person(s) having custody of the child and the sole legal
right and obligation to provide support and medical care for
the child, but only if the child resides in your household on
a permanent basis and the child’s parents are deceased, or
the parental rights of the child’s parents are permanently
terminated, or the Plan Administrator determines, in its sole
discretion, that the child’s parents are totally disabled and
financially unable to provide any support or care for the child.
1. Copy of Birth Certificate issued by a governmental agency;
2. Court Documentation proving your custody and the sole legal right and obligation to provide
support and medical care for the child; proof the child lives in your household on a permanent
basis; proof the child’s parents are deceased or have had their parental rights permanently
terminated (or proof the child’s parents are totally disabled and financially unable to provide any
support or care for the child); and
3. Social Security Number.
Disabled Child
Your disabled child up to the age of 26 is covered under the
eligibilty guidelines described above. Your disabled child over
age 25 may be eligible for continued coverage.
For disabled children over age 25, a physician’s statement showing proof of incapacity is
required. Contact Health & Welfare Benefits for the appropriate forms.
Committed Partner
Your Committed Partner must satisfy all of the requirements
as stated in the Committed Partner Policy.
Your eligible Committed Partner may only be enrolled in
BenefitsPlus, as well as the Dental Plan and the Vision Plan.
You may enroll in the Committed Partner Program for Medical Coverage and/or Passes at any time during the calendar year.
You may find the Committed Partner Enrollment Packet on
SWALIfe>About Me>Launch Self Service>My Benefits>Benefits
Information and Resources>Information and Forms.
See the Southwest Airlines Co. Committed Partner Benefits Policy for required proof of eligibility (available at www.swalife.com or upon request from the Health & Welfare Benefits).
Registered Partner
(Passes Only)
Your Registered Partner must satisfy all of the requirements
stated in the Registered Partner Policy and you must complete
the appropriate paperwork.
You may find the Registered Partner Enrollment Packet on
SWALife>About Me>Launch Self-Service>My Benefits>Benefits
Information and Resources>Information and Forms.
See the Southwest Airlines Co. Committed Partner Benefits Policy for required proof of eligibility (available at www.swalife.com or upon request from the Health & Welfare Benefits).
6
2013 ANNUAL ENROLLMENT
BENEFITSPLUS summary
Effective January 1, 2013, there will be three options
for medical coverage available under the BenefitsPlus
program designed to give you the ability to make
choices that best fit your family’s needs. All BenefitsPlus
programs will be administered by UnitedHealthcare in
2013. All Employees will receive new insurance ID cards
in early January.
Choice Plus Plan: The BenefitsPlus EPO and PPO
options are being combined to form the Choice Plus
Plan. The Choice Plus Plan offers network benefits and
non-network benefits, although it pays more for services
provided by network providers. It includes copays for
office visits and generic drugs and pays a percentage of
the costs for other medical care as well as non-generic
drugs.
Choice Plan C: Medical Plan C is being renamed Choice
Plan C. Modifications include but are not limited to:
• Employees will pay monthly contributions (see
Medical Monthly Contributions chart).
• The Out-of-pocket maximum for Employee coverage
will decrease while the Out-of-pocket maximum for
Family coverage will increase.
• Generic and non-preferred prescription drugs
coinsurance remains unchanged, however the
amount the Employee pays for preferred brand
prescriptions will increase.
Health Savings Plan (HSP): The Health Savings Plan
(HSP): The Health Savings Plan is a new medical option
that offers low monthly contributions, but notably
higher deductible and higher coinsurance requirements.
Employees in the Health Savings Plan are responsible
for the full cost of all healthcare expenses (other than
qualified preventive care) until the higher deductible and
coinsurance are satisfied.
The Health Savings Plan has:
• The option to contribute to a tax-advantaged
Health Savings Account (HSA).
See below for more details
• Lower monthly upfront contributions compared to
the other BenefitsPlus options. The amount saved
on monthly contributions can be contributed to a
Health Savings Account.
• Higher deductibles compared to the other
BenefitsPlus options. The deductible in the Health
Savings Plan works differently than the deductibles
in the other BenefitsPlus medical options. With
“Employee Only” coverage in the Health Savings Plan,
the Employee will be subject to the “Employee Only”
deductible of $1,500. With any other coverage level
besides “Employee Only” (including any Committed
Partner coverage), the “Family” deductible of $3,000
must be met. Unlike the other BenefitsPlus options,
there is no deductible for individual Family members.
There is only one deductible for the entire Family
that is significantly higher than the other BenefitsPlus
options.
• Out-of-Pocket maximums. Your Out-of-pocket
maximum is the maximum amount you pay during
a calendar year for covered charges. The Out-ofpocket maximum is applied to you and each covered
Dependent you add to coverage. Once you have
paid your deductible, and in addition, reached the
coinsurance annual Out-of-pocket maximum, the
Health Savings Plan will cover 100% of all eligible
expenses for the reminder of the calendar year. The
Out-of-pocket maximum excludes deductibles.
• A unique prescription drug benefit. Under the
Health Savings Plan, certain
preventive prescription
BenefitsPlus
drugs are covered at 80% before the deductible is
met. For a list of these preventive prescriptions, go
to SWALife on About Me>My Benefits>Information
and Forms. For all other prescriptions, the Employee
is responsible for the full cost until the medical
deductible is met.
• Coverage for eligible benefits on the autism
spectrum, including Applied Behavioral Analysis
(ABA) Therapy. This coverage is only available
under the Health Savings Plan option. Treatment
associated with autism may be covered, including
speech therapy, occupational therapy, and physical
therapy subject to any plan coverage limitations.
Benefits may be denied or shortened for persons not
progressing in goal-directed rehabilitation services or
if rehabilitation goals were previously met. Benefits
under this section are not available for maintenance/
preventive manipulative treatment. All services
under this benefit for both in and out-of-network
providers require pre-notification or coverage will
be denied. To access benefits for autism coverage
and to meet the pre-notification requirement, call
Clear Skies at 1-800-742-8911.
2013 ANNUAL ENROLLMENT
7
health savings account
A Health Savings Account (HSA) is only available under
the BenefitsPlus Health Savings Plan option.
If you enroll in the Health Savings Plan, you will have
the option, if you meet IRS requirements, of opening
a Health Savings Account (HSA) to save money for
qualified health care expenses. You may choose to open
an HSA with any bank. If you open your account with
OptumHealth Bank, then the amount that you choose to
save can be withheld from your paycheck before taxes
and direct deposited to your HSA. If you open an HSA
with another bank, you may make contributions directly
(for example, by personal check) but payroll deductions
will not be available to you.
The amount in your HSA is yours to use for qualified
medical expenses, including your deductible under the
Health Savings Plan. You do not lose amounts in your
HSA at the end of the year or when your employment
with Southwest ends. It’s your money! You may also
choose for amounts in your HSA to earn interest and
grow tax-free for use on qualified medical expenses in
the future.
How to Open a Health Savings Account (HSA):
To participate in the HSA, you will need to personally
open your own account. You can either (i) choose to
have Southwest deduct your HSA contributions directly
from your paycheck, in which case you must open
your own account with OptumHealth Bank (see details
below), or (ii) choose to make direct contributions (for
example, by personal check) to your HSA in which case
you may open a Health Savings Account with the bank
of your choice.
To open a Health Savings Account with OptumHealth
Bank, you must go to www.OptumHealthBank.com
to complete the bank’s online application including
Southwest Airlines’ Group Number 199409. Your elected
pre-tax payroll contributions will not begin until you
open your account with OptumHealth Bank.
Note: You must open an HSA and have funds in your
HSA before you can use your account to pay for
qualified medical expenses. You may only use your HSA
to pay for medical expenses incurred after the account is
opened.
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2013 ANNUAL ENROLLMENT
HSA Eligibility: Most Southwest Employees will be
eligible to open a Health Savings Account; however,
federal tax law limits participation in a Health Savings
Account in some circumstances. Make sure you
understand these limitations before you make your
elections.
These eligibility requirements only apply to the Health
Savings Account—not the Health Savings Plan option.
If you enroll in the Health Savings Plan intending to
open a Health Savings Account, but then determine you
are not eligible for the Health Savings Account, you will
not be able to change to another medical option until
Annual Enrollment for 2014.
To be eligible to open a Health Savings Account (HSA):
• You may ONLY have medical coverage under an
eligible high deductible health plan (HDHP)—the
Southwest Health Savings Plan.
o You may not have coverage under a spouse’s non-HDHP.
o You may not be enrolled in Medicare (Part A or
B), TRICARE or TRICARE for Life, even as
secondary coverage. (If you are eligible for
Medicare, but not enrolled, then you are eligible
to contribute to an HSA.)
o You must not have received Veteran
Administration (VA) Benefits within three
months of making any contribution to your
Health Savings Account.
• You may not be claimed as a dependent on someone
else’s tax return.
• You, and your spouse (if any), may not contribute to
a Health Care Flexible Spending Account (including
Southwest’s Health Care Flexible Spending Account).
However, you may contribute to a Dependent Care
Flexible Spending Account.
Note: Although a Committed Partner can be covered
under the Health Savings Plan, under federal tax rules,
the Committed Partner’s medical expenses usually will
not constitute qualified medical expenses that can be
paid or reimbursed out of a Health Savings Account.
BenefitsPlus 2013 Monthly
medical Contributions
You may enroll in medical, dental, and vision options independently of each other and each option selected has its
own monthly contribution as shown in the charts below.
For example, you may elect Employee + Family coverage for medical, Employee Only coverage for dental, and Employee
+ Spouse for vision. By carefully choosing the options that are the best fit for your family, you can structure your benefits
to minimize your monthly contributions.
If you select NO COVERAGE for medical, then you will receive a $50.00 credit in your paycheck each month ($60.00 for
eligible SWA to SWA no coverage election).
Fulltime Employees
Benefitsplus
Medical Monthly Contributions
Choice Plus Plan
Choice Plan C
Health Savings Plan
EE ONLY
$49.00
$20.00
$5.00
EE + SPOUSE
EE + COMMITTED PARTNER
$150.00
$70.00
$9.00
EE + CHILDREN
$133.00
$66.00
$7.00
EE + FAMILY
EE + COMMITTED PARTNER + CHILDREN
$221.00
$113.00
$11.00
SWA EE + SWA EE
$98.00
$40.00
$9.00
SWA EE + SWA FAMILY
$182.00
$86.00
$11.00
Parttime Employees
Benefitsplus
Medical Monthly Contributions
Choice Plus Plan
Choice Plan C
Health Savings Plan
EE ONLY
$49.00
$20.00
$5.00
EE + SPOUSE
EE + COMMITTED PARTNER
$510.85
$455.15
$406.34
EE + CHILDREN
$377.30
$329.60
$290.94
EE + FAMILY
EE + COMMITTED PARTNER + CHILDREN
$842.16
$767.75
$695.29
SWA EE + SWA EE
$98.00
$40.00
$9.00
SWA EE + SWA FAMILY
$426.30
$349.60
$294.94
2013 ANNUAL ENROLLMENT
9
2013 benefitsplus
MEDICAL Program
options COMPARISON
Annual Deductible
BenefitsPlus
CHOICE PLUS(5)
Network: $300/Per Person; $750/Family
Non-Network: $600/Per Person; $1,500/Family
(does not apply to Out-of-pocket maximum)
100% After appropriate copay or coinsurance.
In Network:
Co-Pays/Services Performed by Physician
Convenience Care Clinic; $15 (2)
Office Visit $25; Specialist $40; Urgent Care $40;
Emergency Room $150
Other Services after annual deductible 15% coinsurance
Non-Network: 60% coverage, no co-pay
(non-surgical do not apply towards deductible or
Out-of-pocket maximum)
General Level of Benefit Coverage
Network Provider: 85%; Non-Network Provider: 60%
(after annual deductible)
(inpatient and outpatient)
Preventive Care (no deductible)
Network Provider: 100%
Non-Network Provider: 100% of Reasonable and Customary
(Adult and Children)
Newborn Care (inpatient)
Network Provider: 85%; Non-Network Provider: 60%
(after annual deductible)
Includes: circumcision, room and board, general
nursing care, and Doctor’s fees.
See chart on page 12 for more information.
Prescriptions
Services(1): 50% coinsurance after $500 separate lifetime deductible (infertility treatment only), Employee
and spouse combined; $10,000 lifetime maximum — You and your Spouse/Committed Partner combined
Infertility Treatment
(Pre-treatment authorization required by UHC)
Prescription Drugs:
• Network Provider: 50% coinsurance, $5,000 lifetime maximum—You and your Spouse/
Committed Partner combined
• Non-Network Provider: No Coverage
Applied Behavorial Analysis (ABA)
Therapy
ClearSkies Employee Assistance Program
(EAP)
No Coverage
Network Provider: Up to five appointments per person, per issue with ClearSkies at no charge.
Non-Network: no coverage
Mental, Emotional, Behavioral and
Chemical Abuse/Dependency Benefits
Prenotified(3)
Prescription Drugs are covered under the
Network: Outpatient/Inpatient 85%
Non-Network: Outpatient/Inpatient 60%
(after annual deductible)
Prescription Drug Card Program.
Annual Out-of-Pocket Maximum
(excludes deductibles and all copays except
emergency room copays)
Network: $3,200 per person; $6,400 family
Non-Network: $6,400 per person; $12,800 family
(excludes deductibles)
Lifetime Maximum
(combined Medical and Mental Health and
No Limit
Chemical Dependency)
(1) Charges for all prescription drugs and infertility treatment will not apply to the Choice Plus Plan annual out-of-pocket maximum or annual medical deductible. Certain provider and
coverage limitations apply to infertility treatment. You must contact Unitedhealthcare prior to receiving infertility treatment.
(2) List of Convenience Care Clinics available at www.myuhc.com.
10
2013 ANNUAL ENROLLMENT
BenefitsPlus
CHOICE PLAN C(5)
Network: $800/Per Person; $2,000/Family
Non-Network: $1,500/Per Person; $3,750/Family
(does not apply to Out-of-pocket maximum)
HEALTH SAVINGS PLAN (HSP)(6)
Network/Non-Network - $1,500/Employee Only - $3,000/Family(6)
(does not apply to Out-of-pocket maximum)
Co-pays not available
Co-pays not available
Network Provider: 80%;
Non-Network Provider: 60%
Network Provider: 80%
Non-Network provider: 60%
(after annual deductible)
(after annual deductible)
Network Provider: 100%
Network Provider: 100%
Non-Network Provider: 100%
of Reasonable and Customary
Non-Network Provider: 100% of Reasonable and
Customary
No Coverage
Network Provider: 80%; Non-Network Provider: 60%
(after annual deductible)
See chart on page 12 for more information.
See chart on page 12 for more information.
No Coverage
No Coverage
No Coverage
Network Provider: 80%
Non-Network provider: 60%
(after annual deductible)
Network Provider: Up to five appointments per person,
per issue with ClearSkies at no charge.
Non-Network: no coverage
Network Provider: Up to five appointments per person, per
issue with ClearSkies at no charge.
Non-Network: no coverage
Network: Outpatient/Inpatient 80%
Network: Outpatient/Inpatient 80%
Non-Network: Outpatient/Inpatient 60%
Non-Network: Outpatient/Inpatient 60%
(after annual deductible)
(after annual deductible)
Network: $4,000 per person; $8,000 family
Network: $4,500/per person - $9,000/per family
Non-Network: $6,000 per person; $12,000 family
Non-Network: $6,750/per person - $13,500/per family
(excludes deductibles)
(excludes deductibles)
No Limit
No Limit
(3) Refer to the Summary Plan Description on SWALife>About Me for prenotification rules for each medical plan.
(4) List of Specified Preventive medications may be found at SWALIfe>About Me>My Benefits.
(5) For the Choice Plus Plan and Choice Plan C, when an individual in a family meets the individual deductible, coinsurance applies. When the family deductible amount is
met, the rest of the family will receive benefits. One participant can never incur deductible expenses above the individual limit. Family deductible may be reached with any
combination of expense incurred by any Family Member.
(6) For the HSP, if you have anything other than Employee Only coverage, then you will be subject to the entire family deductible before any Family Member receives a
benefits.
2013 ANNUAL ENROLLMENT
11
BENEFITSPLUS PRESCRIPTION COVERAGE
When you enroll in a BenefitsPlus medical option you are automatically enrolled in the corresponding prescription coverage.
Described below are the amounts the Employee is required to pay for prescription coverage.
BenefitsPlus Prescription
Choice Plus Plan
Choice Plan C
Health Savings Plan
30 Day Retail
90 Day Retail/
Mail Order
30 Day Retail
90 Day Retail/
Mail Order
30 Day Retail
90 Day Retail/
Mail Order
Catamaran
Catamaran
Catamaran
Catamaran
OptumRx
OptumRx
$10
$25
10%
($10 min/$35 max)
7%
($25min/$88 max)
20%
20%
25%
($25 min/$50 max)
20%
($45 min/$125 max)
25%
($25 up to $100)
20%
($63 up to $250)
20%
20%
Non-Preferred
Brand
45%
($40 up to $150)
45%
($60 up to $375)
45%
($40 up to $150)
45%
($125 up to $375)
20%
20%
Specialty Drug
25%
($20-$150)
90 day not available
25%
($20-$150)
90 day not available
20%
90 day not available
20%
(deductible waived
for core list of
medications)
Administrator
Generic
Preferred Brand
Preventive
Medications (applies
N/A
N/A
N/A
N/A
20%
(deductible waived
for core list of
medications)
Covered at 100%
by plan
Covered at 100%
by plan
Covered at 100%
by plan
Covered at 100%
by plan
20%
90 day not available
$0.00
$0.00
$50 separate annual
deductible
$50 separate annual
deductible
$1,500/$3,000
(Combined w/Health
Plan Deductible)
$1,500/$3,000
(Combined w/Health
Plan Deductible)
to HSP Plan only)
Diabetic Testing
Supplies
Deductible (annual)
Infertility
Medications
12
50% with $5,000
lifetime maximum
2013 ANNUAL ENROLLMENT
BENEFITSPLUS dental program
The Southwest dental program is administered by Delta Dental and is separate from your medical program. You may go to
any dentist that you choose; however, you will have lower coinsurance requirements if you select a network provider. To print a
dental ID card or locate a network provider go to www.deltadentalins.com/southwest.
If you select NO COVERAGE for dental, then you will receive an $8.50 credit in your paycheck each month.
Dental Monthly Contributions
Parttime Employees
Fulltime Employees
Benefitsplus
Basic
Optional
Basic
Optional
EE ONLY
$1.00
$10.00
$1.00
$10.00
EE + SPOUSE
EE + COMMITTED PARTNER
$3.00
$26.00
$31.02
$56.52
EE + CHILDREN
$3.00
$30.00
$37.02
$65.82
EE + FAMILY
EE + COMMITTED PARTNER + CHILDREN
$5.00
$42.00
$61.04
$103.04
SWA EE + SWA EE
$2.00
$20.00
$2.00
$20.00
SWA EE + SWA FAMILY
$4.00
$40.00
$38.02
$75.82
BENEFITSPLUS vision program
EyeMed Vision Care will be the new vision program
provider effective January 1, 2013. The vision program
is an insured plan (not self-insured by Southwest) and
Southwest has negotiated lower rates compared to
prior years. EyeMed Vision Care offers an expansive
network of doctors and vision care centers including
popular convenient retail locations (e.g., LensCrafters,
Sears, Target Optical, Pearl Vision, JCPenney Optical).
For a comprehensive summary of vision benefits and
network providers go to www.strata-g.com/eyemed/
swa. If you elect vision coverage, a vision ID card will
be mailed in January 2013 to your home address on
record. As a general matter, you may only enroll in
the vision program if you are enrolled in BenefitsPlus.
Although some collectively bargained work groups have
the option to enroll in the Vision Program through the
Regular Plan.
BenefitsPlus
Vision Monthly Contributions
Fulltime and
Parttime Employees
EE ONLY
$4.92
EE + SPOUSE
EE + COMMITTED PARTNER
$9.35
EE + CHILDREN
$9.84
EE + FAMILY
EE + COMMITTED PARTNER + CHILDREN
$14.47
2013 ANNUAL ENROLLMENT
13
regular plan
REGISTRATION REQUIREMENT WHEN CHANGING
FROM THE REGULAR PLAN TO BENEFITSPLUS (OR
FROM BENEFITSPLUS TO THE REGULAR PLAN):
Reminder: There are two programs available for benefits
coverage—BenefitsPlus and the Regular Plan. If you
would like to switch coverage from the Regular Plan to
BenefitsPlus or from BenefitsPlus to the Regular Plan,
you must contact Health & Welfare Benefits before using
the online enrollment tool so that you can be registered
with the desired program. You will be required to
complete a Benefits Request for Program Change Form.
You must allow 24 hours to process your Benefits
Request for Program Change Form before you enroll in
the desired program using the online enrollment tool.
Note: If you switch from the BenefitsPlus program to
the Regular Plan, you and your family members over the
age of 19 may be subject to a three-month pre-existing
condition limitation.
Effective January 1, 2013, UnitedHealthcare will
administer the Regular Plan (not Blue Cross Blue Shield
of Texas). You will receive a new medical ID card in
January 2013.
HEALTH CARE REFORM REQUIRED LEGAL NOTICE:
The Southwest Airlines Co. Funded Welfare Benefit
Plan believes the Regular Plan Benefit Program is a
“grandfathered health plan” under the Patient Protection
and Affordable Care Act (the “Affordable Care Act”). As
permitted by the Affordable Care Act, a grandfathered
health plan can preserve certain basic health coverage
that was already in effect when that law was enacted.
Being a grandfathered health plan means that coverage
under the Regular Plan Benefit Program may not include
certain consumer protections of the Affordable Care
Act that apply to the BenefitsPlus program options, 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 regarding which protections apply
and which protections do not apply to a grandfathered
health plan and what might cause a plan to change
from grandfathered health plan status can be directed
to Health & Welfare Benefits by e-mailing askbenefits@
wnco.com or phoning 1-800-551-1211. 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 do and do not apply to
grandfathered health plan.
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2013 ANNUAL ENROLLMENT
IMPORTANT INFORMATION TO CONSIDER ABOUT THE
REGULAR PLAN: The Regular Plan either does not
offer, or offers but limits, many of the benefits that may
be available under BenefitsPlus. You should carefully
review these limitations before selecting this option.
• Preventive services such as physicals, mammograms,
and colonoscopies are not covered.
• Basic medical and dental coverage is available but it
is more limited than under BenefitsPlus.
• Mail order prescriptions are not available.
• The Vision Program is only offered to some work
groups under the Regular Plan.
• You may not enroll in the Flexible Spending Account
programs (i.e., Health Care Flexible Spending Account
and Dependent Care Flexible Spending Account).
• Optional Life Insurance is limited to the amount equal
to your Basic Life Insurance
• Spouse Life Insurance is limited to a maximum of
$10,000.
• Child Life Insurance is limited to a maximum of
$1,000 for each child less than six months of age, or
$5,000 for each child six months of age or older.
• Optional Accidental Death and Dismemberment
Insurance (AD&D) is limited to the amount equal to
your Basic Life Insurance.
• You may not enroll in optional Accidental Death &
Dismemberment coverage for Family.
• Long Term Disability is not automatically provided by
Southwest when enrolled in the Regular Plan.
• The new voluntary benefit programs (i.e., auto/
home/pet/supplemental hospital insurance) are only
available under BenefitsPlus and are not available
under the Regular Plan.
• Committed partner benefits are not offered in the
Regular Plan.
Medical
Regular Plan
Monthly Contributions
Dental
Vision
Fulltime
Parttime
Fulltime
Parttime
Fulltime
Parttime
EE ONLY
$0
$0
$0
$0
$3.83
$3.83
EE + SPOUSE
EE + COMMITTED PARTNER
$0
$572.76
$0
$28.00
$7.28
$7.28
EE + CHILDREN
$0
$400.93
$0
$33.60
$7.67
$7.67
EE + FAMILY
EE + COMMITTED PARTNER + CHILDREN
$0
$973.69
$0
$56.00
$11.27
$$11.27
SWA EE + SWA EE
$0
$0
$0
$0
$7.28
$7.28
SWA EE + SWA FAMILY
$0
$400.93
$0
$33.60
$11.27
$11.27
You are automatically enrolled in prescription drug coverage administered by OptumRx when you enroll in the Regular
Plan. Preferred brand, non-preferred and specialty medications are available in either a 30 day or 90 day retail supply (no
mail order option). You may refer to the chart below for the schedule of prescription benefits.
Regular Plan
Prescription Chart
Deductible (annual)
$200/$300
(Combined w/Health Plan
Deductible)
Generic
Covered at 100%
(after deductible)
Preferred Brand
20%
(after deductible)
Non-Preferred Brand
20%
(after deductible)
Specialty Drug
20%
(after deductible)
Diabetic Testing Supplies
20%
(after deductible)
Preventive Medications
N/A
Infertility
N/A
2013 ANNUAL ENROLLMENT
15
flexible spending accounts
If you are electing BenefitsPlus Choice Plus Plan or Choice Plan C medical options then you may choose to participate in
the Health Care Flexible Spending Account program.
If you are electing BenefitsPlus Choice Plus Plan, Choice Plan C, or the Health Savings Plan medical option then you may
choose to participate in the Dependent Care Flexible Spending Account program.
All flexible spending programs are administered by UnitedHealthcare.
Expenses Eligible for
Reimbursement
Health Care Flexible
Spending Account
Dependent Care Flexible
Spending Account
Qualified medical expenses ONLY.
Qualified dependent day care expenses ONLY.
Choice Plus Plan
YES
YES
Choice Plan C
YES
YES
Can be elected if enrolled in the
Health Savings Plan Option?
NO
YES
What is this benefit used for?
To participate in the flexible spending account programs, you must make an election each year. Your 2012 elections
will not rollover to 2013. If you choose to participate, then you must determine the amount that you would like to
contribute annually and elect this contribution amount during Annual Enrollment. The annual contribution amount will
be prorated across your paychecks throughout the year. Your monthly flexible spending account contribution(s) will be
withheld from your paychecks before taxes. Amounts contributed to flexible spending accounts do not carry-over from
year-to-year. Both flexible spending accounts operate as use-it-or-lose-it programs. If you don’t use all your Flexible
Spending Account contributions by December 31st, then the remaining balance is forfeited. You have until March 31st
of the following year to file claims, but the eligible expenses must be incurred by December 31st of the prior year.
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2013 ANNUAL ENROLLMENT
HEALTH CARE FLEXIBLE SPENDING ACCOUNT: The Health Care Flexible Spending Account is a way for you to save
money tax-free to use on eligible healthcare expenses, including co-pays and coinsurance, for you and members of your
family that qualify as dependents for federal income tax purposes.
For a complete and current detailed listing of eligible healthcare expenses and ineligible expenses you may go to
www.irs.gov and review Publication 502. As a result of healthcare reform, effective January 1, 2013, the maximum
amount that you may contribute to a Health Care Flexible Spending Account in 2013 is $2,500. The minimum amount
you may contribute for the year is $120.
The Health Care Flexible Spending Account program is different than the Health Savings Account (HSA). You may
not participate in the Health Care Flexible Spending Account if you are enrolled in the BenefitsPlus Health Savings
Plan medical option. The chart below reflects the differences:
Comparison Chart
Health Care Flexible
Spending Account
Health Savings Account
BenefitsPlus Choice Plus Plan
and Choice Plan C ONLY
BenefitsPlus Health Savings Plan (HSP) ONLY
YES
NO
$2,500
$3,250 Employee Only Coverage
$6,450 Family Coverage
(Family Coverage includes: Employee + Spouse/
Committed Partner, Employee + Children)
Roll-over option when Terminate or Retire?
NO
YES
Qualified Medical Expenses only?
YES
YES
Pre-Tax Contributions?
YES
YES*
Can be elected if enrolled in the BenefitsPlus
Health Savings Plan Option?
NO
YES
Medical Program Requirement
Must be Used by Year End?
(“Use it or Lose it”)
Annual Contribution Limit?
* Pre-tax payroll contributions can only be made to a Health Savings Account with OptumHealth Bank. If you open your
Health Savings Account with another bank, contributions cannot be pre-tax payroll deducted, although they may be
considered a tax deduction when filing your annual tax return. Consult your tax advisor for details.
DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT: The Dependent Care Flexible Spending Account allows you to
set aside money each year from your pay to reimburse yourself for eligible expenses for the child or adult daycare or
other qualifying care of your family members that qualify as a dependent for federal income tax purposes. For 2013,
you may contribute any amount from an annual minimum of $120 up to annual maximum of $5,000 (or $2,500 if you
are married and filing separate tax returns) to pay for eligible dependent care expenses. If you do not have child or
adult daycare or other qualifying care expenses, then you should not enroll in the Dependent Care Flexible Spending
Account. If you enroll in the Dependent Care Flexible Spending Account in error, contributions will not be refunded.
2013 ANNUAL ENROLLMENT
17
LIFE INSURANCE
Southwest offers a choice of life insurance options to help provide for your family in the event of your death. The Life
Insurance program is an insured product and, effective January 1, 2013, will be provided by MetLife (not The Standard). The
transition to MetLife will offer additional benefit levels and lower rates.
EMPLOYEE BASIC LIFE INSURANCE: As an Employee at Southwest you automatically receive Basic Life Insurance coverage
at no cost to you. Basic life insurance is equal to your base annual pay up to a maximum of $50,000.
EMPLOYEE OPTIONAL LIFE INSURANCE: You may elect Optional Life Insurance coverage in addition to Basic Life Insurance
coverage. Effective January 1, 2013, if you are enrolled in BenefitsPlus, then you may purchase Optional Life Insurance up to
ten times your base annual pay (increased from six times in 2012) and if you are enrolled in the Regular Plan, then you may
purchase Optional Life Insurance up to a maximum of $50,000. This means that at the time of your death, your beneficiary will
receive a cash payout from MetLife that is equal to the level of coverage you selected. The cost of your premium depends on
your age as of December 31 of the Plan Year.
Age Bands
BenefitsPlus
that determine premium level
Optional Life Insurance Premiums
< 25
$.023 per $1,000 of coverage
25-29
$.023 per $1,000 of coverage
30-44
$.028 per $1,000 of coverage
45-49
$.051 per $1,000 of coverage
50-54
$.079 per $1,000 of coverage
55-59
$.147 per $1,000 of coverage
60-64
$.255 per $1,000 of coverage
65-69
$.493 per $1,000 of coverage
70+
$.793 per $1,000 of coverage
SPOUSE/COMMITTED PARTNER LIFE INSURANCE: Southwest offers this life insurance option to help provide for your family
in the event of the death of your Spouse/Committed Partner. You may elect the Spouse/Committed Partner Life Insurance
coverage level of your choice and upon the death of your Spouse/Committed Partner you or the beneficiary will receive a cash
payout from MetLife in that amount. If you are enrolled in BenefitsPlus, then coverage level choices for Spouse/Committed
Partner BenefitsPlus are $10,000, $20,000, $30,000, $50,000, $100,000, $150,000, or $250,000. If you are enrolled in the
Regular Plan, then you may only purchase Spouse Life Insurance at the $10,000 coverage level and you may not purchase
Committed Partner Life Insurance.
Age Bands
18
BenefitsPlus
that determine premium level
Spouse/Committed Partner
Insurance Premiums
< 25
$.04 per $1,000 of coverage
25-29
$.04 per $1,000 of coverage
30-44
$.05 per $1,000 of coverage
45-49
$.09 per $1,000 of coverage
50-54
$.14 per $1,000 of coverage
55-59
$.26 per $1,000 of coverage
60-64
$.45 per $1,000 of coverage
65-69
$.87 per $1,000 of coverage
70+
$1.40 per $1,000 of coverage
2013 ANNUAL ENROLLMENT
LIFE INSURANCE
(continued)
CHILD LIFE INSURANCE: Southwest offers this life insurance option to help provide for unexpected expenses that may arise
in the event of your child’s death. If you are enrolled in BenefitsPlus, then you may elect Child Life Insurance coverage in the
amount of $10,000 with a monthly premium of $.50 or $20,000 with a monthly premium of $1.00. If you are enrolled in the
Regular Plan, then you may elect Child Life Insurance coverage for a monthly premium of $.26 and your coverage level will be
$1,000 for each child less than six months of age and $5,000 for each child six months of age or older.
Upon the death of your eligible child you will receive a cash payout from MetLife in the amount of coverage you chose.
Eligible children include any children from live birth up to age 25 that qualify as an: unmarried child; disabled child; foster
child; child placed with you for adoption; or child living in your home as your grandchild, your stepchild, or the child of
your Spouse.
IMPORTANT NOTE ABOUT CHILD LIFE INSURANCE:
A number of Employees are paying for Child Life Insurance
who DO NOT have an eligible child.
Removing a child as a dependent for benefits coverage
DOES NOT stop the child life insurance deductions. You
must also go through the Online Annual Enrollment
Tool to remove child life insurance coverage. It is your
responsibility to remove the child from coverage.
Statement of Health (SOH) Requirements: To increase Optional Life Insurance and/or Spouse/Committed Partner
Life Insurance from the level you selected for 2012, you and/or your Spouse/Committed Partner must complete a
Statement of Health (SOH) with MetLife after you complete the Annual Enrollment process. It is your responsibility to
complete this step following enrollment. Your coverage level(s) will not be increased if you do not submit the SOH(s) in
accordance with MetLife’s requirements.
To make the transition process to MetLife a little easier, for the 2013 Annual Enrollment period, the SOH will be a short
form consisting of only five questions. Responses to the short form will determine if you and/or your Spouse/Committed
Partner need to complete the long form and/or be required to submit a medical exam. Any increase in Optional Life
Insurance and/or Spouse/Committed Partner Life Insurance will be suspended until MetLife approves or denies your
increased coverage. You will receive a notification from MetLife once a determination has been made.
Statement of Health Process: If you increase Optional Life Insurance and/or Spouse/Committed Partner Life Insurance,
then a web link for the Statement of Health will be e-mailed to your Company e-mail address within five business days.
The SOH must be completed within thirty days of when the e-mail is delivered to your Company e-mail address. If not
completed, then your 2012 life insurance elections will carry-over to 2013 and your new elections will not take effect.
Age 70 Limitations: MetLife limits Optional Life Insurance, Spouse/Committed Partner Life Insurance, and Accidental
Death and Dismemberment coverage for individuals over age 70; therefore, effective January 1 of the year you or your
Spouse will reach age 70, as applicable, your coverage amount for the applicable program will be reduced by 50%
(regardless of whether your election rolls over or you affirmatively elect a coverage level during Annual Enrollment) and
your premiums will be adjusted accordingly.
2013 ANNUAL ENROLLMENT
19
optional accidental death and
dismemberment (ad&D) insurance
Southwest offers the option to purchase Accidental Death and Dismemberment (AD&D) Insurance as part of the life
insurance program to help provide for your family in the event of accidental death or dismemberment. You may elect
AD&D Insurance coverage level of your choice and (i) upon the death of you or your Family Member you will receive a
cash payout from MetLife equal to your coverage level, and (ii) upon the dismemberment of you or your Family Member
you will receive a cash payout from MetLife that is equal to a percentage of your coverage level subject to certain limits.
If you are enrolled in BenefitsPlus, you may purchase AD&D Insurance coverage up to ten times your annual base pay
(increased from six times in 2012). If you are in the Regular Plan, then you may purchase AD&D Insurance up to your
level of Basic Life Insurance.
For the first time in 2013, if you are enrolled in BenefitsPlus, in addition to an Employee Only Coverage option, you
will have the option to purchase Employee + Family Coverage. The Employee + Family option is not available to
Employees enrolled in the Regular Plan.
You may review your applicable monthly premium rates for AD&D Insurance in the online Annual Enrollment tool.
beneficiary designation
Updating your Beneficiary Designation: It is very important that MetLife have up to date beneficiary designations for
Life Insurance and Accidental Death and Dismemberment Insurance. This ensures that MetLife can timely distribute
the cash payments in the event of a death or dismemberment under the Life Insurance or Optional Accidental Death
and Dismemberment Insurance programs. If you would like to update your beneficiary designations, access the MetLife
website at www.metlife.com/mybenefits. Once registered on the MetLife website, you may change your beneficiary
designation during Annual Enrollment or at any other time you would like to update this information.
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2013 ANNUAL ENROLLMENT
long term disability insurance (ltd)
The Long Term Disability Insurance program is an insured product and, effective January 1, 2013, will be provided by
CIGNA (not Aetna). Southwest offers you the opportunity to purchase Long Term Disability Insurance to help provide
for you and your family in the event that you become disabled and cannot work for an extended period of time. Pilots
are not eligible but may elect long term disability coverage through SWAPA.
CIGNA is offering reduced rates for coverage in 2013. You can go to the online Annual Enrollment tool to calculate your
2013 premiums.
Transition to CIGNA: The coverage option you currently have under the Aetna Long Term Disability program will
automatically transfer to the Cigna Long Term Disability program if you do not make a new election. If you become
disabled January 1 or later, your claim will be actively managed by Cigna’s Long Term Disability claims unit. If you
currently have an active claim or become disabled prior to January 1, 2013, Aetna’s claims unit will continue to manage
your claim until you return to work.
Southwest will continue to offer the following long-term disability coverage options:
BASIC LONG TERM DISABILITY INSURANCE: If you are enrolled in BenefitsPlus, you will be automatically enrolled
in Basic Long Term Disability Insurance at no cost to you. If you have a qualifying disability, you would receive forty
percent of your base salary. Basic Long Term Disability Insurance is not available if you are enrolled in the Regular Plan.
OPTIONAL LONG TERM DISABILITY INSURANCE: If you are enrolled in BenefitsPlus or the Regular Plan and you would
like to purchase Optional Long Term Disability Insurance, depending on your work group, you may purchase coverage
that would provide you with up to sixty percent of your base salary. If you are enrolled in BenefitsPlus, then you may
choose whether you would like to purchase this as a taxable benefit (your premiums will be deducted on an after-tax
basis, a portion of the benefit you receive from the insurance carrier will be subject to tax) or a non-taxable benefit (your
premiums will be deducted on an after-tax basis, the benefit you receive from the insurance carrier will not be subject to
tax). If you are enrolled in the Regular Plan then your Optional Long Term Disability Insurance is a non-taxable benefit
(your premiums will be deducted on an after-tax basis, the benefit you receive from the insurance carrier will not be
subject to tax).
If you need additional information about selecting the Long Term Disability Insurance option that is best for your family,
please contact Health & Welfare Benefits.
2013 ANNUAL ENROLLMENT
21
benefitsplus voluntary benefits
NEW FOR 2013! Southwest expanded the insurance programs available to Employees that enroll in BenefitsPlus. You
now have the choice to purchase Supplemental Hospital Insurance, Auto Insurance, Homeowners Insurance, and/or
Pet Insurance. All premiums are paid through payroll deductions.
SUPPLEMENTAL HOSPITAL INSURANCE: During Annual Enrollment, Southwest Employees who enroll in BenefitsPlus
will have the option of enrolling in Supplemental Hospital Insurance Plan effective January 1, 2013. Supplemental Hospital
Insurance is an insured product provided by Combined Worksite Solutions. Southwest offers this option to Employees
enrolled in the BenefitsPlus program to provide an additional cash resource in the event that you or a qualified family
member is hospitalized. There are no health questions or medical exams required to purchase this insurance.
Numerous exclusions apply to Supplemental Hospital Insurance including, but not limited to: (i) an individual that is
pregnant as of the coverage effective date will not be eligible for a Supplemental Hospital Insurance benefit for days in
the hospital in connection with maternity and (ii) treatment for being overweight, gastric bypass or stapling, intestinal
bypass, and any related procedures, including complications is also excluded. For a complete list of exclusions you may
review details in the materials from Combined Worksite Solutions that are posted on SWALife>About Me>My Benefits>
Information and Forms.
If you purchase supplemental Hospital Insurance, you will be eligible for up to $2,500 in payments per year for you and
each qualified family member. Upon your or a qualified family member’s initial confinement to the hospital, you will
receive $750. For each additional day in a regular hospital room during the year, you will receive an additional $250 per
day up to three days. For each additional day in an ICU hospital room during the year, you will receive an additional
$250 per day up to four days.
Note: Supplemental Hospital Insurance does not replace coverage that you have under your BenefitsPlus medical
option. Supplemental Hospital Insurance benefits are paid directly to you in cash to help you cover costs that may arise
during your time in the hospital. You could use the money to pay deductibles or coinsurance in connection with your
hospital stay or you could use the money to pay for any other need (e.g., your mortgage).
Benefitsplus
Supplemental Hospital
Insurance Program
Monthly Premium Rates
EE ONLY
$11.44
EE + SPOUSE
EE + COMMITTED PARTNER
$26.72
EE + CHILDREN
$25.42
EE + FAMILY
EE + COMMITTED PARTNER + FAMILY
$39.68
AUTO/HOME INSURANCE: Effective January 1, 2013, Southwest Employees who enroll in BenefitsPlus will have the option
of purchasing auto or homeowners insurance at discounted rates. The Auto/Home Insurance program is an insured
product provided by MetLife Auto & Home (although note that home insurance is not offered in Florida or Massachusetts).
Southwest used its sizable purchasing power to give Employees enrolled in the BenefitsPlus program the opportunity
to purchase Auto Insurance and/or Homeowners Insurance at discounted rates. January 1, 2013, Employees enrolled
in BenefitsPlus may call MetLife to request a quote and enroll. MetLife Auto & Home will obtain quotes from multiple
insurance companies to determine your proposed rate. Additional information will be provided soon!
PET INSURANCE: Effective January 1, 2013, Southwest Employees who enroll in BenefitsPlus will have the option to
purchase pet insurance at discounted rates. The Pet Insurance program is an insured product provided by Veterinary
Pet Insurance (VPI). Southwest used its sizable purchasing power to give Employees enrolled in the BenefitsPlus
program the opportunity to purchase Pet Insurance at discounted rates. VPI policies cover wellness care as well as
significant medical incidents. Pet Insurance offers you the chance to manage the risk associated with your pet’s medical
issues. Additional information will be provided soon!
22
2013 ANNUAL ENROLLMENT
clear skies
employee assistance program
ClearSkies Employee Assistance Program is a confidential program available to all Southwest Employees and family
members from the day you join the Company. You do not have to be covered through one of the medical programs to
be eligible. Southwest offers you the ClearSkies program so that you have a confidential resource to help you and your
family deal with any personal problem that may affect your health, family life, or work including relationships, financial
concerns, alcohol, drugs, stress, depression, and emotional distress. When you contact ClearSkies at 1-800-742-8911, a
licensed counselor will assess your situation, determine what assistance is needed, and provide you possible resources
for treatment. You may also access ClearSkies via the web at www.liveandworkwell.com and use pin number: swa737.
wellness programs
Southwest encourages you and your family to live well! In the coming months you will see more opportunities to
participate in Wellness Programs including fitness challenges, fitness center discounts, weight management programs,
and more! Additional information is online at SWALife>AboutMe>MyWellness.
2013 ANNUAL ENROLLMENT
23
IMPORTANT PHONE NUMBERS AND WEB SITES
Would you like to check the status of a claim or the services that are available to you? The chart below lists web sites and phone
numbers for your benefit administrators and providers. You may also access these from SWALife>AboutMe.
BENEFIT PROGRAM
NAME & PHONE NUMBER
Medical Programs
UnitedHealthcare (UHC)
877-246-0857
Group # 199409
ChOIce Plus Plan, Choice Plan C,
Health Savings Plan,
and ReguLAr Plan
WEB SITE
Find a Network Provider if not a member of UHC:
www.myuhc.com/groups/nhswa
To become a UHC member: Enter your Social Security
number and desired password for access to
www.myuhc.com
Catamaran
800-451-3101
To find Network pharmacies in your area
WalgreensHealth.com
Optum Rx
877-246-0857
To find Network pharmacies in your area
www.myuhc.com
UnitedHealthcare (UHC)
877-311-7849
www.myuhc.com
You must be enrolled in myuhc.com. Enter your
Social Security number and desired password for
instant access.
OptumHealth Bank
800-791-9361
www.optumhealthbank.com
You must provide a group number when opening an
account: 199409
OptumHealth Behavioral Solutions
800-742-8911
Find a Provider
www.liveandworkwell.com
Use Pin Number: swa737
life events
live and work well
Life Events
OptumHealth Behavioral Solutions
(United Behavioral Health)
800-538-8310
Provides information for EAP, MHCD and Life Events
www.liveandworkwell.com
Use Pin Number: swa737
dental program
Delta Dental
866-204-5502
Find a Network Dentist and Print ID Card
www.deltadentalins.com/southwest
vision program
EyeMed Vision Care
855-219-4451
http://www.strata-g.com/eyemed/swa
Long term disability PROGRAM
Cigna
888-873-2127
www.cigna.com
life insurance
MetLife
Call Center: 866-492-6983
Claims: 800-638-6420 #2
Statement of Health: 800-638-6420 #1
www.metlife.com/mybenefits
Combined Worksite Solutions
800-964-7096
Web site coming January 1. 2013
Wage Works
877-924-3967
www.getwageworks.com/southwest
Prescription drug program
Choice Plus plan and choice Plan c
Prescription drug program
health savings plan
and regular plan
Flexible Spending Accounts
health care FLEXIBLE spending account
(available for Choice Plan Plus and Choice Plan C)
dependent care FLEXIBLE spending account
(Available for choice pLus plan, CHoice Plan C, and
Health Savings Plan)
health savings account (HSA)
Health savings plan (HSP) only
Clearskies
employee assistance plan (EAP) and Mental health
chemical dependency
supplementAL hospital insurance
BENEFITSPLUS
commuter benefits
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However, it is possible for site addresses to change from time to time.